Gender Differences in Prognostic Impact of Appendicular Skeletal Muscle Mass in Patients with Acute Heart Failure

Background: Clinical significance of skeletal muscle mass in patients with acute heart failure (AHF) remains unclear. Methods: We assessed lean body mass by dual energy X-ray absorptiometry in 108 hospitalized patients with AHF (age 72 ± 11, male 62%). Low appendicular skeletal muscle mass index (ASMI, appendicular skeletal muscle mass/height2) was defined according to the Asia Working Group for Sarcopenia criteria (<7.0 kg/m2 in male, <5.4 kg/m2 in female). AHF patients were followed until occurring cardiovascular (CV) events (CV death, nonfatal myocardial infarction, ischemic stroke, unstable angina, HF re-hospitalization, or coronary revascularization). Results: The prevalence of low-ASMI was 56% (n=61) in whole cohort and higher in male compared with female (64% versus 44%, P=.04). Forty eight patients developed CV events (median follow-up, 17 months). The incidence of CV events was significantly higher in female AHF patients with low-ASMI than in those with normal-ASMI, but not male (female: 72% versus 17%, P=.001, male: 51% versus 38%, P=.32, log-rank test). Low-ASMI significantly correlated with the future CV events in female AHF patients (female: unadjusted hazard ratio 5.79, P=.002, male: unadjusted hazard ratio 1.48, P=.32, p for interaction=0.04). Multivariate Cox hazard analysis demonstrated that low-ASMI was an independent predictor for CV events in female AHF patients (hazard ratio 29.5, 95%-confidence interval 4.1–211.4, P=.001). Conclusions: Low-ASMI could predict the future CV events in female patients with AHF.