Complementary Role of Arm Circumference to Body Mass Index in Risk Stratification in Heart Failure

详细信息    查看全文

• 作者：Kentaro Kamiya ; PT ; PhD^a ; ^{k-kamiya@kitasato-u.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Takashi Masuda ; MD ; PhD^b ; ^c ; Yuya Matsue ; MD ; PhD^d ; Takayuki Inomata ; MD ; PhD^e ; Nobuaki Hamazaki ; PT ; MSc^a ; ^b ; Ryota Matsuzawa ; PT ; PhD^a ; Shinya Tanaka ; PT ; MSc^b ; Kohei Nozaki ; PT ; MSc^a ; Emi Maekawa ; MD ; PhD^e ; Chiharu Noda ; MD ; PhD^e ; Minako Yamaoka-Tojo ; MD ; PhD^b ; ^c ; Atsuhiko Matsunaga ; PT ; PhD^b ; ^c ; Tohru Izumi ; MD ; PhD^e ; Junya Ako ; MD ; PhD^e
• 关键词：arm circumference ; heart failure ; obesity paradox ; waist circumference
• 刊名：JACC: Heart Failure
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：4
• 期：4
• 页码：265-273
• 全文大小：1121 K

文摘

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.