Prognostic Impact Of Sarcopenia And Subcutaneous Adipopenia In Patients With Cancer Following Acute Decompensated Heart Failure Hospitalization.

Sarcopenia, a prevalent syndrome in heart failure (HF) and cancer, and subcutaneous adipopenia are associated with worse outcomes; however, they have not been studied in patients suffering from HF and cancer. We hypothesized that the presence of sarcopenia and subcutaneous adipopenia are associated with worse outcomes among patients with HF and cancer hospitalized for acute decompensated HF (ADHF). We included 409 consecutive patients hospitalized for ADHF from 2017 to 2020 with computed tomography of the chest one month before the discharge date. Semi-automatic measurements were made at T12 (Figure 1A) and adjusted for height squared to obtain skeletal muscle index (SMI) and subcutaneous adipose tissue index (SATI). To compare survival, patients with cancer were further grouped based on sarcopenia (lowest sex-stratified SMI tertile cutoffs of 29.6 cm²/m² in males and 26.7 cm²/m² in females) and subcutaneous adipopenia (lowest sex-stratified SATI tertile cutoffs of 22.7 cm²/m² in males and 42.1 cm²/m² in females). The mean age of our study cohort was 72±14 years, 44% were female, and 172 (42%) had a cancer history (39.5% metastatic). There were no significant differences in SMI or SATI between patients with versus without cancer, but patients with cancer had higher all-cause mortality (HR 1.48, 95%CI 1.14-1.92, p=0.004). During a median 14.8 (1.6-30.9) months of follow-up, all-cause mortality was higher in patients with cancer with sarcopenia (72.9%) versus without (57.5%) (Figure 1); this remained significant on adjustment for age, male sex, Caucasian race, coronary artery disease (CAD), chronic kidney disease, chronic obstructive pulmonary disease (COPD), metastasis, left ventricular ejection fraction, and NT-proBNP (HR 1.66, 95%CI 1.08-2.56, p=0.021). Furthermore, after similar multivariable adjustment, higher all-cause mortality was seen in patients with cancer with subcutaneous adipopenia (69.0%) versus without (59.6%) (HR 1.61, 95%CI 1.05-2.48, p=0.029). Metastasis remained an independent predictor of mortality in both models, along with CAD, COPD, and elevated NT-proBNP. Among patients with HF and cancer, lower skeletal muscle and subcutaneous adipose tissue quantity were independently associated with increased mortality risk after adjustment for predictors of disease severity. [ABSTRACT FROM AUTHOR]