IJCS | Volume 32, Nº2, May/June 2019

255 Rosário et al. Adductor pollicis muscle in heart failure Int J Cardiovasc Sci. 2019;32(3)253-260 Original Article by Frisancho. 17 The AMA was directly classified based on the percentiles of reference defined by Frisancho. 18 The APM thickness was measured thrice with the scientific adipometer Lange Skinfold Caliper on the dominant side of the body, in the center of an imaginary triangle formed by the index finger and thumb. During this assessment, the individual remained seated with the hand relaxed and resting on his or her thigh, and the arm positioned so as to form a 90° angle with the forearm. 19 The mean values obtained for the dominant arm were classified according to gender and age, and patients with values below the 5 th percentile were considered malnourished. The 5th percentile values are 20, 23, and 18 mm for men in the age range of 18 - 29 years, 30 - 59 years, and above 60 years, respectively. Considering the same age ranges, the 5th percentile values for women are 16, 17, and 14 mm, respectively. 20 Electrical bioimpedance EBI was assessed with the tetrapolar equipment BIA 450 (Biodynamics Corporation, Shoreline, WA, USA) with a 50 kHz sine wave and 800 mA current. The evaluation was performed at the same moment as that of the anthropometric measurements and followed the measurement protocol known as horizontal EBI, 21 in addition to the criteria proposed by the Brazilian Medical Association. 10 The following EBI parameters were evaluated: phase angle (PA), percentage of body fat (BF), and lean mass. Standard PA values (SPA) were estimated according to the following equation: PA value observed minus the PA reference value according to gender and age, divided by the respective standard deviation. 22 Values of PA exceeding 4.2° were considered adequate. 23 Statistical analysis The distribution of the variables was assessed with the Kolmogorov-Smirnov test, and the data are presented as mean ± standard deviation or median (interquartile range) values, as appropriate. Categorical data are presented as percentage. Comparisons between groups were performed with unpaired Student’s t test for parametric variables or Mann- Whitney test for nonparametric variables. One-way analysis of variance (ANOVA) was used to compare parametric variables among three or more groups. The correlation between the variables of interest was performed using Pearson’s or Spearman’s correlation coefficients, as appropriate. The significance level was set at 5% (p < 0.05), and the statistical analysis was performed using the software Statistical Package for the Social Sciences (SPSS), version 19.0. Results A total of 90 patients with HF were considered eligible, of whom 16 (17.7%) were excluded for meeting the exclusion criteria. Of the 74 patients evaluated, most (66.2%) were male and the most frequent etiology of HF was ischemia (28.4%), followed by idiopathic (24.3%), hypertensive (18.9%), alcoholic and infectious (both with 8.1%), and hereditary (5.4%) causes. Chagas’ disease and drug use had frequencies of 4.1% and 2.7%, respectively. Among the patients evaluated, 31 (41.9%) had type 2 diabetes mellitus, 7 (9.5%) had chronic renal disease receiving conservative treatment, and 3 (4.1%) had chronic obstructive pulmonary disease. Approximately 8% of the patients had undergone angioplasty with stent placement. The HF functional class of higher prevalence was NYHA II (40.5%), followed by I (33.8%), III (23.0%), and IV (2.7%). With respect to EF, 88% (n = 65) of the patients presented a value below 50%. Only 7% (n = 5) of the patients presented PA values below 4.2°. The characteristics of the study population are described in Table 1. The classification of the nutritional status according to the different nutritional parameters evaluated is presented inTable 2.Most patients presentedmalnutrition according to the APM thickness, corresponding to approximately 80% (n = 39) of the men and 56% (n = 14) of the women. The mean APM values in individuals classified as malnourished and well-nourished were 13.1 ± 3.9 and 18.9 ± 2.9 mm, respectively (p < 0.0001, unpaired Student’s t test). Patients considered malnourished had lower SPA values when compared with those classified as eutrophic (-0.5 ± 1.42 versus -0.05 ± 1.56, p = 0.012, Mann-Whitney test). The mean APM thickness values were not different when patients were stratified according to the HF etiology, classification of BMI, AMC or AMA (performed by one-wayANOVA). Also no differencewas observed in APM thickness when the patients were stratified by age (< or ≥ 60 years, unpaired Student’s t test). However, the APM values were higher in patients with NYHA I when