Prognostic Impact of Sarcopenia in Men Versus Women with Acute Decompensated Heart Failure and Preserved Left Ventricular Ejection Fraction

Sarcopenia is associated with poor prognosis in chronic heart failure. The fat-free mass index (FFMI) is an indicator of resting energy expenditure and is used to clinically diagnose sarcopenia. We aimed to elucidate the prognostic impact of sarcopenia diagnosed via FFMI by sex in patients admitted for acute decompensated heart failure (ADHF) and preserved left ventricular ejection fraction (LVEF).Patients' data were extracted from the Prospective Multicenter Observational Study of Patients with Heart Failure with Preserved Ejection Fraction study, a prospective multicenter observational registry for patients with ADHF with LVEF ≥ 50% in Osaka. We studied 831 patients who survived and were discharged. Fat-free mass (FFM) was estimated using the Forbes formula (FFM [kg] = 7.38 + 0.02908 × urinary creatinine [mg/day]) and normalized to the square of the patient's height in meters to calculate the FFMI at discharge. Sarcopenia was defined as FFMI < 17 kg/m² in men and < 15 kg/m² in women.During the follow-up period of 3.3 ± 1.6 years, 351 patients died. Multivariate Cox analysis showed that sarcopenia was independently associated with all-cause mortality in women (P = 0.003) but not in men (P = 0.118) after adjustment for major confounders. Although sarcopenia was not associated with cardiac death in either sex, it was independently associated with noncardiac death in men (P = 0.048) and women (P < 0.001).Sarcopenia diagnosed via FFMI was associated with poor clinical outcomes in patients with ADHF and preserved LVEF, primarily attributable to its association with noncardiac death, regardless of sex.