Sarcopenia And Cardiopulmonary Exercise Response In Adolescents And Adults With Congenital And Acquired Cardiovascular Disease

PURPOSE: Low lean muscle mass, or sarcopenia, is common in the context of advanced cardiac dysfunction and heart failure. We conducted a retrospective study to evaluate associations between sarcopenia and cardiopulmonary exercise testing (CPET) indices in adolescent and young adult patients undergoing testing at a freestanding children’s hospital. METHODS: We reviewed 1658 clinically referred CPETs with simultaneous bioimpedance analysis (BIA, InBody570, Cerritos, CA, USA) performed between 6/2020 - 10/2024. Submaximal CPETs (peak respiratory exchange ratio < 1.1) were excluded. BIA measurements included skeletal muscle mass (SMM; kg) and skeletal muscle mass indexed to height (SMI; kg/m2). Sarcopenia was defined by previously published BIA standards of SMI <7.0 kg/m2 for men and < 5.5 kg/m2 for women, irrespective of age. Data is presented as median [Q1, Q3]. RESULTS: Median age was 21.5 years and 48% of patients were female. Sarcopenia was present in 8.1% of the tests (134/1524) with a SMI of 6.1 kg/m2 in the sarcopenia group vs 7.6 kg/m2 in the other group. These subjects had lower height, weight, and BSA (p < 0.001 for all 3), and were younger (19.7 vs 21.7 years; p = 0.004). Peak VO2 was lower in the sarcopenia group (1.2 [1.0, 1.5] vs 1.9 [1.5, 2.4] L/min). This difference persisted even when indexing VO2 to body mass or to BSA. SMM (kg) correlated strongly with both peak VO2 (L/min) and O2P (ml/beat) with a Pearson R = 0.73, p < 0.0001 and 0.74, p < 0.0001; respectively. These results are depicted in Figure 1 and Table 1. CONCLUSION: Individuals referred for CPET who met criteria for sarcopenia had substantially worse exercise performance. The causality of this association and its implications remain to be identified. Future studies should evaluate the clinical outcomes associated with those with sarcopenia in specific heart conditions and evaluate the differences in muscle mass distribution, as assessed by BIA.