Impact of sarcopenia and osteopenia on prognosis in elderly heart failure patients: a computed tomography-based comparative study

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Abstract Background Frailty, including sarcopenia and osteopenia, is an independent prognostic determinant in patients with heart failure (HF). However, the evaluation of sarcopenia or osteopenia requires measurement of grip strength, walking speed, skeletal muscle mass and bone density test. Frailty is a common complication in elderly patients, but it is difficult to accurately assess frailty in elderly patients, especially in those with HF. Purpose This study aimed to evaluate sarcopenia and osteopenia as markers of frailty using computed tomography (CT) imaging in elderly HF patients and to investigate their impact on two-year all-cause mortality. Methods We included patients aged 75 years and older who underwent abdominal CT scan during hospitalization for HF between April 2015 and March 2023 in our hospital. Sarcopenia was defined by psoas muscle area index, and osteopenia was defined by CT-attenuation values of trabecular bone between the T12 and L5 vertebral levels, with an emphasis on L1 measures. Participants were categorized into four groups: Group A (without sarcopenia and osteopenia, n=157); Group B (without sarcopenia with osteopenia, n=464); Group C (with sarcopenia without osteopenia, n=67); Group D (with sarcopenia and osteopenia, n= 204). The primary outcome was two-year all-cause mortality. Results A total of 893 elderly HF patients were included in the final analysis. Sarcopenia was present in 272 patients (30.5%), while osteopenia was identified in 668 patients (74.8%). Kaplan-Meier survival curves indicated that patients in Group C had significantly poorer survival outcomes compared to those in other Groups (log-rank test, P=0.042, Figure). In multivariable analysis, sarcopenia defined by CT scan was significantly associated with all-cause mortality (HR 1.77; 95% CI 1.06-2.95, P=0.029), whereas osteopenia was not significantly associated with mortality (HR 0.88; 95% CI 0.54-1.70, P= 0.881). Conclusion Sarcopenia and osteopenia were common in elderly patients with HF. Sarcopenia, assessed by CT imaging, was a significant prognostic predictor of all-cause mortality in this population, whereas osteopenia did not demonstrate a similar association. These findings suggest that CT-based sarcopenia assessment may provide valuable prognostic insights in elderly HF patients.Figure

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