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Reduced thoracic skeletal muscle size is associated with adverse outcomes in diabetes patients with heart failure and reduced ejection fraction: quantitative analysis of sarcopenia by using cardiac MRI.
- Source :
-
Cardiovascular diabetology [Cardiovasc Diabetol] 2024 Jan 13; Vol. 23 (1), pp. 28. Date of Electronic Publication: 2024 Jan 13. - Publication Year :
- 2024
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Abstract
- Background: Sarcopenia is frequently found in patients with heart failure with reduced ejection fraction (HFrEF) and is associated with reduced exercise capacity, poor quality of life and adverse outcomes. Recent evidence suggests that axial thoracic skeletal muscle size could be used as a surrogate to assess sarcopenia in HFrEF. Since diabetes mellitus (DM) is one of the most common comorbidities with HFrEF, we aimed to explore the potential association of axial thoracic skeletal muscle size with left ventricular (LV) remodeling and determine its prognostic significance in this condition.<br />Methods: A total of 243 diabetes patients with HFrEF were included in this study. Bilateral axial thoracic skeletal muscle size was obtained using cardiac MRI. Patients were stratified by the tertiles of axial thoracic skeletal muscle index (SMI). LV structural and functional indices, as well as amino-terminal pro-B-type natriuretic peptide (NT-proBNP), were measured. The determinants of elevated NT-proBNP were assessed using linear regression analysis. The associations between thoracic SMI and clinical outcomes were assessed using a multivariable Cox proportional hazards model.<br />Results: Patients in the lowest tertile of thoracic SMI displayed a deterioration in LV systolic strain in three components, together with an increase in LV mass and a heavier burden of myocardial fibrosis (all P < 0.05). Moreover, thoracic SMI (β = -0.25; P < 0.001), rather than body mass index (β = -0.04; P = 0.55), was independently associated with the level of NT-proBNP. The median follow-up duration was 33.6 months (IQR, 20.4-52.8 months). Patients with adverse outcomes showed a lower thoracic SMI (40.1 [34.3, 47.9] cm <superscript>2</superscript> /m <superscript>2</superscript> vs. 45.3 [37.3, 55.0] cm <superscript>2</superscript> /m <superscript>2</superscript> ; P < 0.05) but a similar BMI (P = 0.76) compared with those without adverse outcomes. A higher thoracic SMI indicated a lower risk of adverse outcomes (hazard ratio: 0.96; 95% confidence interval: 0.92-0.99; P = 0.01).<br />Conclusions: With respect to diabetes patients with HFrEF, thoracic SMI is a novel alternative for evaluating muscle wasting in sarcopenia that can be obtained by a readily available routine cardiac MRI protocol. A reduction in thoracic skeletal muscle size predicts poor outcomes in the context of DM with HFrEF.<br /> (© 2024. The Author(s).)
- Subjects :
- Humans
Quality of Life
Biomarkers
Stroke Volume physiology
Natriuretic Peptide, Brain
Magnetic Resonance Imaging
Peptide Fragments
Muscle, Skeletal diagnostic imaging
Heart Failure diagnostic imaging
Sarcopenia diagnostic imaging
Sarcopenia epidemiology
Ventricular Dysfunction, Left diagnostic imaging
Ventricular Dysfunction, Left etiology
Diabetes Mellitus diagnosis
Diabetes Mellitus epidemiology
Subjects
Details
- Language :
- English
- ISSN :
- 1475-2840
- Volume :
- 23
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Cardiovascular diabetology
- Publication Type :
- Academic Journal
- Accession number :
- 38218882
- Full Text :
- https://doi.org/10.1186/s12933-023-02109-7