ESC Congress 2026 Abstract · Oct 26, 2026
Prognostic impact of estimated appendicular skeletal muscle index in relation to CONUT score in acute decompensated heart failure patients with reduced and preserved left ventricular ejection fraction
By Kondo T, Yamada T, Asai M et al.
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