IJCS | Volume 32, Nº2, May/June 2019

256 Table 1 - Anthropometric and clinical characteristics of the study population Total sample (n = 74) Men (n = 49) Women (n = 25) p value Age (years) 60 (14.5) 59 (19) 65 (11) 0.012† APM (mm) 14.8 ± 4.4 15.7 ± 4.0 13.0 ± 4.8 0.015* EF (%) 35.8 ± 12.3 36.2 ± 13.0 34.9 ± 11.1 0.67* BMI (kg/m²) 26.9 ± 3.6 26.8 ± 3.5 27.1 ± 3.9 0.70* TSF (mm) 21.2 ± 6.1 19.8 ± 4.8 23.8 ± 7.4 0.02* AMA (cm 2 ) 45.9 (16.4) 49.8 (13.9) 42.0 (12.1) 0.005† AMC (cm) 24.0 (4.2) 25 (3.4) 23.0 (3.25) 0.005† LM (kg) 51.9 ± 10.9 57.3 ± 8.2 41.5 ± 7.6 < 0.001* BF (%) 30.2 ± 6.9 26.9 ± 5.1 36.8 ± 5.1 < 0.001* PA (°) 6.4 ± 1.2 6.7 ± 1.1 5.7 ± 1.1 < 0.001* SPA (°) -0.30 (1.22) -0.42 (1.28) -0.20 (1.27) 0.458† P values refer to comparisons between men and women. † Mann-Whitney test; *Unpaired Student's t test. APM, adductor pollicis muscle; EF: ejection fraction; BMI: body mass index; TSF: triceps skinfold; AMA: arm muscle area; AMC: arm muscle circumference; LM: lean mass; BF: body fat; PA: phase angle; SPA: standard phase angle. Table 2 - Nutritional status of patients with heart failure according to assessed nutritional indicators Parameter Classification N (%) APM Malnutrition 53 (71.6) Eutrophy 21 (28.4) BMI Malnutrition - Eutrophy 21 (28.4) Pre-obesity 37 (50.0) Obesity 16 (21.6) AMC Malnutrition 29 (39.2) Eutrophy 37 (50.0) Overweight/obesity 8 (10.8) AMA Severe malnutrition 3 (4.1) Mild/moderate malnutrition 7 (9.5) Eutrophy 64 (86.5) AP: adductor pollicis muscle; BMI: body mass index; AMC: arm muscle circumference; AMA: arm muscle area. Rosário et al. Adductor pollicis muscle in heart failure Int J Cardiovasc Sci. 2019;32(3)253-260 Original Article significant difference was observed in APM thickness values between groups with EF above and below 50% (unpaired Student’s t test). The APM thickness correlated with the PA, SPA, and anthropometric variables, as shown in Table 3. Discussion Proteinmalnutrition is a frequent condition in patients with HF. 3,24 Despite the assessment of the APM thickness being considered a useful tool to assess somatic protein status in general, 20 its use in the assessment of the nutritional status in patients with HF is still emerging. In this sense, our study was a pioneer in assessing APM thickness in patients with HF and found that about 70% of the patients were considered malnourished when the values of the APM thickness were compared to reference values according to gender and age. The reduction in muscle mass in patients with HF can be explained by physical inactivity, hypermetabolic status, and drug-nutrient interaction, which leads to symptoms such as anorexia, diarrhea, and intestinal edema which, once present, are responsible for the reduction in food ingestion and absorption of nutrients. 1 In addition, chronic inflammation is closely related to the development of protein depletion in these patients. 1,2 compared with those with NYHA II (16.6 ± 4.1 versus 13.7 ± 4.3 mm, p = 0.045, unpaired Student’s t test). No