Sex-Specific Prognostic Patterns of Sarcopenia Components in Patients With Heart Failure

Background: Whether the components of sarcopenia provide sex-specific prognostic information in heart failure (HF) remains uncertain. Methods and Results: We enrolled 604 patients with HF (259 women; median age, 73 years) undergoing dual-energy X-ray absorptiometry. During 2.18-year follow-up, 124 deaths occurred. All sarcopenia components as continuous variables were associated with death in the overall cohort. Asian Working Group for Sarcopenia (AWGS2019) cutoffs for weak handgrip strength, prolonged fivetimes sittostand time (FTSS), or low Short Physical Performance Battery (SPPB) score showed the strongest association, whereas low appendicular skeletal muscle mass index (ASMI) did not predict death. No significant sex interactions were observed for ASMI, gait speed, FTSS, or SPPB, and only handgrip strength showed a borderline interaction trend (P=0.058), with a stronger association for death in women. Despite a nonsignificant interaction (P=0.284), the AWGS2019 criteria predicted death in men (adjusted HR, 2.23; 95% confidence interval (CI), 1.21–4.09, P=0.013) but not in women (aHR, 1.28; 95% CI, 0.70–2.34, P=0.423). Exploratory analyses showed that optimized, HF-specific ASMI thresholds improved prognostic performance. Conclusions: Performancebased sarcopenia components can provide valuable mortality risk stratification in HF irrespective of sex. Although sex interactions were limited, population-derived muscle mass thresholds showed reduced prognostic performance in women, indicating that refining disease-specific or sex-adapted thresholds may enhance risk stratification in HF.