Introduction: Cachexia and muscle wasting are known as poor prognostic factors in patients with heart failure (HF). However, most of evidences are derived from studies in HF with reduced left ventricular ejection fraction (LVEF). There is a paucity of data regarding muscle and fat mass in patients with preserved LVEF (HFpEF).
Hypothesis: Muscle and fat mass may be different between HFpEF and HF with reduced EF, and may have a prognostic impact in HFpEF.
Methods: We retrospectively analyzed 263 consecutive patients admitted due to acute HF. Muscle and fat mass were assessed by dual-energy X-ray absorptiometry at stable state after decongestion therapy.
Results: This cohort included 133 patients with HFpEF (LVEF >=40%) and 130 with reduced LVEF (<40%), whose NYHA was 2.2 +0.4 at their stable state. HFpEF patients are predominantly female (51%) in comparison with HFrEF (28%, p<0.001). Even though HFpEF patients are older than those with reduced LVEF (76+-10 vs 67+-15 years, p<0.001), their appendicular skeletal muscle mass index (ASMI: sum of skeletal muscle mass in both arms and legs, divided by height squared) was similar both in male (7.0+-1.3 in HFpEF vs 6.9+-1.2 kg/m2 in HFrEF, p=0.59) and female (5.8+-0.8 in HFpEF vs 5.6 +-1.3 kg/m2 in HFrEF, p=0.29) patients. HFpEF patients included 53 patients with severe valvular disease, whose ASMI was non-significantly lower (6.1+-1.2 vs 6.5 +-1.2 kg/m2, p=0.06) than 80 patients without severe valvular disease. Among HFpEF patients, ASMI was inversely associated with age (r=-0.42, p<0.001) and ln BNP (r=-0.26, p<0.01), but not with LVEF, length of HF history, and other biomarkers (i.e., C-reacting protein, creatinine, and albumin). Twenty patients (15%) with HFpEF died during follow-up period (mean 662 +-415 days). Lower ASMI below the median value (6.7 kg/m2; unadjusted hazard ratio =3.97, 95% confidence interval =1.09 to 14.49, p=0.037) was a significant predictor of death only in men, whereas lower fat mass did not predict of death in both sexes.
Conclusions: We charactrized muscle wasting in patients with HFpEF in comparison with those with reduced LVEF. Skeletal muscle mass rather than fat mass may have prognostic impact in male patients with HFpEF.