Prognostic values of muscle mass assessed by dual‐energy X‐ray absorptiometry and bioelectrical impedance analysis in older patients with heart failure

Abstract

Aim This study aimed to compare bioelectrical impedance analysis (BIA) and dual‐energy X‐ray absorptiometry (DEXA) in measuring skeletal muscle mass (MM), and its prognostic implications in old patients with heart failure. Methods We prospectively evaluated MM measured by both BIA and DEXA in 226 hospitalized elderly (≥65 years) patients with heart failure. The cut‐off values proposed by the Asian Working Group in Sarcopenia were used to define low MM. The prognostic endpoint was all‐cause death. Results The median age of the cohort was 82 years (interquartile range: 75–87), and 51.8% of patients were men. According to the BIA and DEXA, 177 (78.3%) and 120 (53.1%) patients were diagnosed with low MM, respectively, and the two assessment tools showed poor agreement (Cohen's kappa coefficient: 0.294). During the follow‐up, 32 patients (14.2%) died; only low MM defined by DEXA (hazard ratio 2.45, 95% confidence interval 1.05–5.72, P = 0.039), but not BIA (hazard ratio 1.03, 95% confidence interval 0.35–3.06, P = 0.955), was associated with poor prognosis after adjusting for pre‐existing risk factors. Moreover, low MM defined by DEXA (net reclassification improvement: 0.58, P < 0.001), but not BIA (net reclassification improvement: −0.005, P = 0.975), provides incremental prognostic predictability when considered with pre‐existing risk factors and brain natriuretic peptide level at discharge. Conclusions In elderly hospitalized patients with heart failure, low MM defined by DEXA and BIA show significant discordance. The MM defined by DEXA, but not BIA, provides additional prognostic value to pre‐existing prognostic models. Geriatr Gerontol Int 2022; 22: 610–615.

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

“…Moreover, we have already reported from FRAGILE‐HF that sarcopenia assessed using BIA was independently associated with 1 year mortality, irrespective of left ventricular ejection fraction 7 . However, no study has reported an association between sarcopenia defined using DEXA and prognosis, although DEXA may be superior to BIA in terms of its prognostic value in patients with heart failure 10 . The current study is the first to show that sarcopenia diagnosed using DEXA is independently associated with all‐cause mortality.…”

“… 7 However, no study has reported an association between sarcopenia defined using DEXA and prognosis, although DEXA may be superior to BIA in terms of its prognostic value in patients with heart failure. 10 The current study is the first to show that sarcopenia diagnosed using DEXA is independently associated with all‐cause mortality.…”

“…2,6 Although both DEXA and BIA are useful for risk stratification in patients with heart failure, [7][8][9] we previously reported that DEXA has a better prognostic value than BIA. 10 Although DEXA is the gold standard for evaluating ASM, it can only be measured in a limited number of hospitals and is challenging to measure repeatedly owing to its availability. 11 In addition, the medical costs of DEXA may be imposed on patients.…”

“…Sarcopenia guidelines currently recommend dual‐energy X‐ray absorptiometry (DEXA) or bioelectrical impedance analysis (BIA) for diagnosing low appendicular skeletal muscle mass (ASM) in Asians and Europeans 2,6 . Although both DEXA and BIA are useful for risk stratification in patients with heart failure, 7–9 we previously reported that DEXA has a better prognostic value than BIA 10 …”

“… 2 , 6 Although both DEXA and BIA are useful for risk stratification in patients with heart failure, 7 , 8 , 9 we previously reported that DEXA has a better prognostic value than BIA. 10 …”