Arm lean mass measured using dual-energy X-ray absorptiometry to predict mortality in older patients with heart failure. (July 2022)

• Record Type: Journal Article
• Authors: Saito, Hiroshi; Matsue, Yuya; Maeda, Daichi; Kamiya, Kentaro; Kagiyama, Nobuyuki; Endo, Yoshiko; Yoshioka, Kenji; Mizukami, Akira; Minamino, Tohru
• Is Part Of: Archives of gerontology and geriatrics. Volume 101(2022)
• Publication Date: 2022-07
• Subjects: Dual-energy X-ray absorptiometry -- Arm muscle mass -- Heart failure -- Prognosis; NRI net reclassification improvement; Aging -- Periodicals; Geriatrics -- Periodicals; Gerontology -- Periodicals; Electronic journals; 305.26
• DOI: 10.1016/j.archger.2022.104689
• Languages: English
• ISSNs: 0167-4943

Abstract

Highlights: Arm and leg indices were calculated as the muscle mass divided by height squared. The arm and leg indices showed good agreement. The arm index was associated with mortality independent of other risk factors. Abstract: Purpose: The objective of this study was to compare the prognostic values of arm and leg muscle mass (MM) measured using dual-energy X-ray absorptiometry (DEXA) in elderly patients with heart failure (HF). Materials and methods: We included 271 elderly (≥65 years) patients hospitalized with HF. Arms and legs indices were calculated as the sum of MM in the arms and legs divided by height squared. Values below the median value for each sex were defined as low arms and legs indices. The prognostic endpoint was all-cause mortality. Results: The median age of the cohort was 83 years (interquartile range: 75–87), and 137 (50.6%) of the patients were men. Furthermore, 133 (49.1%) patients had low arms and legs indices. During follow-up, 54 patients (19.9%) died; only a low arms index (hazard ratio [HR] 2.05, 95% confidence interval [CI] 1.09–3.84, P = 0.026), in contrast to a low legs index (HR 1.15, 95% CI 0.62–2.11, P = 0.663), was associated with poor prognosis after adjusting for pre-existing risk factors. Moreover, a low arms index (net reclassification improvement [NRI]: 0.353, 95% CI 0.059–0.646, P = 0.018), in contrast to a low legs index (NRI: 0.219; 95% CI, -0.081–0.518; P = 0.153), provided incremental prognostic predictability when considered with pre-existing risk factors and brain natriuretic peptide level at discharge. Conclusions: In elderly patients hospitalized with HF, extremity MM, specifically upper arm MM, measured using DEXA has an incremental prognostic value in addition to that of pre-existing risk factors.