Evaluation of Skeletal Muscle Ultrasound For The Assessment of Body Composition In Healthy Controls And Patients With Heart Failure

Abstract

Introduction Wasting of skeletal muscle mass, termed sarcopenia, is common in patients with advanced heart failure (HF). Dual-energy X-ray absorptiometry (DXA) is the reference standard, but limitations include expense, ionizing radiation and non-portability. The use of a bedside skeletal muscle ultrasound (US) device to screen for low muscle mass may bolster efforts to identify and treat sarcopenia among patients with HF. Hypothesis We hypothesized that skeletal muscle US measurements would be strongly associated with DXA appendicular lean mass (ALM) measurements in healthy controls and patients with HF. Methods We recruited healthy volunteers and patients with HF (with or without advanced therapies) and measured skeletal muscle mass via Hologic Discovery A full-body DXA scan and A-mode BodyMetrix Pro US at 7 anatomical locations (dominant side). Upper body strength was evaluated using a handgrip strength test and lower body strength by 5 timed sit-to-stands. Sarcopenia was determined by international ALM criteria. Linear regression was used to evaluate the relationship between US measures of muscle thickness and DXA-measured ALM, with a stepwise selection model defining which anatomic locations of US muscle thickness were the strongest descriptors of DXA ALM (plus additional candidate covariates age, height and sex). Pearson correlation coefficients were used to evaluate the relationship between upper extremity US muscle thickness and handgrip strength, and lower extremity US muscle thickness and sit-to-stand time. Results Skeletal muscle mass was assessed in 17 healthy controls (7 females, mean age: 24 years, BMI: 24, ALM: 27 kg, Sarcopenia: 0%) and 11 patients with HF (1 female, mean age: 64 years, BMI: 28, ALM: 24 kg, Sarcopenia: 18%). Linear regression analyses revealed that age (p=0.04) and height (p Conclusion US measurements for lateral thigh, forearm and maximum bicep are the strongest descriptors of DXA-measured ALM. These findings suggest that skeletal muscle ultrasound performed at these 3 anatomical landmarks can be used to screen for sarcopenia in patients with HF and will be prospectively validated in a future study.