Current Approach to the Diagnosis of Sarcopenia in Heart Failure: A Narrative Review on the Role of Clinical and Imaging Assessments

Abstract

Sarcopenia has been established as a predictor of poor outcomes in various clinical settings. It is particularly prevalent in heart failure, a clinical syndrome that poses significant challenges to health care worldwide. Despite this, sarcopenia remains overlooked and undertreated in cardiology practice. Understanding the currently proposed diagnostic process is paramount for the early detection and treatment of sarcopenia to mitigate downstream adverse health outcomes.

Keywords: cardiology; diagnosis; frailty; heart failure; muscles; radiology; sarcopenia.

Figure 1.

The wasting continuum in heart failure entails the loss of muscle quantity and quality preceding the loss of adipose tissue and bone mass. There is significant overlap between the pathogenesis of sarcopenia, cachexia, and malnutrition in heart failure with a gradual decline in functional status from fitness to frailty and finally disability without appropriate intervention.

Figure 2.

Algorithm for the diagnosis and grading of sarcopenia in clinical practice, adapted from the consensus definitions by the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) in 2018, the Asian Working Group for Sarcopenia (AWGS) in 2019, and the Sarcopenia Definition and Outcomes Consortium (SDOC) in 2020. SARC-F, Strength, Assistance with walking, Rising from chair, Climbing stairs, and Falls; MSRA, Mini Sarcopenia Risk Assessment; CT, computed tomography; MRI, magnetic resonance imaging; DEXA, dual-energy x-ray absorptiometry; BIA, bioelectrical impedance analysis; US, ultrasound; SPPB, short physical performance battery; TUG, timed-up-and-go.

Figure 3.

Computed tomography axial slices demonstrating the skeletal muscles found at the most commonly studied vertebral levels, including normal (2A) and low (2B) muscle mass above the aortic arch (about the third thoracic vertebra), normal (2C) and low (2D) muscle mass at the twelfth thoracic vertebra, and normal (2E) and low (2F) muscle mass at the third lumbar vertebra.