Key result
Low pectoral muscle area is linked to ~91% higher mortality in HFmrEF and HFrEF.
Why the study?
Skeletal muscle depletion and malnutrition are common in HF and their complementary prognostic value using imaging and nutritional indices remains unclear.
Do total pectoral muscle area and Prognostic Nutritional Index predict all-cause mortality in patients hospitalized with decompensated HFmrEF/HFrEF?
Cohort (n=138)
No
Do total pectoral muscle area and Prognostic Nutritional Index predict all-cause mortality in patients hospitalized with decompensated HFmrEF/HFrEF?
Hazard Ratio: 1.911 (95% CI 1.118–3.266)
p-value: p=0.018
Reduced total pectoral muscle area and lower Prognostic Nutritional Index are independent and complementary predictors of long-term mortality in hospitalized patients with HFmrEF/HFrEF.
May aid risk stratification in decompensated HFmrEF/HFrEF; extends sarcopenia evidence but leaves open whether interventions improve survival.
Background: Skeletal muscle depletion and malnutrition are common in heart failure (HF) and are associated with poor outcomes. Whether imaging-derived skeletal muscle reserve and laboratory-based nutritional indices provide complementary prognostic information remains unclear. We evaluated the prognostic value of total pectoral muscle area (TPMA), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT) scores in patients hospitalized with HFmrEF/HFrEF. Methods: In this retrospective single-center study, consecutive patients hospitalized with decompensated HF between 2017 and 2025 who underwent thoracic computed tomography were included. TPMA was measured at the T4 level. Nutritional status was assessed using PNI and CONUT. Receiver operating characteristic analysis, Kaplan–Meier analysis, Spearman correlation, and Cox regression were used to evaluate long-term all-cause mortality. Results: A total of 138 patients (median age 66 years; 35.5% women) were included. During a median follow-up of 34.4 months, 87 patients (63.0%) died. Non-survivors had lower TPMA (2589 vs. 3012 mm2, p = 0.002) and PNI (46.0 ± 5.5 vs. 50.2 ± 7.2, p < 0.001). TPMA (AUC 0.661, p = 0.001) and PNI (AUC 0.663, p = 0.001), but not CONUT (AUC 0.561, p = 0.226), predicted mortality. TPMA correlated modestly with PNI (ρ = 0.325, p < 0.001). Low TPMA (<3000 mm2; HR 1.911, p = 0.018), higher BNP (HR 1.024 per 100 pg/mL, p = 0.014), and lower PNI (HR 0.956, p = 0.024) independently predicted mortality. Conclusions: Reduced TPMA and lower PNI were independently associated with long-term mortality in hospitalized patients with HFmrEF/HFrEF. Their modest correlation suggests that they may capture partly distinct aspects of systemic impairment; however, the incremental prognostic value of their combined assessment requires further evaluation.
No takes yet. Share an insight, caveat, or question.
Alak et al. (2026) conducted a cohort in Decompensated Heart Failure with LVEF < 50% (HFmrEF/HFrEF) (n=138). Low total pectoral muscle area (TPMA <3000 mm2) vs. TPMA ≥ 3000 mm2 was evaluated on All-cause mortality (HR 1.911, 95% CI 1.118-3.266, p=0.018). Low total pectoral muscle area (<3000 mm2) was independently associated with nearly a two-fold higher risk of long-term all-cause mortality (HR 1.911) in patients hospitalized with HFmrEF/HFrEF.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: