Impact of sarcopenia on prognosis in patients with heart failure with reduced and preserved ejection fraction

Abstract

Aims Sarcopenia, one of the extracardiac factors for reduced functional capacity and poor outcome in heart failure (HF), may act differently between HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF). We sought to investigate the impact of sarcopenia on mortality in HFpEF and HFrEF. Methods and results We performed a post hoc analysis of a multicentre prospective cohort study, including 942 consecutive older (age ≥65 years) hospitalized patients: 475 with HFpEF (ejection fraction ≥45%, age 81 ± 7 years, 48.8% men) and 467 with HFrEF (ejection fraction <45%, age 78 ± 8 years, 68.1% men). Sarcopenia was diagnosed according to the international criteria incorporating muscle strength (handgrip strength), physical performance (gait speed), and skeletal muscle mass (appendicular skeletal mass). The HFpEF group consisted of fewer patients with low appendicular skeletal muscle mass index measured using bioelectrical impedance analysis [<7.0 kg/m2 (men) and <5.7 (women); 22.1% vs. 31.0%, P = 0.003], and more patients with low handgrip strength [<26 kg (men) and <18 (women); 67.8% vs. 55.5%, P < 0.001], and slow gait speed [<0.8 m/s (both sexes); 54.5% vs. 41.1%, P < 0.001] than the HFrEF group, resulting in a similar sarcopenia prevalence in the two groups (18.1% vs. 21.6%, P = 0.191). Sarcopenia was an independent predictor of 1-year mortality in both HFpEF and HFrEF [hazard ratio (95% confidence interval) 2.42 (1.36–4.32), P = 0.003 in HFpEF and 2.02 (1.08–3.75), P = 0.027 in HFrEF; P for interaction = 0.666] after adjustment for other predictors. Conclusions In older patients with HF, sarcopenia contributes to mortality similarly in HFpEF and HFrEF.

Clinical characteristics and frailty status in heart failure with preserved vs. reduced ejection fraction

“…24 In addition, in an age-matched comparison in that study, the prevalences of low handgrip strength and slow gait speed were similar in HFpEF patients and HFrEF patients. 24 It has been reported that the prevalences of physical dysfunction, frailty, and cognitive impairments were similar in HFpEF patients and HFrEF patients after adjusting for age, sex, BMI, and comorbidities. 10 Considering that HFpEF patients were older than HFrEF patients in the present study, the difference in the proportions of patients with low handgrip strength and slow gait speed may be partly due to age differences.…”

“…Konishi et al . reported that larger proportions of HFpEF patients had low handgrip strength and slow gait speed than did HFrEF patients (67.8% vs. 55.5% and 54.5% vs. 41.1%, respectively) and that the prevalences of sarcopenia were similar in the two groups 24 . In addition, in an age‐matched comparison in that study, the prevalences of low handgrip strength and slow gait speed were similar in HFpEF patients and HFrEF patients 24 .…”

Multidomain Frailty as a Therapeutic Target in Elderly Patients with Heart Failure

“…13) Sarcopenia, or physical frailty, is also associated with disease progression, mobility, and QoL among patients with HF. 14) Given the lack of standard treatment, RE represents a non-pharmacological strategy that shows potential for attenuating sarcopenia or physical frailty, in HF patients.…”

Barthel Index Score Predicts Mortality in Elderly Heart Failure ― A Goal of Comprehensive Cardiac Rehabilitation ―

“…33,34 A plausible explanation for the close association between a decline in ADL and increased mortality is that repeated rehospitalization events because of reduced ADL contribute to further declines in cardiac and physical function, leading to death (i.e., a trajectory of illness for HF). 35 Importantly, changes in body composition, such as muscle/ fat mass, novel prognostic markers in HF, and changes in physical function, such as exercise tolerance and muscle strength, were not analyzed in the present study, [36][37][38][39][40] although low BI was an independent predictor of mortality even after adjustment for cachexia (Table 2). Furthermore, although the number of comorbidities, including dementia (i.e., CCI), was similar in the 2 groups after IPTW (Table 1; Figure 3A), the severity of each comorbidity, such as cognitive impairment and respiratory diseases, was not analyzed in the present study.…”