Prognostic impact of muscle and fat mass in patients with heart failure

Abstract

Background Cachexia, characterized by loss of muscle with or without loss of fat mass, is a poor prognostic factor in patients with heart failure (HF). However, there is limited investigation on the prognostic impact of muscle and fat mass separately in HF. We hypothesized that muscle and fat mass have different effects on the prognosis of HF. Methods This was an observational cohort study of 418 patients (59% were men) admitted with a diagnosis of HF (71 ± 13 years [mean ± standard deviation]), with left ventricular ejection fraction (LVEF) of 39 ± 16%, including 31.3%, 14.8%, and 53.8% of patients with preserved LVEF (LVEF ≥ 50%), mid‐range LVEF (40–50%), and reduced (<40%) LVEF, respectively. Dual‐energy X‐ray absorptiometry was performed with the patients in the stable state after decongestion therapy. Results The mean body mass index of patients was 22.1 ± 4.6 kg/m2, and the mean appendicular skeletal mass (ASM) index was 6.88 ± 1.23 kg/m2 in men and 5.59 ± 0.92 in women; 54.1% of the patients showed reduced muscle mass defined by the international cut‐off value (7.0 kg/m2 for men and 5.4 for women). The mean fat mass was 20.4 ± 7.2% in men and 27.2 ± 8.6% in women. During a median follow‐up of 37 months, 92 (22.0%) of 418 patients with HF died (1 and 3 year mortality: 8.4% and 17.3%, respectively). Lower values of both skeletal muscle and fat mass were independently associated with increased risk of mortality adjusted for age, sex, haemoglobin, New York Heart Association functional class, and height squared (hazard ratio with 95% confidence interval of 0.825 [0.747–0.908] per 1 kg increase of ASM, P < 0.001, and 0.954 [0.916–0.993] per 1 kg increase of fat mass, P = 0.018, respectively). Conclusions More than half of the patients with HF showed reduced muscle mass. Lower values of both muscle and fat mass were associated with higher mortality in HF.

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

“…Recently, Konishi et al have clearly showed low MM defined by DEXA was associated with prognosis independent of other prognostic factors. 23 In contrast, a study that evaluated the MM of 359 outpatients with HF with BIA showed that low MM was not associated with mortality independent of other covariates. 24 Although these studies have not simultaneously evaluated MM using BIA and DEXA and did not compare their prognostic predictability, these findings are consistent with our study results.…”

“…Recently, Konishi et al . have clearly showed low MM defined by DEXA was associated with prognosis independent of other prognostic factors 23 . In contrast, a study that evaluated the MM of 359 outpatients with HF with BIA showed that low MM was not associated with mortality independent of other covariates 24 .…”

Association of Lean Body Mass and Fat Mass With 1-Year Mortality Among Patients With Heart Failure

“…Firstly, this is the first large-scale, nationwide study to assess the association between body composition and mortality among HF patients. To date, only a limited number of studies have examined this relation, and the findings were inconsistent (16)(17)(18)(19). Although these studies used a direct measurement of body composition, the lack of statistical power that resulted from the small sample size (198-418 patients) makes it impossible to draw firm conclusions.…”

“…Direct measurement of body composition is high-cost and requires sophisticated technologies, which limits its utilization in clinical practice. Therefore, to date, few studies, with relatively small sample size, have reported the effect of body composition among HF patients (16)(17)(18)(19). There is a need to evaluate this association in a large population to assure adequate statistic power.…”

Development and validation of a nomogram to predict the risk of death within 1 year in patients with non-ischemic dilated cardiomyopathy: a retrospective cohort study

“…Many factors affect the prognosis of NIDCM; these include genetics and family history, aetiology, gender, age, and presence of comorbidities such as renal failure, chronic obstructive pulmonary disease, etc. 5 – 9 . Several of these factors are of high predictive value for the prognosis of NIDCM 10 .…”