Prognostic utility of the total body muscle mass index in heart failure: insights from the JEDI-AHF registry
Y Ikeda, N Taisuke, Y Matsue, Y Fujimoto, Y Nakamura, Y Akama, D Maeda, T Sunayama, S Yatsu, S Ishiwata, S Suda, T Kato, M Hiki, T Kasai, T MinaminoAbstract
Background
Accurate assessment of skeletal muscle mass is central to diagnosing sarcopenia, yet commonly used methods such as bioelectrical impedance analysis and dual-energy X-ray absorptiometry are limited in heart failure because of fluctuating volume status, feasibility constraints, and cost. A creatinine–cystatin C-derived total body muscle mass index (TBMM) has been proposed as an objective and readily available marker of muscle mass, but its prognostic value in heart failure remains uncertain.
Purpose
To determine whether low TBMM is independently associated with post-discharge all-cause mortality after hospitalisation for acute heart failure and to examine its correlation with estimated appendicular skeletal muscle mass index (ASMI).
Methods
We retrospectively analysed data from the database for acute heart failure (JEDI-AHF), including patients with acute heart failure admitted to a high care unit or coronary care unit between January 2015 and December 2021. TBMM was calculated from body weight, serum creatinine, and cystatin C and categorised using pre-specified sex-specific cut-offs (men <38.846; women <26.476). The primary outcome was all-cause mortality after discharge. Associations between low TBMM and mortality were evaluated using Cox proportional hazards models adjusted a priori for the Get With the Guidelines–Heart Failure risk score, log-transformed B-type natriuretic peptide (BNP), anaemia, New York Heart Association functional class, and left ventricular ejection fraction. Missing covariates were addressed using multiple imputation. Pearson correlation coefficients were used to assess associations between TBMM and ASMI estimated by anthropometric and biomarker-based equations.
Results
Of 919 patients hospitalised with acute heart failure, 369 were excluded because creatinine or cystatin C data were unavailable and outcome data were missing, leaving 550 patients for analysis (median age 78 years [IQR 69–85]; 39.8% women). Using the pre-specified cut-offs, 271 (49.3%) were classified as low TBMM and 279 (50.7%) as high TBMM. Compared with the high TBMM group, the low TBMM group was older and had a lower body mass index, lower haemoglobin, and higher BNP, while the prevalence of hypertension and diabetes was similar. Over a median follow-up of 2.6 years (IQR 0.81–4.10), 134 deaths occurred (29.2% in the low TBMM group vs 19.7% in the high TBMM group). Survival was significantly lower in the low TBMM group (log-rank P<0.001). Low TBMM remained independently associated with higher post-discharge mortality (HR 1.48, 95% CI 1.03–2.13; P=0.038). TBMM correlated strongly with ASMI estimated by both approaches (anthropometric r=0.909; biomarker-based r=0.968; both P<0.001).
Conclusion
Low TBMM was common and independently associated with post-discharge mortality after acute heart failure. TBMM may provide a practical, blood-based measure of muscle mass that complements risk stratification in patients with heart failure.For image description, please refer to the figure legend and surrounding text.