March 07, 2016
JACC: Heart Failure

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This study, conducted in Japan, explored the complementary role of arm circumference to body mass index (BMI) in risk stratification of patients with heart failure (HF), given that high BMI is associated with improved survival in patients with HF but does not discriminate between fat and lean muscle as a predominant factor. In 570 patients, BMI (P = .016), waist circumference (P = .044), and mid-upper arm circumference (P < .001) were all inversely associated with better HF prognosis. Further analysis showed that arm but not waist circumference plays a complementary role to BMI in predicting prognosis in patients with HF. Evaluation of mid-upper arm circumference could be used in addition to BMI for prediction of mortality associated with HF. Abstract OBJECTIVES This study was performed to investigate the complementary role of arm circumference to body mass index (BMI) in risk stratification of patients with heart failure (HF). BACKGROUND High BMI is associated with improved survival in patients with HF. However, it does not discriminate between fat and lean muscle as a predominant factor. METHODS BMI, waist circumference (WC), and mid-upper arm circumference (MUAC) were evaluated in 570 consecutive Japanese patients with HF (mean age 67.4 ± 14.0 years). Patients were stratified into low and high groups according to BMI, WC, and MUAC and combined into low- or high-BMI and low- or high-WC groups or low- or high-BMI and low- or high-MUAC groups. The endpoint was all-cause mortality. RESULTS Seventy deaths occurred over a median follow-up period of 1.5 years (interquartile range: 0.7 to 2.8 years). After adjusting for several pre-existing prognostic factors, including Seattle Heart Failure Score and exercise capacity, BMI (hazard ratio [HR]: 0.68; p = 0.016), WC (HR: 0.76; p = 0.044), and MUAC (HR: 0.52; p < 0.001) were all inversely associated with prognosis. Compared with the high-BMI/high-WC group, both the low-BMI/high-WC and low-BMI/low-WC groups showed comparably poorer prognosis. However, the low-BMI/low-MUAC group but not the low-BMI/high-MUAC group showed poorer prognosis than the high-BMI/high-MUAC group. Adding MUAC to BMI (0.70 vs. 0.63, p = 0.012) but not WC to BMI (0.64 vs. 0.63, p = 0.763) significantly increased the area under the curve on receiver-operating characteristic curve analysis. CONCLUSIONS MUAC, but not WC, plays a complementary role to BMI in predicting prognosis in patients with HF. Story Source
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