Pathophysiologic and prognostic relevance of mid-upper arm circumference index in heart failure with preserved ejection fraction

Background Malnutrition is common in heart failure with preserved ejection fraction (HFpEF). Despite the increasing awareness, nutritional assessment and intervention may be underutilized in practice, needing a simple screening tool to identify patients at high nutritional risk. This study sought to determine the association of mid-upper arm circumference indexed to height (MUACi) with nutritional measures, exercise capacity, and clinical outcomes in HFpEF. Methods Patients with HFpEF ( n = 247) and controls with no HF ( n = 240) underwent ergometry exercise echocardiography with simultaneous expired gas analysis. Patients with HFpEF were divided into two groups based on the median value of MUACi. Results Compared to controls and HFpEF highMUACi ( n = 124), HFpEF lowMUACi ( n = 123) had lower body mass index, waist circumference, and geriatric nutritional risk index. Despite similar cardiac structure and function at rest and during peak ergometry exercise, peak workload achieved and mechanical efficiency (peak workload relative to peak oxygen consumption) were more reduced in HFpEF lowMUACi than controls and HFpEF highMUACi . During a median observation period of 385 days, 25 composite outcomes of all-cause mortality, HF hospitalizations, unplanned visits requiring intravenous diuretics, and intensifications of oral diuretics occurred. HFpEF lowMUACi had 11-fold and 2-fold increased risks of the outcome compared to controls and HFpEF highMUACi , respectively [hazard ratio (HR) 10.8, 95 % confidence intervals (CI) 2.47–47.3, p = 0.002 and HR 2.54, 95 % CI 1.05–6.16]. Conclusion These data suggest that MUACi may be a useful screening metric to identify patients with HFpEF at malnutrition risk in clinical practice to help guide more specialized nutritional assessment.