Impact of sarcopenia and atrial fibrillation on the incidence of heart failure in elderly patients.

Objective: Sarcopenia is an age-dependent skeletal muscle disorder that is associated with multiple adverse outcomes including cardiovascular events. Sarcopenia can influence the outcomes of patients with heart failure, myocardial infarctions, and atrial fibrillation (AF). This study aimed to clarify the clinical significance of sarcopenia in the incidence of heart failure in elderly individuals. Design and method: A total of 118 elderly participants with cardiovascular risk factors (mean age 76.7 years old) were included in the study. The body composition including the skeletal muscle mass index (SMI), body fat percentage, ratio of extracellular water to the total body water (ECW/TBW), and phase angle were measured using a multifrequency bioelectrical impedance analysis (BIA). Sarcopenia was defined according to the criteria of the Asian Working Group, which involves a low grip strength or slow gait speed and low SMI. Heart failure (HF) was defined according to the Framingham criteria. Statistical associations between those BIA-related parameters and the incidence of HF were evaluated by multiple logistic regression analysis. The threshold for a statistical significance was set at p < 0.05. Result: Sarcopenia was observed in 33 subjects (28.0%) and AF was observed in 29 (25.4%) of 118 participants. The ECW/TBW, which reflected cellular edema, was higher in patients with HF than in those without whereas the body fat percentage and phase angle did not differ between the patients with and without HF. Although AF was associated with the incidence of HF and sarcopenia was not associated with it, concomitant sarcopenia and AF, was associated with the incidence of HF than sarcopenia or AF alone. A multiple logistic regression analysis showed that AF accompanied with sarcopenia and ECW/TBW were significantly and positively associated with the incidence of HF independently of the age, gender, and other cardiovascular risk factors. Conclusion: In the present study, AF complicated with sarcopenia and cellular edema increased the incidence of HF in elderly individuals with cardiovascular risk factors. The obtained results suggested that the management of sarcopenia and cellular edema is a critical problem for the prevention of HF in elderly patients with AF.