Masaaki Konishi1,2, Nobuyuki Kagiyama3,4,5, Kentaro Kamiya6, Hiroshi Saito5,7, Kazuya Saito8, Yuki Ogasahara9, Emi Maekawa10, Toshihiro Misumi11, Takeshi Kitai12, Kentaro Iwata13, Kentaro Jujo14, Hiroshi Wada15, Takatoshi Kasai16, Hirofumi Nagamatsu17, Tetsuya Ozawa18, Katsuya Izawa19, Shuhei Yamamoto20, Naoki Aizawa21, Akihiro Makino22, Kazuhiro Oka23, Shin-Ichi Momomura24, Yuya Matsue16. 1. Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan. 2. Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004 Yokohama, Japan. 3. Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan. 4. Department of Digital Health and Telemedicine R&D, Juntendo University, Tokyo, Japan. 5. Department of Cardiovascular Medicine, Juntendo University, Tokyo, Japan. 6. Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan. 7. Department of Rehabilitation, Kameda Medical Center, Kamogawa, Japan. 8. Department of Rehabilitation, The Sakakibara Heart Institute of Okayama, Okayama, Japan. 9. Department of Nursing, The Sakakibara Heart Institute of Okayama, Okayama, Japan. 10. Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan. 11. Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan. 12. Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan. 13. Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan. 14. Department of Cardiology, Nishiarai Heart Center Hospital, Tokyo, Japan. 15. Department of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan. 16. Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan. 17. Department of Cardiology, Tokai University School of Medicine, Isehara, Japan. 18. Department of Rehabilitation, Odawara Municipal Hospital, Odawara, Japan. 19. Department of Rehabilitation, Kasukabe Chuo General Hospital, Kasukabe, Japan. 20. Department of Rehabilitation, Shinshu University Hospital, Matsumoto, Japan. 21. Department of Cardiovascular Medicine, Nephrology and Neurology, University of the Ryukyus, Okinawa, Japan. 22. Department of Rehabilitation, Kitasato University Medical Center, Sagamihara, Japan. 23. Department of Rehabilitation, Saitama Citizens Medical Center, Saitama, Japan. 24. Department of Medicine, Saitama Citizens Medical Center, Saitama, Japan.
Abstract
AIMS: Sarcopenia, one of the extracardiac factors for reduced functional capacity and poor outcome in heart failure (HF), may act differently between HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF). We sought to investigate the impact of sarcopenia on mortality in HFpEF and HFrEF. METHODS AND RESULTS: We performed a post hoc analysis of a multicentre prospective cohort study, including 942 consecutive older (age ≥65 years) hospitalized patients: 475 with HFpEF (ejection fraction ≥45%, age 81 ± 7 years, 48.8% men) and 467 with HFrEF (ejection fraction <45%, age 78 ± 8 years, 68.1% men). Sarcopenia was diagnosed according to the international criteria incorporating muscle strength (handgrip strength), physical performance (gait speed), and skeletal muscle mass (appendicular skeletal mass). The HFpEF group consisted of fewer patients with low appendicular skeletal muscle mass index measured using bioelectrical impedance analysis [<7.0 kg/m2 (men) and <5.7 (women); 22.1% vs. 31.0%, P = 0.003], and more patients with low handgrip strength [<26 kg (men) and <18 (women); 67.8% vs. 55.5%, P < 0.001], and slow gait speed [<0.8 m/s (both sexes); 54.5% vs. 41.1%, P < 0.001] than the HFrEF group, resulting in a similar sarcopenia prevalence in the two groups (18.1% vs. 21.6%, P = 0.191). Sarcopenia was an independent predictor of 1-year mortality in both HFpEF and HFrEF [hazard ratio (95% confidence interval) 2.42 (1.36-4.32), P = 0.003 in HFpEF and 2.02 (1.08-3.75), P = 0.027 in HFrEF; P for interaction = 0.666] after adjustment for other predictors. CONCLUSIONS: In older patients with HF, sarcopenia contributes to mortality similarly in HFpEF and HFrEF. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Sarcopenia, one of the extracardiac factors for reduced functional capacity and poor outcome in heart failure (HF), may act differently between HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF). We sought to investigate the impact of sarcopenia on mortality in HFpEF and HFrEF. METHODS AND RESULTS: We performed a post hoc analysis of a multicentre prospective cohort study, including 942 consecutive older (age ≥65 years) hospitalized patients: 475 with HFpEF (ejection fraction ≥45%, age 81 ± 7 years, 48.8% men) and 467 with HFrEF (ejection fraction <45%, age 78 ± 8 years, 68.1% men). Sarcopenia was diagnosed according to the international criteria incorporating muscle strength (handgrip strength), physical performance (gait speed), and skeletal muscle mass (appendicular skeletal mass). The HFpEF group consisted of fewer patients with low appendicular skeletal muscle mass index measured using bioelectrical impedance analysis [<7.0 kg/m2 (men) and <5.7 (women); 22.1% vs. 31.0%, P = 0.003], and more patients with low handgrip strength [<26 kg (men) and <18 (women); 67.8% vs. 55.5%, P < 0.001], and slow gait speed [<0.8 m/s (both sexes); 54.5% vs. 41.1%, P < 0.001] than the HFrEF group, resulting in a similar sarcopenia prevalence in the two groups (18.1% vs. 21.6%, P = 0.191). Sarcopenia was an independent predictor of 1-year mortality in both HFpEF and HFrEF [hazard ratio (95% confidence interval) 2.42 (1.36-4.32), P = 0.003 in HFpEF and 2.02 (1.08-3.75), P = 0.027 in HFrEF; P for interaction = 0.666] after adjustment for other predictors. CONCLUSIONS: In older patients with HF, sarcopenia contributes to mortality similarly in HFpEF and HFrEF. Published on behalf of the European Society of Cardiology. All rights reserved.