Kimura Takanari, Tamaki Shunsuke, Yamada Takahisa, Watanabe Tetsuya, Fukunami Masatake, Yasumura Yoshio, Nakagawa Akito, Nakagawa Yusuke, Yano Masamichi, Hayashi Takaharu, Hikoso Shungo, Nakatani Daisaku, Sotomi Yohei, Sakata Yasushi
Division of Cardiology, Osaka General Medical Center.
Division of Cardiology, Amagasaki Chuo Hospital.
Int Heart J. 2025;66(3):363-374. doi: 10.1536/ihj.24-475.
Sarcopenia is associated with poor prognosis in chronic heart failure. The fat-free mass index (FFMI) is an indicator of resting energy expenditure and is used to clinically diagnose sarcopenia. We aimed to elucidate the prognostic impact of sarcopenia diagnosed via FFMI by sex in patients admitted for acute decompensated heart failure (ADHF) and preserved left ventricular ejection fraction (LVEF).Patients' data were extracted from the Prospective Multicenter Observational Study of Patients with Heart Failure with Preserved Ejection Fraction study, a prospective multicenter observational registry for patients with ADHF with LVEF ≥ 50% in Osaka. We studied 831 patients who survived and were discharged. Fat-free mass (FFM) was estimated using the Forbes formula (FFM [kg] = 7.38 + 0.02908 × urinary creatinine [mg/day]) and normalized to the square of the patient's height in meters to calculate the FFMI at discharge. Sarcopenia was defined as FFMI < 17 kg/m in men and < 15 kg/m in women.During the follow-up period of 3.3 ± 1.6 years, 351 patients died. Multivariate Cox analysis showed that sarcopenia was independently associated with all-cause mortality in women (P = 0.003) but not in men (P = 0.118) after adjustment for major confounders. Although sarcopenia was not associated with cardiac death in either sex, it was independently associated with noncardiac death in men (P = 0.048) and women (P < 0.001).Sarcopenia diagnosed via FFMI was associated with poor clinical outcomes in patients with ADHF and preserved LVEF, primarily attributable to its association with noncardiac death, regardless of sex.
肌肉减少症与慢性心力衰竭的不良预后相关。去脂体重指数（FFMI）是静息能量消耗的一个指标，用于临床诊断肌肉减少症。我们旨在阐明在因急性失代偿性心力衰竭（ADHF）入院且左心室射血分数（LVEF）保留的患者中，通过FFMI诊断的肌肉减少症按性别对预后的影响。患者数据取自射血分数保留的心力衰竭患者前瞻性多中心观察研究，这是一项针对大阪地区LVEF≥50%的ADHF患者的前瞻性多中心观察登记研究。我们研究了831名存活并出院的患者。使用福布斯公式（去脂体重[kg]=7.38+0.02908×尿肌酐[mg/天]）估算去脂体重（FFM），并将其除以患者身高（米）的平方进行标准化，以计算出院时的FFMI。肌肉减少症的定义为男性FFMI<17kg/m²，女性FFMI<15kg/m²。在3.3±1.6年的随访期内，351名患者死亡。多变量Cox分析显示，在调整主要混杂因素后，肌肉减少症与女性的全因死亡率独立相关（P=0.003），而与男性无关（P=0.118）。尽管肌肉减少症在两性中均与心源性死亡无关，但它与男性（P=0.048）和女性（P<0.001）的非心源性死亡独立相关。通过FFMI诊断的肌肉减少症与ADHF且LVEF保留的患者的不良临床结局相关，主要归因于其与非心源性死亡的关联，与性别无关。
