Anthropometric parameters‐derived estimation of muscle mass predicts all‐cause mortality in heart failure patients

Abstract

Aims Reduction in appendicular skeletal muscle mass index (ASMI) assessed by dual‐energy X‐ray absorptiometry (DEXA) has been shown to be independently associated with a higher mortality rate in patients with heart failure (HF). However, DEXA is not suitable for measurement of muscle mass in a daily clinical setting and in large population‐based studies. The aim of this study was to determine whether ASMI predicted from anthropometric indicators (predicted ASMI) serves as an alternative to DEXA‐measured ASMI for predicting all‐cause death in HF patients. Methods and Results Data for 539 HF patients who received a DEXA scan and measurements of calf circumferences (CC) and mid‐arm circumferences (MAC) in our hospital were analysed. Predicted ASMI was calculated as we previously reported: predicted ASMI (kg/m2) = [0.214 × weight (kg) + 0.217 × CC (cm) − 0.189 × MAC (cm) + 1.098 (male = 1, female = −1) + 0.576]/height2 (m2). Low ASMI values were defined as <7.00 kg/m2 and <5.40 kg/m2 for men and women, respectively, according to the criteria of the Asian Working Group for Sarcopenia. The median follow‐up period was 1.75 years (interquartile range, 0.96–2.37 years), and 79 patients (15%) died. Kaplan–Meier survival curves showed that patients with low DEXA‐measured ASMI and patients with low predicted ASMI had significantly lower survival rates than those for patients with high ASMI. In multivariate Cox proportional hazard analyses adjusted for age, sex, logarithmic B‐type natriuretic peptide, cystatin C based‐estimated glomerular filtration rate, and gait speed, DEXA‐measured ASMI [hazard ratio (HR), 0.982; 95% confidence interval (CI), 0.967–0.998; P = 0.026] and predicted ASMI (HR, 0.979; 95% CI, 0.962–0.996; P = 0.018) were independent predictors of all‐cause mortality. Inclusion of predicted ASMI into the adjustment model significantly improved continuous net reclassification improvement (0.338; 95% CI, 0.103–0.572; P < 0.01) and integrated discrimination improvement (0.020; 95% CI, 0.004–0.035; P < 0.05) for predicting mortality after discharge. Conclusions Predicted ASMI, as well as DEXA‐measured ASMI, can predict all‐cause death in HF patients, and calculation of predicted ASMI will be useful for detecting high‐risk patients in a daily clinical setting and in large population‐based studies.

Sarcopenia prognosis using dual‐energy X‐ray absorptiometry and prediction model in older patients with heart failure

“…Evidence on the prognostic impact of ASMI, defined by Anthropometric and Predicted models, is scarce in patients with heart failure. A retrospective study enrolling 539 patients with heart failure revealed that a low Predicted‐ASMI was significantly associated with all‐cause mortality and provided additional prognostic value to pre‐existing risk factors 16 . However, the prognostic impact of sarcopenia assessed using the Predicted‐ASMI has not yet been investigated.…”

“…In contrast, the Predicted model, which was calculated using sex, weight, calf circumference (CC), and mid‐arm circumference (MAC), showed excellent correlation with DEXA‐measured ASM in patients with heart failure 15 . ASM measured using the Predicted model was associated with all‐cause mortality in patients with heart failure 16 . However, whether sarcopenia is evaluated using Anthropometric or Predicted models has not been directly compared with that diagnosed using the gold standard method, DEXA, in older patients with heart failure.…”

“… 15 ASM measured using the Predicted model was associated with all‐cause mortality in patients with heart failure. 16 However, whether sarcopenia is evaluated using Anthropometric or Predicted models has not been directly compared with that diagnosed using the gold standard method, DEXA, in older patients with heart failure.…”

Coexistence of sarcopenia and self‐reported weight loss is a powerful predictor of mortality in older patients with heart failure

“…Sarcopenia, that is, a decline in skeletal muscle mass and function, has been shown to be an age‐dependent phenomenon, but aging is not the sole mechanism of sarcopenia, and various pathological conditions, including HF, play pivotal roles in the promotion of muscle wasting 12 . Results of recent studies, including our previous study, showed that the presence of muscle wasting is a powerful and independent predictor for mortality in patients with HF 13–16 . Thus, sarcopenia is a useful marker of poor clinical outcome in HF patients.…”

“…12 Results of recent studies, including our previous study, showed that the presence of muscle wasting is a powerful and independent predictor for mortality in patients with HF. [13][14][15][16] Thus, sarcopenia is a useful marker of poor clinical outcome in HF patients. Furthermore, the results of a pioneering study by Anker et al showed that weight loss of ≥6% after inclusion in the study was a strong predictor of impaired survival in HF patients.…”