(CCSP084) ULTRASOUND OF QUADRICEPS FEMORIS AS A VALID TOOL FOR MALNUTRITION SCREENING IN HEART FAILURE CLINICS

Background: Malnutrition is a common issue among patients with chronic heart failure (HF), with reported prevalence ranging from 16 to 90%. This comorbidity has significant impacts on health costs and overall quality of life but is still undiagnosed. As nutritional status is directly associated with muscle preservation, we believe that measuring muscle mass could be a reliable indicator of malnutrition in these patients. Therefore, an easily implementable tool that can facilitate early detection and diagnosis of at-risk patients is needed. Our study aimed to assess the reproducibility of quadriceps femoris muscle (QFM) thickness measured by 2D-ultrasound and evaluate its potential as a tool for detecting malnutrition in patients with HF.

METHODS AND RESULTS: Our study included thirty HF participants, fifteen of whom were malnourished and fifteen were well-nourished. Nutritional status was assessed using the GLIM tool, which served as the reference method. QFM thickness was measured at two points (mid-point and 2/3-point) in each patient. We conducted paired T-tests to assess differences in QFM thickness according to leg side (left vs right), condition of measure (with pressure vs no pressure), operator, and round. Right vs left was different for 1 comparison at the mid-point, no pressure condition. Intraclass coefficients (ICC) were used to test intra- and inter-operator agreement. We used area under the curve (AUC) analysis to assess the sensitivity and specificity of the QFM measurements in detecting malnutrition. Our T-test analyses showed no differences for most comparisons (total comparisons n=48). The intra- and inter-operator agreement results are presented in the table. QFM thickness at the 2/3-point showed no significant difference in any comparison. Our ICC analyses ranged from 0.942 to 0.996 for intra-operator comparisons and from 0.892 to 0.978 for inter-operator comparisons. Our ROC analysis was significant for the 2/3-point (p=0.049) but not for the mid-point QFM (p=0.150). The AUC for the 2/3-point QFM was 0.711, and we found that the cut-off point of 1.18 cm had a sensitivity of 73.3% and specificity of 67%.

Conclusion: Our preliminary results suggest that QFM thickness, measured using 2D-ultrasound with pressure applied, is a reproducible and consistent measurement that performs better when measured at the 2/3-point rather than the mid-point. We believe that this tool could be useful as an initial screening test to identify malnutrition in patients with chronic heart failure. However, these preliminary findings need to be confirmed in a larger sample size.