LAUSR

Background: It is well known that sarcopenia worsens the prognosis among patients with heart failure (HF). Causes and incidence of sarcopenia in patients with HF have become more important because of the increasing number of elderly HF patients worldwide. Although previous basic research suggested that loop diuretics can lead skeletal muscle depletion, the relationship has not been clarified in the clinical settings. The purpose of this study is to investigate the relationship between skeletal muscle loss and use of loop diuretics in patients with HF. Methods: We retrospectively evaluated 178 patients being evaluated for known or suspected coronary artery disease with cardiac catheterization from January 2010 to January 2019 and receiving abdominal computed tomography (CT) both baseline and at follow-up (mean 522 days).The skeletal muscle cross-sectional area was measured using CT scan at the level of third vertebra and total volume of the skeletal muscle cross-sectional area with five slices every 1mm apart was evaluated. Impact of loop-diuretics use on skeletal muscle depletion and overall survival was evaluated using 1:1 propensity score (PS) matching analysis. Results: A total of fifty-eight patients were evaluated (twenty-nine patients in both loop-diuretics use group and non-loop group) after 1:1 PS matching. The median absolute muscle-loss volume was significantly larger in loop diuretics use group (714 cm 2 ) compared to non-loop group (73.3cm 2 ). (p=0.026) Univariable analysis revealed that duration-adjusted skeletal muscle depletion volume was significantly associated with loop diuretic use (Δ=480cm 2 /year: 95% confidence interval, 64.1-897: p=0.024). Median overall survival was 796 days in the loop-diuretics use group and 865 days in the non-loop diuretics group (hazard ratio 0·99, 95% CI 0·35-2.75; p=0.979). Conclusion: Our study suggested that the use of loop diuretics can be related with skeletal muscle loss among patients being evaluated for known or suspected coronary artery disease.