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Sarcopenia in Heart Failure: When the image holds more than the blood
Session:
CO 08 - Insuficiência cardíaca crónica
Speaker:
Mariana Sousa Paiva
Congress:
CPC 2021
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.3 Chronic Heart Failure – Diagnostic Methods
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Mariana Sousa Paiva; Gonçalo Cunha; Pedro Freitas; Bruno Rocha; João Adriano Sousa; Sara Guerreiro; António m Ferreira; Carlos Aguiar; Miguel Mendes
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Background</strong>: Sarcopenia (reduced muscular mass) is an ominous sign in patients(pts) with heart failure (HF). The aim of this study was to compare the prognostic value of 3 surrogate markers of sarcopenia in pts with HF and left ventricular ejection fraction (LVEF) <50%: serum albumin, modified body mass index (mBMI), and area of <em>pectoralis major</em> muscles (PM).</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong>: This was a retrospective single-centre cohort study of pts with HF undergoing cardiac magnetic resonance imaging (CMR). The key exclusion criteria were LVEF >50%, known neuromuscular disorders, hematologic malignancies and infiltrative diseases. Laboratory data were collected from electronic records up to 6 months from the CMR. By definition, mBMI was the product of body mass index (kg/m<sup>2</sup>) by serum albumin (g/dL). To estimate sarcopenia, we considered the area of PM measured in CMR on standard axial images at the level of the carina (<strong><span style="color:#0070c0">fig 1A</span></strong>). PM area was expressed as the difference between the pt’s PM area and the mean PM area of a healthy cohort, expressed in standard deviations of the controls (z-score). The primary outcome was a composite of all-cause mortality or HF hospitalization. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong>: A total of 246 pts were included (mean age 63 ± 13 years, 76.8% male, 61% in NYHA II-III). We found a weak correlation between mean PM z-score and serum albumin, mBMI, serum creatinine (Pearson r = 0,258; 0,258; -0,015, respectively; p values 0.01 to 0.042). Over a median follow-up of 25 months, 59 pts had a primary outcome event. In univariable analysis, all of the 3 surrogate markers were able to predict the occurrence of events. However, after adjustment for serum creatinine, NT-proBNP, LVEF and gender, only the mean PM z-score retained statistical significance (HR 0.595, 95% CI 0.450-0.792, p=0.005). Splitting the study population according to the best cut-off value for mean PM z-score yielded good risk stratification (<strong><span style="color:#0070c0">fig 1B</span></strong>). </span></span></p> <p><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Conclusions</span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">: A simple measurement of muscular area in patients undergoing CMR seems to be an independent predictor of outcome in patients with HFrEF. In contrast, and despite their accessibility, serum albumin and mBMI add little prognostic value to well-defined markers. </span></span></p>
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