Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan; Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan.
Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan; Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Kanagawa, Japan.
Can J Cardiol. 2023 Nov;39(11):1630-1637. doi: 10.1016/j.cjca.2023.08.006. Epub 2023 Oct 6.
Sarcopenia is associated with risks of various adverse outcomes, and the assessment of skeletal muscle mass is necessary for its diagnosis. However, heart failure (HF) is a syndrome characterised by fluid retention, which affects muscle mass measurements. Different measurement methods have been reported to have different prognostic implications. We investigated the association between skeletal muscle mass metrics measured with the use of bioelectrical impedance analysis (BIA) and anthropometric measures and prognosis in patients with HF.
The findings of 869 consecutive patients with HF were reviewed. We investigated the skeletal muscle mass index (SMI) measured with the use of BIA, the mid-upper arm circumference (MUAC), the arm muscle circumference (AMC), and the calf circumference (CC), and the patients were divided into 3 groups according to the sex-specific tertiles of the skeletal muscle mass metrics. The end points were all-cause death and readmission due to HF.
The high MUAC and AMC groups showed significantly better prognoses than their respective low groups (combined events: high MUAC group hazard ratio [HR] 0.559, 95% confidence interval [CI] 0.395-0.789 [P < 0.01]; high AMC group HR 0.505, 95% CI 0.359-0.710 [P < 0.01]), although high SMI and high CC were not associated with better prognoses.
Among patients with HF, MUAC and AMC are more associated with prognosis than SMI and CC, which are recommended in preexisting sarcopenia guidelines. MUAC and AMC may also be useful measures in sarcopenia assessments.
肌少症与各种不良结局的风险相关，骨骼肌肉量的评估对其诊断必不可少。然而，心力衰竭（HF）是一种以液体潴留为特征的综合征，会影响肌肉量的测量。已有报道称，不同的测量方法具有不同的预后意义。我们研究了使用生物电阻抗分析（BIA）和人体测量学指标测量的骨骼肌质量指标与 HF 患者预后之间的关系。
我们回顾了 869 例连续 HF 患者的发现。我们研究了使用 BIA 测量的骨骼肌质量指数（SMI）、中上臂围（MUAC）、臂肌围（AMC）和小腿围（CC），并根据骨骼肌质量指标的性别特异性三分位将患者分为 3 组。终点为全因死亡和因 HF 再次入院。
高 MUAC 和 AMC 组的预后明显优于各自的低组（复合事件：高 MUAC 组 HR 0.559，95%CI 0.395-0.789 [P<0.01]；高 AMC 组 HR 0.505，95%CI 0.359-0.710 [P<0.01]），尽管高 SMI 和高 CC 与更好的预后无关。
在 HF 患者中，MUAC 和 AMC 与预后的相关性高于 SMI 和 CC，这在现有的肌少症指南中得到了推荐。MUAC 和 AMC 也可能是肌少症评估中有用的指标。
