• Christina Kronberger, Katharina Mascherbauer, Robin Willixhofer, Franz Duca, René Rettl, Christina Binder-Rodriguez, Michael Poledniczek, Nikita Ermolaev, Carolina Donà, Matthias Koschutnik, Christian Nitsche, Luciana Camuz Ligios, Dietrich Beitzke, Roza Badr Eslam, Jutta Bergler-Klein, Johannes Kastner, and Andreas A Kammerlander.
• Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
• Eur. J. Intern. Med. 2024 Nov 1; 129: 939993-99.

BackgroundHeart failure with preserved ejection fraction (HFpEF) is associated with heart failure (HF) hospitalizations and death. Previous studies have shown that altered muscle composition is associated with higher risk of adverse outcome in HFpEF patients.AimThe purpose of our study was to investigate the association between skeletal muscle composition, as measured by skeletal muscle T1-times on cardiac magnetic resonance (CMR) imaging, and adverse outcome.MethodsWe measured skeletal muscle T1-times of the back muscles on standard CMR images in a prospective cohort of HFpEF patients. Cox regression models were used to test the association of skeletal muscle T1-times and adverse outcome defined as hospitalization for HF and/or cardiovascular death.ResultsWe included 101 patients (mean age 72±7 years, 71 % female) in our study. The median skeletal muscle T1-times were 842 ms (IQR 806-881 ms). In univariate analysis high muscle T1-time was associated with adverse outcome (HR=1.96 [95 % CI, 1.31-2.94] per every 100 ms increase; p=.001). After adjustment for age, sex, body mass index, left- and right ventricular ejection fraction, N-terminal pro-brain natriuretic peptide and myocardial native T1-times, native skeletal muscle T1-time remained an independent predictor for adverse outcome (HR=1.94 [95 % CI, 1.24-3.03] per every 100 ms increase; p=.004).ConclusionIn patients with HFpEF, high skeletal muscle T1-times on standard CMR scans are associated with higher rates of HF hospitalizations and cardiovascular death.Condensed AbstractSkeletal muscle abnormalities are common in patients with heart failure with preserved ejection fraction (HFpEF). The present study evaluates skeletal muscle composition, as quantified by native skeletal muscle T1-times of the back muscles on standard cardiac magnetic resonance imaging, and assessed the association with adverse outcome, defined as hospitalization for heart failure and/or cardiovascular death. In a prospective cohort of 101 patients with HFpEF, we found that high native skeletal muscle T1-times are associated with an increased risk for adverse outcome. These findings suggest that native skeletal muscle T1-time may serve as marker for improved risk prediction.Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.

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