Key result
Low ASMI plus high CONUT score linked to increased mortality in HFrEF and HFpEF.
Why the study?
Whether estimated appendicular skeletal muscle mass index (ASMI) provides prognostic information in relation to malnutrition (CONUT score) in patients with ADHF with reduced and preserved LVEF remained unclear.
Does the combination of estimated appendicular skeletal muscle mass index (ASMI) and CONUT score predict all-cause mortality in patients with acute decompensated heart failure with reduced or preserved ejection fraction?
Cohort (n=551)
Does the combination of estimated appendicular skeletal muscle mass index (ASMI) and CONUT score predict all-cause mortality in patients with acute decompensated heart failure with reduced or preserved ejection fraction?
Combining estimated appendicular skeletal muscle mass index and CONUT score at discharge effectively stratifies mortality risk in patients with acute decompensated heart failure, regardless of whether they have reduced or preserved ejection fraction.
Answers are grounded in this paper and cite their sources.
Supports combined ASMI-CONUT assessment for risk stratification in ADHF; leaves open whether interventions improve outcomes in HFrEF and HFpEF.
Background Both malnutrition and sarcopenia are strong predictors of poor clinical outcome in patients with heart failure. CONUT score is known as well-established marker of nutrition. Recently, a simple method was developed to estimate the appendicular skeletal muscle mass index (ASMI). However, it remains to be clarified whether the estimated ASMI could provide prognostic information in relation to malnutrition in patients with acute decompensated heart failure (ADHF) with reduced and preserved left ventricular ejection fraction (LVEF). Purpose We aimed to investigate the prognostic impact of ASMI and CONUT score in ADHF patients with reduced LVEF (HFrEF) and preserved LVEF (HFpEF). Methods We prospectively studied 551 patients with ADHF. All study patients were divided into HFrEF group (LVEF less than 50%, n=305) and HFpEF group (LVEF of 50% or more, n=246). ASMI was estimated at discharge using an equation as follows: [0.193 * body weight + 0.107 * height – 4.157 * gender – 0.037 * age - 2.631] / height2. CONUT score was also calculated at discharge. The primary outcome was all-cause mortality. Results ASMI was 0.70±1.07 in men and -2.16±1.09 in women and CONUT score was 3.5±2.3 at discharge. During a mean follow-up period of 4.5±2.8 years, 297 patients experienced primary outcome. ASMI and CONUT score was significantly independently associated with primary outcome after multivariate adjustment both in HFrEF (p<0.001 and p=0.001, respectively) and HFpEF (p<0.001 and p<0.001, respectively) groups. Kaplan-Meier analysis revealed that patients with either low ASMI (0.654 or less in male and -1.895 or less in female by ROC curve analysis) or high CONUT (≥5 by ROC curve analysis) had significantly higher risk for primary outcome than those with high ASMI and low CONUT both in HFrEF group (p=0.006) and HFpEF (p=0.033). Furthermore, patients with both low ASMI and high CONUT demonstrated even higher risk in both groups (p<0.001 in HFrEF and p=0.002 in HFpEF). Conclusion(s) The combination of estimated appendicular skeletal muscle mass index and CONUT score could provide prognostic information in risk stratification in patients with acute decompensated heart failure regardless of left ventricular ejection fraction.Survival rate in HFrEF and HFpEF
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Kondo et al. (2026) conducted a cohort in Acute decompensated heart failure (ADHF) with reduced (HFrEF) or preserved (HFpEF) left ventricular ejection fraction (n=551). Low estimated appendicular skeletal muscle mass index (ASMI) and high CONUT score (≥5) vs. High ASMI and low CONUT score (<5) was evaluated on All-cause mortality (p=<0.001). Low estimated ASMI combined with a high CONUT score (≥5) was associated with increased all-cause mortality in both HFrEF and HFpEF patients.
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