부산대학교 도서관

Introduction: Low urinary excretion of creatinine in heart failure (HF) reflects reduction of muscle mass and worsens prognosis. Spot urinary creatinine (SUCR) has been suggested as a useful prognostic factor. This more practical approach was not tested in unselected HF population. The prognostic role of SUCR was also not adjusted for differences in body composition.Hypothesis: Low SUCR in unselected HF patients is linked to worse outcome after accounting for body composition.Methods: In 719 HF patients (age: 52±10 years, female: 14%, NYHA: 2.9±0.9, LVEF: 25±11%), morning SUCR along with whole body dual-energy X-ray absorptiometry (DEXA) scanning were performed. Patients were divided according to cut-point of 13.1 g/L of SUCR identified on ROC curve for 3-year all-cause mortality. Optimal treatment was applied to all, and patients had no volume overload. Beyond Kaplan-Meier curves, we used Cox method to estimate relative risk of death for low as compared to high SUCR, after adjusting for total fat mass, total fat-free mass, and in separate analysis for appendicular muscle mass by DEXA.Results: During 3 years of follow-up 222 (31%) patients died. In Kaplan-Meier survival was worse in low as compared to high SUCR (log rank p=0.0006), (fig 1). The group with low SUCR had less fat, non-fat tissue, and less appendicular muscles. In adjusted analysis, age, sex, % weight loss, fat-free mass, LVEF and MVO2, but not fat mass were significantly associated with prognosis. When we replaced fat-free mass with appendicular muscles, all parameters with exception of total fat predicted prognosis. For each 1 kg increase of total non-fat mas (model 1), or appendicular muscles (model 2) the risk of death decreased by 2% (p=0.02) and 24% (p=0.001) respectively.Conclusions: In unselected HF population low SUCR is associated with worse prognosis independently of muscle mass. Protective role of different muscle compartments may not be identical in this population.