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Arm lean mass measured using dual-energy X-ray absorptiometry to predict mortality in older patients with heart
Hiroshi Saito1, Yuya Matsue2, Daichi Maeda2
1Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan; Department of Rehabilitation, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, Japan.
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.
