Comparison of SARC-F, MRSA-5, and MRSA-7 Questionnaires for detecting sarcopenia among Egyptian patients with chronic heart failure with left ventricular systolic dysfunction

Comparison of SARC-F, MRSA-5, and MRSA-7 Questionnaires for detecting sarcopenia among Egyptian patients with chronic heart failure with left ventricular systolic dysfunction | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Comparison of SARC-F, MRSA-5, and MRSA-7 Questionnaires for detecting sarcopenia among Egyptian patients with chronic heart failure with left ventricular systolic dysfunction Ahmed M Alashry, Hanan M Elshoura, Yosra A. Elshaikh, Ahmed Gaafar This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7998770/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Sarcopenia is a significant comorbidity in patients with chronic heart failure (CHF) and contributes to poor outcomes and increased healthcare utilization. Early and accurate detection via simple clinical tools is essential. This study compared the diagnostic performance of three commonly used sarcopenia screening questionnaires—the SARS-F, MRSA-5, and MRSA-7—in Egyptian patients with CHF. Methods: A cross-sectional study involving 90 Egyptian CHF (EF<50%) patients was conducted. The participantswere assessed for sarcopenia using the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria as the reference standard. Demographic, clinical, and echocardiographic parameters were collected. SARC-F, MRSA-5, and MRSA-7 scores were calculated. Diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the ROC curve (AUC) were compared. Results: Of the 90 participants, 56 (62.2%) were classified as sarcopenic patients. The SARC-F score demonstrated the highest specificity (97.1%) and PPV (96.9%) but had a sensitivity of only 55.4%. The MRSA-5 score exhibited the highest sensitivity (89.3%) and accuracy (74.4%), whereas the MRSA-7 score showed a balance between sensitivity (75%) and specificity (67.6%). The AUCs for all three tools were comparable: SARC-F (0.754), MRSA-5 (0.753), and MRSA-7 (0.754). Conclusion: Among CHF patients, MRSA-5 offers the best sensitivity for detecting sarcopenia and is suitable for initial screening. Owing to its high specificity, the SARC-F score is valuable for confirming the diagnosis. MRSA-7 provides balanced diagnostic performance. A tiered approach using MRSA-5 followed by the SARC-F may optimize sarcopenia screening in clinical practice. Chronic Heart Failure SARC-F MRSA-5 MRSA-7 Sarcopenia Figures Figure 1 Introduction Sarcopenia, defined as the progressive and generalized loss of skeletal muscle mass and strength, has emerged as a critical comorbidity in patients with chronic heart failure (CHF) [1,2]. This syndrome is associated with reduced exercise tolerance, impaired quality of life, increased hospitalization rates, and increased mortality [3,4]. The interplay between CHF and sarcopenia is multifactorial and involves chronic inflammation, neurohormonal activation, reduced mobility, and nutritional deficiencies. Sarcopenia and heart failure (HF) have similar pathophysiological processes. Skeletal muscle in HF patients exhibits atrophy, reduced capillary density, and fiber loss, affecting up to 68% of patients. Protein imbalance, oxidative stress, and increased inflammatory cytokines hasten muscle loss. Hormonal alterations, such as GH resistance and decreased IGF-1, affect muscle development by inhibiting the PI3K/Akt/mTOR pathway and activating catabolic pathways. Nutritional deficits, poor perfusion, and limited physical activity in heart failure increase muscle loss, encouraging sarcopenia. [5,6]. Several screening tools and diagnostic questionnaires have been proposed to detect sarcopenia, including the SARC-F, MRSA-5, and MRSA-7 questionnaires [7–9]. Each offers varying degrees of sensitivity and specificity, yet limited data are comparing their utility in CHF populations, particularly in Middle Eastern cohorts. Given the increasing prevalence of CHF in Egypt [10] and the scarcity of regional data on sarcopenia screening, it is imperative to determine which tool best correlates with objective diagnostic measures. This study aimed to compare the effectiveness of three sarcopenia screening questionnaires in detecting sarcopenia among Egyptian patients with chronic heart failure via comprehensive diagnostic assessments, including handgrip strength, body composition analysis, and functional performance measures. Methods This cross-sectional observational study was conducted between March 2024 and March 2025 at Ain Shams University and Helwan University hospitals, Cairo, Egypt. A total of 90 adult patients diagnosed with chronic heart failure (CHF) were consecutively recruited from outpatient cardiology clinics and the physical medicine and rehabilitation clinics of both institutions. The study participants were adults over the age of 50 who had been diagnosed with chronic heart failure with LV systolic dysfunction (EF<50%) based on the European Society of Cardiology (ESC) guidelines [11] and had maintained a stable clinical condition for at least four weeks before inclusion. Individuals were excluded if they had acute decompensated heart failure, severe valvular disease requiring urgent intervention, neurological or musculoskeletal disorders that could interfere with muscle strength evaluation, or uncontrolled endocrine or metabolic disorders such as uncontrolled diabetes or thyroid dysfunction. Cardiac assessment was also part of the evaluation process. All participants underwent detailed trans-thoracic echocardiography (TTE) performed by experienced cardiologists, following the guidelines of the American Society of Echocardiography and the European Association of Cardiovascular Imaging (EACVI). The key parameters recorded included left ventricular ejection fraction (LVEF) via Simpson’s method (EF = (EDV - ESV)/EDV), left atrial volume index (LAVI), right ventricular systolic pressure (RVSP), diastolic function grading (E/E’), and the presence of structural abnormalities (e.g., hypertrophy, chamber enlargement) [12]. The functional classification was determined via the New York Heart Association (NYHA) classification [13]. The laboratory test results included B-type natriuretic peptide (BNP) levels, which were measured according to standard hospital laboratory protocols, to assess heart failure. When B-type natriuretic peptide (BNP) is ≥35 pg/mL, it is considered abnormal. [11] Sarcopenia evaluation followed the European Working Group on Sarcopenia in Older People (EWGSOP2) guidelines [1]. The assessments were supervised by physical medicine and rehabilitation specialists, and the sarcopenia evaluation consisted of 4 parameters: muscle strength, muscle mass, physical performance, and body composition. The patient is considered sarcopenic if any of these parameters are abnormal. 1. Muscle Strength: Handgrip strength was measured via a calibrated dynamometer (Jamar®️ or equivalent) following standardized protocols. Hand grip is measured by a dynamometer in kilograms, and the reference for diagnosing sarcopenia is < 26 kgf in males and <18 kgf in females [14]. Three trials were performed for each hand, with the highest value recorded. 2. Muscle mass: Bioelectrical impedance analysis (BIA) was used to estimate the skeletal muscle mass index (SMI) in accordance with international consensus. BIA (bioelectrical impedance measured by the IN-body device measured in kg/m2 body surface area): Sarcopenia is diagnosed if it is < 7 kg/m2 in males and < 5.7 kg/m2) [15]. 3. Physical Performance: The six-minute walk test (6MWT) was performed following American Thoracic Society guidelines [16] to assess endurance and mobility. 4. Body composition: Body mass index (BMI) was calculated as weight (kg)/height² (m²) following the World Health Organization criteria [17]. Questionnaires Administered Each patient completed the following validated sarcopenia screening tools: SARC-F (strength, ambulation, rising from a chair, stair climbing, and history of falling) questionnaire [7] Mini-Sarcopenia Risk Assessment–5-item (MRSA-5) [8] MRSA-7 (7-item version) [9] The data were collected from the three structured questionnaires and administered by a trained research assistant. The questionnaires were translated into clear, culturally appropriate Arabic by two bilingual professors of public health and community medicine. To ensure linguistic and conceptual validity, the translated versions were reviewed for accuracy and clarity. A pilot study was conducted on a representative sample of 10 participants from the target population to assess the clarity, relevance, and reliability of the Arabic versions. Necessary modifications were made on the basis of the feedback of the pilot study, and statistical validation of the tools was performed to ensure internal consistency and validity before the main data collection. Ethical Considerations: The study protocol was approved by the Ethics Committees of Ain Shams University and Helwan University (approval number: [REC-FMHU 37-2024]). Written informed consent was obtained from all participants before enrollment, and the study was conducted in accordance with the Declaration of Helsinki [18]. Statistical analysis : Descriptive analysis and comparisons between sarcopenic and nonsarcopenic patients were performed via chi-square tests and t tests. Diagnostic values (sensitivity, specificity, PPV, NPV, accuracy) were calculated in clinical practice according to the standard cutoff points. ROC curve analysis was used to determine the area under the curve (AUC) for each tool. Results The study participants were 56.14 ± 8.06 years old on average, and more than half of the study patients were males, 51.1%, with no significant difference between the sarcopenia and non - sarcopenia groups (p 0.057). Based on the EWGSOP2 recommendations, 56 patients (62.2%) were diagnosed with sarcopenia. We discovered that sarcopenic patients had greater BNP levels (P = 0.008), a greater incidence of ischemic heart disease (IHD) (p = 0.002), and a greater incidence of dyspnea in NYHA III patients (p = 0.004). Sarcopenia patients had a greater BMI (32.21 vs. 27.70, p 0.001) but significantly poorer muscle mass, 6-MWT, and hand grip strength (p 0.001 for each parameter). Sarcopenia was significantly identified in nonsarcopenic patients via these four methods (p<0.001). Receiver operating characteristic (ROC) analysis of the three tools for the prediction of sarcopenia revealed that the SARC-F test at the cutoff point of 3.5 had the highest specificity, 98.8%, and it also had the highest specificity, 97.1%, in clinical use at the standard cutoff point of ≥ 4. The MRS-5 at the cutoff point (45) had the highest sensitivity (89.3%) and accuracy (74.4%). These values are consistent with its performance in clinical use. MRSA-7 at the cutoff point (30) had the best balance between sensitivity, specificity, and accuracy (75%, 67.6%, and 72.2%, respectively) in both the ROC analysis and clinical use. The three tools demonstrated comparable diagnostic performance, with similar areas under the curve (AUCs) ranging from 0.753 to 0.754. Discussion Recent research by Ansaripour et al. revealed that sarcopenia can increase the risk of mortality in cardiac patients [19]. They concluded that sarcopenia significantly increased the risk of early and late mortality following cardiac surgery, as did poorer functional outcomes. Another study by Won et al. [20] revealed that in patients undergoing percutaneous coronary intervention, sarcopenia was associated with higher rates of major adverse cardiac events within one year. The current study provides valuable insights into sarcopenia screening in Egyptian CHF patients. Our study participants were 90 patients with chronic heart failure. A recent systematic review by Zuo et al. [21] reported that the prevalence of sarcopenia in patients with chronic heart failure was 32%, which was significantly higher than that reported in the general population (13%). Our results revealed that sarcopenia was diagnosed in 56 (62.2%) of the study participants who had chronic heart failure. We believe that the higher prevalence in our study was related to the wider age range used in the Zuo et al. meta-analysis; additionally, the meta-analysis included many ethnic groups. These findings highlight the importance of effective screening in this patient group, especially in Egyptians. Our results revealed that, with respect to LVEF, there was no significant difference between sarcopenic and nonsarcopenic patients, but BNP levels were greater in sarcopenic patients. Additionally, both NYHA II and III were more prevalent among sarcopenic patients (p 0.002), indicating that sarcopenic patients had greater myocardial stress and were more symptomatic irrespective of their LVEF. We found that ischemic heart disease was significantly more prevalent among patients with sarcopenia (p = 0.002). These findings suggest that sarcopenia is strongly associated with atherosclerosis. [22] A meta-analysis by Li Huang et al. [23] reported that MSRA's sensitivity was 82% and that SARC-F's specificity was 87%. Sousa et al. [24] reported that the SARC-F questionnaire was associated with longer hospital stays and increased need for mechanical ventilation in older adults with cardiovascular diseases admitted to the emergency room. Our findings revealed that the SARC-F, MRSA-5, and MRSA-7 questionnaires significantly detected sarcopenia in the sarcopenia group (p < 0.001). Nevertheless, the high specificity (97.1%) of the SARC-F makes it ideal for ruling out sarcopenia, whereas its low sensitivity (55.4%) limits its use as a sole screening tool. In contrast, the MRSA-5 questionnaire had the highest sensitivity (89.3%), which suggests that it is more suitable for initial screening, although it has lower specificity (50%). The MRSA-7 questionnaire offered a middle ground, with reasonably balanced sensitivity (75%) and specificity (67.6%), making it useful when both detection and exclusion are critical. Our findings showed that the three tools had comparably high AUCs in the ROC analysis, which means that the tools are useful in detecting sarcopenia in our patients. This aligns with previous studies by Zhao et al. [25], who reported similar trends in questionnaire performance across populations with chronic illnesses. However, regional validation is essential because cultural and physiological differences affect muscle mass and function. Conclusion In Egyptian CHF patients, the MRSA-5 is the most sensitive screening tool for sarcopenia, whereas the SARC-F is best for confirming the diagnosis because of its high specificity. MRSA-7 serves as a balanced alternative. Combining these tools could enhance sarcopenia detection in clinical settings. Declarations Funding No funding was obtained for this study. Ethics declarations Ethics approval The guiding principles of the Declaration of Helsinki were followed in this investigation. Approval was granted by the Research Ethics Committee (REC) at the Faculty of Medicine, Ain Shams University. Consent to participate All the participants were informed about the study aims, methodology, any possible risk, the anticipated benefits, and their right to refuse participation at any time without any effect on the recommended treatment or receiving the best available care. Every participant provided clear, written consent to agree to participate in the study. References Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Aging . 2019;48(1):16–31. Morley JE, Anker SD, von Haehling S. Prevalence, incidence, and clinical impact of sarcopenia: facts, numbers, and epidemiology—update 2014. J Cachexia Sarcopenia Muscle . 2014;5(4):253–9. Fülster S, Tacke M, Sandek A, et al. Muscle wasting in patients with chronic heart failure: results from the Studies Investigating Comorbidities Aggravating Heart Failure (SICA-HF). Eur Heart J . 2013;34(7):512–9. Bekfani T, Pellicori P, Morris DA, et al. Sarcopenia in patients with heart failure with preserved ejection fraction: impact on muscle strength, exercise capacity and quality of life. Int J Cardiol . 2016;222:41–6. Springer J, Springer JI, Anker SD. Muscle wasting and sarcopenia in heart failure and beyond: update 2017. ESC Heart Fail . 2017;4(4):492–8. von Haehling S, Ebner N, Dos Santos MR, Springer J, Anker SD. Muscle wasting and cachexia in heart failure: mechanisms and therapies. Nat Rev Cardiol . 2017;14(6):323–41. Malmstrom TK, Morley JE. SARC-F: a simple questionnaire to rapidly diagnose sarcopenia. J Am Med Dir Assoc . 2013;14(8):531–2. Barbosa-Silva TG, Menezes AM, Bielemann RM, Malmstrom TK, Gonzalez MC. Enhancing SARC-F: improving sarcopenia screening in clinical practice. J Am Med Dir Assoc . 2016;17(12):1136–41. Woo J, Leung J, Morley JE. Validating the SARC-F for sarcopenia screening in primary care. J Am Med Dir Assoc . 2014;15(9):630–4. Ibrahim MM. Epidemiology of cardiovascular disease in Egypt. East Mediterr Health J . 2012;18(12):1173–80. McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J . 2021;42(36):3599–726. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the ASE and EACVI. J Am Soc Echocardiogr . 2015;28(1):1–39. Dolgin M; New York Heart Association. Nomenclature and criteria for diagnosis of diseases of the heart and great vessels . 9th ed. Boston: Little, Brown & Co; 1994. Roberts HC, Denison HJ, Martin HJ, et al. A review of the measurement of grip strength in clinical and epidemiological studies: toward a standardized approach. Age Aging . 2011;40(4):423–9. Kyle UG, Bosaeus I, De Lorenzo AD, et al. Bioelectrical impedance analysis—part I: review of principles and methods. Clin Nutr . 2004;23(5):1226–43. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med . 2002;166(1):111–7. World Health Organization. Body mass index classification. Geneva: WHO; 2020. World Medical Association. Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA . 2013;310(20):2191–4. Ansaripour A, Arjomandi Rad A, Koulouroudias M, Angouras D, Athanasiou T, Kourliouros A. Sarcopenia adversely affects outcomes following cardiac surgery: a systematic review and meta-analysis. J Clin Med . 2023;12(17):5573. doi:10.3390/jcm12175573. PMID: 37685640; PMCID: PMC10488406. Won MH, Yun KH, Kim H, Son YJ. Prognostic role of sarcopenia on major adverse cardiac events among patients who underwent successful percutaneous coronary intervention: a retrospective cohort study. Eur J Cardiovasc Nurs . 2024;23(3):287–95. doi:10.1093/eurjcn/zvad080. PMID: 37579073. Zuo X, Li X, Tang K, Zhao R, Wu M, Wang Y, et al. Sarcopenia and cardiovascular diseases: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle . 2023;14(3):1183–98. doi:10.1002/jcsm.13221. PMID: 37002802; PMCID: PMC10235887. Campos AM, Moura FA, Santos SN, Freitas WM, Sposito AC. Sarcopenia, but not excess weight or increased caloric intake, is associated with coronary subclinical atherosclerosis in the very elderly. Atherosclerosis . 2017;258:138–44. doi:10.1016/j.atherosclerosis.2017.01.005. Huang J, Li M, Luo Q, Li J. The association of sarcopenia, possible sarcopenia and cognitive impairment: a systematic review and meta-analysis. PLoS One . 2025;20(5):e0324258. Sousa LDL, de Lima PB, Dos Santos MDG, de Macedo OG, Alexandre TDS, Garcia PA. Association between SARC-F and clinical outcomes in older adults with cardiovascular diseases admitted to the emergency room: a longitudinal study. J Geriatr Phys Ther . 2024 Dec 11. doi:10.1519/JPT.0000000000000438. PMID: 39665293. Zhao W, Lu M, Wang X, et al. The role of sarcopenia questionnaires in hospitalized patients with chronic heart failure. Aging Clin Exp Res . 2021;33:339–44. doi:10.1007/s40520-020-01561-9. Tables Table 1. Baseline Characteristics of Cardiac Patients According to Sarcopenia Status Variable Total =90 Sarcopenia cases =56 Non sarcopenia cases =34 Test of significance P value Age (year) 56.14 ± 8.064 55.76 ± 8.12 56.76 ± 8.03 t=-0.57 0.573 Gender Male Female 46 (51.1%) 44 (48.9%) 33 (58.9%) 23 (41.1%) 13 (38.2%) 21 (61.8%) Χ 2 = 2.85 0.917 EF (%) 38.78 ±10.71 36.67 ± 9.33 37.29 ± 10.67 t=1.02 0.309 BNR pg/dl 393.78 ± 233.42 444.11 ± 242.28 310.88 ± 194.25 t=2.72 0.008* BMI ( kg/m 2 ) 30.51±5.399 32.21 ± 5.13 27.70 ± 4.65 t=4.18 0.001* Normal Over Obese 18 (20%) 25 (27.8%) 47 (52.2%) 9 (16.1%) 6 (10.7%) 41(73.2%) 9 (26.5%) 19 (55.9%) 6 (17.6%) Χ 2 = 29.19 0.001* NYHA III II 18 (20%) 72 (80%) 17 (30.4%) 39 (69.6%) 1 (2.9%) 33 (97.1%) Χ 2 = 8.29 0.004* SHD IHD DCM 49 (54.5%) 41 (45.5%) 38 (67.9%) 18 (32.1%) 11 (32.4%) 23 (67.6%) Χ 2 = 9.37 0.002* HG (kgf) 18.62 ± 4.71 17.38 ± 3.61 20.68 ± 5.59 t=3.41 0.001* 6-MWT (meters) 317.56 ± 153.44 283.9 ± 95.05 447.94 ± 142.44 t= 8.37 0.001* BIA, muscle mass (kg/m 2 ) 5.07 ± 1.43 4.37 ± 0.86 6.22 ± 1.44 t= 7.67 0.001* Sarc-F Score 3.24± 1.37 3.63 ± 1.23 2.65 ± 0.77 t= -4.16 < 0.001* Mrsa-5 score 36.30 ± 13.89 31.18 ± 10.78 42.24 ± 12.01 t= 4.52 < 0.001* Mrsa-7 score 33.32 ± 13.03 27.98 ± 11.09 37.44 ± 10.93 t= 3.94 < 0.001* SARC-F (Classification) Sarcopenia Non-sarcopenia 32 (35.5%) 58 (64.4%) 31 (55.4%) 25 (44.6%) 1 (2.9%) 33 (97.1%) Χ 2 = 23.13 < 0.001* MRSA-5 (classification) Sarcopenia Non-sarcopenia 67 (74.4%) 23 (25.6%) 50 (89.3%) 6 (10.7%) 17 (50%) 17 (50%) Χ 2 =15.16 < 0.001* MRSA-7 (classification) Sarcopenia Non-sarcopenia 53 (58.9%) 37 (41.1%) 42 (75%) 14 (25%) 11 (32.4%) 23 (67.6%) Χ 2 = 14.18 < 0.001* *p value ≤ 0.05 is significant, Χ 2 ; chi square test, *; p value is significant < 0.05, t; independent t test. Data are presented as mean ± SD or counts (percentages), kgf; kilogram-force. Comparisons between sarcopenia and non-sarcopenia groups were performed using t-tests and chi-square tests as appropriate. HG (Hand Grip measured by dynamometer in kilograms), 6-MWT(6-minute walk test), BIA (Bio-electrical impedance measured by IN body device measured in kg/m2 body surface area) Table 2. Diagnostic Performance of SARC-F, MRSA-5, and MRSA-7 in Detecting Sarcopenia (EWGSOP2 Criteria) Test Sensitivity (%) Specificity (%) PPV (%) NPV (%) Accuracy (%) SARC-F 55.4 97.1 96.9 56.9 71.1 MRSA-5 89.3 50.0 74.6 73.9 74.4 MRSA-7 75.0 67.6 79.2 62.2 72.2 Sensitivity, specificity, PPV (positive predictive value), NPV (negative predictive value), and accuracy are calculated at the EWGSOP2 recommended cut-offs. Table 3. Receiver Operating Characteristic (ROC) Analysis of SARC-F, MRSA-5, and MRSA-7 for Sarcopenia Detection TEST AUC 95% CI Cut-off point Sensitivity% Specificity% SARC-F 0.754 0.653 - 0.856 3.5 55.4 98.8 MRSA-5 0.753 0.646 - 0.859 45 89.3 50 MRSA-7 0.754 0.638 - 0.842 30 75 67.7 AUC; area under the curve, CI; confidence interval. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7998770","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":546178550,"identity":"4c4f9a6a-84a0-48fd-a32f-b66220c70e87","order_by":0,"name":"Ahmed M Alashry","email":"","orcid":"","institution":"Faculty of Medicine helwan Universit","correspondingAuthor":false,"prefix":"","firstName":"Ahmed","middleName":"M","lastName":"Alashry","suffix":""},{"id":546178551,"identity":"dab9b9cc-01f6-47cf-b3fd-aa7f1b88cc3d","order_by":1,"name":"Hanan M Elshoura","email":"","orcid":"","institution":"Ain Shams University","correspondingAuthor":false,"prefix":"","firstName":"Hanan","middleName":"M","lastName":"Elshoura","suffix":""},{"id":546178552,"identity":"409fe052-7338-451e-9480-394b7f20f6dd","order_by":2,"name":"Yosra A. 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This syndrome is associated with reduced exercise tolerance, impaired quality of life, increased hospitalization rates, and increased mortality [3,4]. The interplay between CHF and sarcopenia is multifactorial and involves chronic inflammation, neurohormonal activation, reduced mobility, and nutritional deficiencies. Sarcopenia and heart failure (HF) have similar pathophysiological processes. Skeletal muscle in HF patients exhibits atrophy, reduced capillary density, and fiber loss, affecting up to 68% of patients. Protein imbalance, oxidative stress, and increased inflammatory cytokines hasten muscle loss. Hormonal alterations, such as GH resistance and decreased IGF-1, affect muscle development by inhibiting the PI3K/Akt/mTOR pathway and activating catabolic pathways. Nutritional deficits, poor perfusion, and limited physical activity in heart failure increase muscle loss, encouraging sarcopenia. [5,6].\u003c/p\u003e\n\u003cp\u003eSeveral screening tools and diagnostic questionnaires have been proposed to detect sarcopenia, including the SARC-F, MRSA-5, and MRSA-7 questionnaires [7\u0026ndash;9]. Each offers varying degrees of sensitivity and specificity, yet limited data are comparing their utility in CHF populations, particularly in Middle Eastern cohorts. Given the increasing prevalence of CHF in Egypt [10] and the scarcity of regional data on sarcopenia screening, it is imperative to determine which tool best correlates with objective diagnostic measures.\u003c/p\u003e\n\u003cp\u003eThis study aimed to compare the effectiveness of three sarcopenia screening questionnaires in detecting sarcopenia among Egyptian patients with chronic heart failure via comprehensive diagnostic assessments, including handgrip strength, body composition analysis, and functional performance measures.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis cross-sectional observational study was conducted between March 2024 and March 2025 at Ain Shams University and Helwan University hospitals, Cairo, Egypt. A total of 90 adult patients diagnosed with chronic heart failure (CHF) were consecutively recruited from outpatient cardiology clinics and the physical medicine and rehabilitation clinics of both institutions.\u003c/p\u003e\n\u003cp\u003eThe study participants were adults over the age of 50 who had been diagnosed with chronic heart failure with LV\u0026nbsp;systolic dysfunction (EF\u0026lt;50%)\u0026nbsp;based on the European Society of Cardiology (ESC) guidelines [11] and had maintained a stable clinical condition for at least four weeks before inclusion. Individuals were excluded if they had acute decompensated heart failure, severe valvular disease requiring urgent intervention, neurological or musculoskeletal disorders that could interfere with muscle strength evaluation, or uncontrolled endocrine or metabolic disorders such as uncontrolled\u0026nbsp;diabetes or thyroid dysfunction.\u003c/p\u003e\n\u003cp\u003eCardiac assessment was also part of the evaluation process. All participants underwent detailed trans-thoracic echocardiography (TTE) performed by experienced cardiologists, following the guidelines of the American Society of Echocardiography and the European Association of Cardiovascular Imaging (EACVI). The key parameters recorded included left ventricular ejection fraction (LVEF) via Simpson\u0026rsquo;s method (EF = (EDV - ESV)/EDV), left atrial volume index (LAVI), right ventricular systolic pressure (RVSP), diastolic function grading (E/E\u0026rsquo;), and the presence of structural abnormalities (e.g., hypertrophy, chamber enlargement) [12].\u003c/p\u003e\n\u003cp\u003eThe functional classification was determined via the New York Heart Association (NYHA) classification [13]. The laboratory test results included B-type natriuretic peptide (BNP) levels, which were measured according to standard hospital laboratory protocols, to assess heart failure. When B-type natriuretic peptide (BNP) is \u0026ge;35 pg/mL, it is considered abnormal.\u0026nbsp;[11]\u003c/p\u003e\n\u003cp\u003eSarcopenia evaluation followed the European Working Group on Sarcopenia in Older People (EWGSOP2) guidelines [1]. The assessments were supervised by physical medicine and rehabilitation specialists, and the sarcopenia evaluation consisted of 4 parameters: muscle strength, muscle mass, physical performance, and body composition. The patient is considered sarcopenic if any of these parameters are abnormal.\u003c/p\u003e\n\u003cp\u003e1. Muscle Strength: Handgrip strength was measured via a calibrated dynamometer (Jamar\u0026reg;️ or equivalent) following standardized protocols. Hand grip is measured by a dynamometer in kilograms, and the reference for diagnosing sarcopenia is \u0026lt; 26 kgf in males and \u0026lt;18 kgf in females [14]. Three trials were performed for each hand, with the highest value recorded.\u003c/p\u003e\n\u003cp\u003e2. Muscle mass: Bioelectrical impedance analysis (BIA) was used to estimate the skeletal muscle mass index (SMI) in accordance with international consensus. BIA (bioelectrical impedance measured by the IN-body device measured in kg/m2 body surface area): Sarcopenia is diagnosed if it is \u0026lt; 7 kg/m2 in males and \u0026lt; 5.7 kg/m2) [15].\u003c/p\u003e\n\u003cp\u003e3. Physical Performance: The six-minute walk test (6MWT) was performed following American Thoracic Society guidelines [16] to assess endurance and mobility.\u003c/p\u003e\n\u003cp\u003e4. Body composition: Body mass index (BMI) was calculated as weight (kg)/height\u0026sup2; (m\u0026sup2;) following the World Health Organization criteria [17].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuestionnaires Administered\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEach patient completed the following validated sarcopenia screening tools:\u003c/p\u003e\n\u003cp\u003eSARC-F (strength, ambulation, rising from a chair, stair climbing, and history of falling) questionnaire [7]\u003c/p\u003e\n\u003cp\u003eMini-Sarcopenia Risk Assessment\u0026ndash;5-item (MRSA-5) [8]\u003c/p\u003e\n\u003cp\u003eMRSA-7 (7-item version) [9]\u003c/p\u003e\n\u003cp\u003eThe data\u0026nbsp;were\u0026nbsp;collected from the three structured questionnaires and administered by a trained research assistant. The questionnaires were translated into clear, culturally appropriate Arabic by two bilingual professors of public health and community medicine. To ensure linguistic and conceptual validity, the translated versions were reviewed for accuracy and clarity. A pilot study was conducted on a representative sample of 10 participants from the target population to assess the clarity, relevance, and reliability of the Arabic versions. Necessary modifications were made on the basis of the feedback of the pilot study, and statistical validation of the tools was performed to ensure internal consistency and validity before the main data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Considerations:\u0026nbsp;\u003c/strong\u003eThe study protocol was approved by the Ethics Committees of Ain Shams University and Helwan University (approval number: [REC-FMHU 37-2024]). Written informed consent was obtained from all participants before enrollment, and the study was conducted in accordance with the Declaration of Helsinki [18].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eanalysis\u003c/strong\u003e: Descriptive analysis and comparisons between sarcopenic and nonsarcopenic patients were performed via chi-square tests and t tests. Diagnostic values (sensitivity, specificity, PPV, NPV, accuracy) were calculated in clinical practice according to the standard cutoff points. ROC curve analysis was used to determine the area under the curve (AUC) for each tool.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe study participants were 56.14 \u0026plusmn; 8.06 years old on average, and more than half of the study patients were males, 51.1%, with no significant difference between the sarcopenia and non\u003cspan dir=\"RTL\"\u003e-\u003c/span\u003esarcopenia groups (p 0.057). Based on the EWGSOP2 recommendations, 56 patients (62.2%) were diagnosed with sarcopenia. We discovered that sarcopenic patients had greater BNP levels (P = 0.008), a greater incidence of ischemic heart disease (IHD) (p = 0.002), and a greater incidence of dyspnea in NYHA III patients (p = 0.004). Sarcopenia patients had a greater BMI (32.21 vs. 27.70, p 0.001) but significantly poorer muscle mass, 6-MWT, and hand grip strength (p 0.001 for each parameter). Sarcopenia was significantly identified in nonsarcopenic patients via these four methods (p\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003eReceiver operating characteristic (ROC) analysis of the three tools for the prediction of sarcopenia revealed that the SARC-F test at the cutoff point of 3.5 had the highest specificity, 98.8%, and it also had the highest specificity, 97.1%, in clinical use at the standard cutoff point of \u0026ge; 4. The MRS-5 at the cutoff point (45) had the highest sensitivity (89.3%) and accuracy (74.4%). These values are consistent with its performance in clinical use. MRSA-7 at the cutoff point (30) had the best balance between sensitivity, specificity, and accuracy (75%, 67.6%, and 72.2%, respectively) in both the ROC analysis and clinical use. The three tools demonstrated comparable diagnostic performance, with similar areas under the curve (AUCs) ranging from 0.753 to 0.754.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eRecent research\u0026nbsp;by Ansaripour et al. revealed that sarcopenia can increase the risk of mortality in cardiac patients [19]. They concluded that sarcopenia significantly increased the risk of early and late mortality following cardiac surgery, as did poorer functional outcomes. Another study by Won et al. [20] revealed that in patients undergoing percutaneous coronary intervention, sarcopenia was associated with higher rates of major adverse cardiac events within one year.\u003c/p\u003e\n\u003cp\u003eThe current study provides valuable insights into sarcopenia screening in Egyptian CHF patients. Our study participants were 90 patients with chronic heart failure.\u003c/p\u003e\n\u003cp\u003eA recent systematic review by Zuo et al. [21] reported that the prevalence of sarcopenia in patients with chronic heart failure was 32%, which was significantly higher than that reported in the general population (13%). Our results revealed that sarcopenia was diagnosed in 56 (62.2%) of the study participants who had chronic heart failure. We believe that the higher prevalence in our study was related to the wider age range used in the Zuo et al. meta-analysis; additionally, the meta-analysis included many ethnic groups. These findings highlight the importance of effective screening in this patient group, especially in Egyptians.\u003c/p\u003e\n\u003cp\u003eOur results revealed that, with respect to LVEF, there was no significant difference between sarcopenic and nonsarcopenic patients, but BNP levels were greater in sarcopenic patients. Additionally, both NYHA II and III were more prevalent among sarcopenic patients (p 0.002), indicating that sarcopenic patients had greater myocardial stress and were more symptomatic irrespective of their LVEF.\u003c/p\u003e\n\u003cp\u003eWe found that ischemic heart disease was significantly more prevalent among patients with sarcopenia (p = 0.002). These findings suggest that sarcopenia is strongly associated with atherosclerosis. [22]\u003c/p\u003e\n\u003cp\u003eA meta-analysis by Li\u0026nbsp;Huang et al. [23] reported that MSRA\u0026apos;s sensitivity was 82% and that SARC-F\u0026apos;s specificity was 87%. Sousa et al. [24] reported that the SARC-F questionnaire was associated with longer hospital stays and increased need for mechanical ventilation in older adults with cardiovascular diseases admitted to the emergency room.\u003c/p\u003e\n\u003cp\u003eOur findings revealed that the SARC-F, MRSA-5, and MRSA-7 questionnaires significantly detected sarcopenia in the sarcopenia group (p \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003eNevertheless, the high specificity (97.1%) of the SARC-F makes it ideal for ruling out sarcopenia, whereas its low sensitivity (55.4%) limits its use as a sole screening tool. In contrast, the MRSA-5 questionnaire had the highest sensitivity (89.3%), which suggests that it is more suitable for initial screening, although it has lower specificity (50%). The MRSA-7 questionnaire offered a middle ground, with reasonably balanced sensitivity (75%) and specificity (67.6%), making it useful when both detection and exclusion are critical.\u003c/p\u003e\n\u003cp\u003eOur findings showed that the three tools had comparably high AUCs in the ROC analysis, which means that the tools are useful in detecting sarcopenia in our patients. This aligns with previous studies by Zhao et al. [25], who reported similar trends in questionnaire performance across populations with chronic illnesses. However, regional validation is essential because cultural and physiological differences affect muscle mass and function.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn Egyptian CHF patients, the MRSA-5 is the most sensitive screening tool for sarcopenia, whereas the SARC-F is best for confirming the diagnosis because of its high specificity. MRSA-7 serves as a balanced alternative. Combining these tools could enhance sarcopenia detection in clinical settings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was obtained for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval\u003c/p\u003e\n\u003cp\u003eThe guiding principles of the Declaration of Helsinki were followed in this investigation. Approval was granted by the Research Ethics Committee (REC) at the Faculty of Medicine, Ain Shams University.\u003c/p\u003e\n\u003cp\u003eConsent to participate\u003c/p\u003e\n\u003cp\u003eAll the participants were informed about the study aims, methodology, any possible risk, the anticipated benefits, and their right to refuse participation at any time without any effect on the recommended treatment or receiving the best available care. Every participant provided clear, written consent to agree to participate in the study.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eCruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. \u003cem\u003eAge Aging\u003c/em\u003e. 2019;48(1):16\u0026ndash;31.\u003c/li\u003e\n \u003cli\u003eMorley JE, Anker SD, von Haehling S. Prevalence, incidence, and clinical impact of sarcopenia: facts, numbers, and epidemiology\u0026mdash;update 2014. \u003cem\u003eJ Cachexia Sarcopenia Muscle\u003c/em\u003e. 2014;5(4):253\u0026ndash;9.\u003c/li\u003e\n \u003cli\u003eF\u0026uuml;lster S, Tacke M, Sandek A, et al. Muscle wasting in patients with chronic heart failure: results from the Studies Investigating Comorbidities Aggravating Heart Failure (SICA-HF). \u003cem\u003eEur Heart J\u003c/em\u003e. 2013;34(7):512\u0026ndash;9.\u003c/li\u003e\n \u003cli\u003eBekfani T, Pellicori P, Morris DA, et al. Sarcopenia in patients with heart failure with preserved ejection fraction: impact on muscle strength, exercise capacity and quality of life. \u003cem\u003eInt J Cardiol\u003c/em\u003e. 2016;222:41\u0026ndash;6.\u003c/li\u003e\n \u003cli\u003eSpringer J, Springer JI, Anker SD. Muscle wasting and sarcopenia in heart failure and beyond: update 2017. \u003cem\u003eESC Heart Fail\u003c/em\u003e. 2017;4(4):492\u0026ndash;8.\u003c/li\u003e\n \u003cli\u003evon Haehling S, Ebner N, Dos Santos MR, Springer J, Anker SD. Muscle wasting and cachexia in heart failure: mechanisms and therapies. \u003cem\u003eNat Rev Cardiol\u003c/em\u003e. 2017;14(6):323\u0026ndash;41.\u003c/li\u003e\n \u003cli\u003eMalmstrom TK, Morley JE. SARC-F: a simple questionnaire to rapidly diagnose sarcopenia. \u003cem\u003eJ Am Med Dir Assoc\u003c/em\u003e. 2013;14(8):531\u0026ndash;2.\u003c/li\u003e\n \u003cli\u003eBarbosa-Silva TG, Menezes AM, Bielemann RM, Malmstrom TK, Gonzalez MC. Enhancing SARC-F: improving sarcopenia screening in clinical practice. \u003cem\u003eJ Am Med Dir Assoc\u003c/em\u003e. 2016;17(12):1136\u0026ndash;41.\u003c/li\u003e\n \u003cli\u003eWoo J, Leung J, Morley JE. Validating the SARC-F for sarcopenia screening in primary care. \u003cem\u003eJ Am Med Dir Assoc\u003c/em\u003e. 2014;15(9):630\u0026ndash;4.\u003c/li\u003e\n \u003cli\u003eIbrahim MM. Epidemiology of cardiovascular disease in Egypt. \u003cem\u003eEast Mediterr Health J\u003c/em\u003e. 2012;18(12):1173\u0026ndash;80.\u003c/li\u003e\n \u003cli\u003eMcDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. \u003cem\u003eEur Heart J\u003c/em\u003e. 2021;42(36):3599\u0026ndash;726.\u003c/li\u003e\n \u003cli\u003eLang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the ASE and EACVI. \u003cem\u003eJ Am Soc Echocardiogr\u003c/em\u003e. 2015;28(1):1\u0026ndash;39.\u003c/li\u003e\n \u003cli\u003eDolgin M; New York Heart Association. \u003cem\u003eNomenclature and criteria for diagnosis of diseases of the heart and great vessels\u003c/em\u003e. 9th ed. Boston: Little, Brown \u0026amp; Co; 1994.\u003c/li\u003e\n \u003cli\u003eRoberts HC, Denison HJ, Martin HJ, et al. A review of the measurement of grip strength in clinical and epidemiological studies: toward a standardized approach. \u003cem\u003eAge Aging\u003c/em\u003e. 2011;40(4):423\u0026ndash;9.\u003c/li\u003e\n \u003cli\u003eKyle UG, Bosaeus I, De Lorenzo AD, et al. Bioelectrical impedance analysis\u0026mdash;part I: review of principles and methods. \u003cem\u003eClin Nutr\u003c/em\u003e. 2004;23(5):1226\u0026ndash;43.\u003c/li\u003e\n \u003cli\u003eATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. \u003cem\u003eAm J Respir Crit Care Med\u003c/em\u003e. 2002;166(1):111\u0026ndash;7.\u003c/li\u003e\n \u003cli\u003eWorld Health Organization. Body mass index classification. Geneva: WHO; 2020.\u003c/li\u003e\n \u003cli\u003eWorld Medical Association. Declaration of Helsinki: ethical principles for medical research involving human subjects. \u003cem\u003eJAMA\u003c/em\u003e. 2013;310(20):2191\u0026ndash;4.\u003c/li\u003e\n \u003cli\u003eAnsaripour A, Arjomandi Rad A, Koulouroudias M, Angouras D, Athanasiou T, Kourliouros A. Sarcopenia adversely affects outcomes following cardiac surgery: a systematic review and meta-analysis. \u003cem\u003eJ Clin Med\u003c/em\u003e. 2023;12(17):5573. doi:10.3390/jcm12175573. PMID: 37685640; PMCID: PMC10488406.\u003c/li\u003e\n \u003cli\u003eWon MH, Yun KH, Kim H, Son YJ. Prognostic role of sarcopenia on major adverse cardiac events among patients who underwent successful percutaneous coronary intervention: a retrospective cohort study. \u003cem\u003eEur J Cardiovasc Nurs\u003c/em\u003e. 2024;23(3):287\u0026ndash;95. doi:10.1093/eurjcn/zvad080. PMID: 37579073.\u003c/li\u003e\n \u003cli\u003eZuo X, Li X, Tang K, Zhao R, Wu M, Wang Y, et al. Sarcopenia and cardiovascular diseases: a systematic review and meta-analysis. \u003cem\u003eJ Cachexia Sarcopenia Muscle\u003c/em\u003e. 2023;14(3):1183\u0026ndash;98. doi:10.1002/jcsm.13221. PMID: 37002802; PMCID: PMC10235887.\u003c/li\u003e\n \u003cli\u003eCampos AM, Moura FA, Santos SN, Freitas WM, Sposito AC. Sarcopenia, but not excess weight or increased caloric intake, is associated with coronary subclinical atherosclerosis in the very elderly. \u003cem\u003eAtherosclerosis\u003c/em\u003e. 2017;258:138\u0026ndash;44. doi:10.1016/j.atherosclerosis.2017.01.005.\u003c/li\u003e\n \u003cli\u003eHuang J, Li M, Luo Q, Li J. The association of sarcopenia, possible sarcopenia and cognitive impairment: a systematic review and meta-analysis. \u003cem\u003ePLoS One\u003c/em\u003e. 2025;20(5):e0324258.\u003c/li\u003e\n \u003cli\u003eSousa LDL, de Lima PB, Dos Santos MDG, de Macedo OG, Alexandre TDS, Garcia PA. Association between SARC-F and clinical outcomes in older adults with cardiovascular diseases admitted to the emergency room: a longitudinal study. \u003cem\u003eJ Geriatr Phys Ther\u003c/em\u003e. 2024 Dec 11. doi:10.1519/JPT.0000000000000438. PMID: 39665293.\u003c/li\u003e\n \u003cli\u003eZhao W, Lu M, Wang X, et al. The role of sarcopenia questionnaires in hospitalized patients with chronic heart failure. \u003cem\u003eAging Clin Exp Res\u003c/em\u003e. 2021;33:339\u0026ndash;44. doi:10.1007/s40520-020-01561-9.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Baseline Characteristics of Cardiac Patients According to Sarcopenia Status\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"104%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e=90\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSarcopenia cases\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e=56\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon sarcopenia cases\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e=34\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003eTest of significance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003eAge (year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e56.14 \u0026plusmn; \u0026nbsp;8.064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e55.76\u003cstrong\u003e\u003cu\u003e\u0026plusmn;\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e8.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e56.76\u003cstrong\u003e\u003cu\u003e\u0026plusmn;\u003c/u\u003e\u003c/strong\u003e8.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003et=-0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.573\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003eGender\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e46 (51.1%)\u003c/p\u003e\n \u003cp\u003e44 (48.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e33 (58.9%)\u003c/p\u003e\n \u003cp\u003e23 (41.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e13 (38.2%)\u003c/p\u003e\n \u003cp\u003e21 (61.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026Chi;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e= 2.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.917\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003eEF \u0026nbsp;(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e38.78 \u0026plusmn;10.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e36.67\u003cstrong\u003e\u003cu\u003e\u0026plusmn;\u003c/u\u003e\u003c/strong\u003e9.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e37.29\u003cstrong\u003e\u003cu\u003e\u0026plusmn;\u003c/u\u003e\u003c/strong\u003e10.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003et=1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.309\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003eBNR pg/dl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e393.78 \u0026plusmn; 233.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e444.11\u003cstrong\u003e\u003cu\u003e\u0026plusmn;\u003c/u\u003e\u003c/strong\u003e242.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e310.88\u003cstrong\u003e\u003cu\u003e\u0026plusmn;\u003c/u\u003e\u003c/strong\u003e194.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003et=2.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.008*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003eBMI (\u003cstrong\u003ekg/m\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e30.51\u0026plusmn;5.399\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e32.21\u003cstrong\u003e\u003cu\u003e\u0026plusmn;\u003c/u\u003e\u003c/strong\u003e5.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e27.70\u0026nbsp;\u003cstrong\u003e\u003cu\u003e\u0026plusmn;\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e4.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003et=4.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003cp\u003eOver\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eObese\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e18 (20%)\u003c/p\u003e\n \u003cp\u003e25 (27.8%)\u003c/p\u003e\n \u003cp\u003e47 (52.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e9 (16.1%)\u003c/p\u003e\n \u003cp\u003e6 (10.7%)\u003c/p\u003e\n \u003cp\u003e41(73.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e9 (26.5%)\u003c/p\u003e\n \u003cp\u003e19 (55.9%)\u003cbr\u003e\u0026nbsp;6 (17.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026Chi;\u003csup\u003e2\u003c/sup\u003e= 29.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003eNYHA\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003cp\u003eII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e18 (20%)\u003c/p\u003e\n \u003cp\u003e72 (80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e17 (30.4%)\u003c/p\u003e\n \u003cp\u003e39 (69.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 (2.9%)\u003c/p\u003e\n \u003cp\u003e33 (97.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026Chi;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e= 8.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003eSHD\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; IHD\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; DCM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e49 (54.5%)\u003c/p\u003e\n \u003cp\u003e41 (45.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e38 (67.9%)\u003c/p\u003e\n \u003cp\u003e18 (32.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e11 (32.4%)\u003c/p\u003e\n \u003cp\u003e23 (67.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026Chi;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e= 9.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHG (kgf)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e18.62 \u0026plusmn; 4.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e17.38\u0026nbsp;\u003cstrong\u003e\u003cu\u003e\u0026plusmn;\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e3.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e20.68\u0026nbsp;\u003cstrong\u003e\u003cu\u003e\u0026plusmn;\u003c/u\u003e\u003c/strong\u003e 5.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003et=3.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6-MWT (meters)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e317.56 \u0026plusmn; 153.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e283.9\u0026nbsp;\u003cstrong\u003e\u003cu\u003e\u0026plusmn;\u003c/u\u003e\u003c/strong\u003e 95.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e447.94\u0026nbsp;\u003cstrong\u003e\u003cu\u003e\u0026plusmn;\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e142.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003et= 8.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBIA, muscle mass (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e5.07 \u0026plusmn; 1.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e4.37\u0026nbsp;\u003cstrong\u003e\u003cu\u003e\u0026plusmn;\u003c/u\u003e\u003c/strong\u003e 0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e6.22\u0026nbsp;\u003cstrong\u003e\u003cu\u003e\u0026plusmn;\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e1.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003et= 7.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSarc-F Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e3.24\u0026plusmn; 1.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e3.63 \u0026plusmn; 1.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e2.65 \u0026plusmn; 0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003et= -4.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMrsa-5 score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e36.30 \u0026plusmn; 13.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e31.18 \u0026plusmn; 10.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e42.24 \u0026plusmn; 12.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003et= 4.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMrsa-7 score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e33.32 \u0026plusmn; 13.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e27.98 \u0026plusmn; 11.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e37.44 \u0026plusmn; 10.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003et= 3.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003eSARC-F (Classification)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; Sarcopenia\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; Non-sarcopenia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e32 (35.5%)\u003c/p\u003e\n \u003cp\u003e58 (64.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e31 (55.4%)\u003c/p\u003e\n \u003cp\u003e25 (44.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 (2.9%)\u003c/p\u003e\n \u003cp\u003e33 (97.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026Chi;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e= 23.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003eMRSA-5 (classification)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Sarcopenia\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Non-sarcopenia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e67 (74.4%)\u003c/p\u003e\n \u003cp\u003e23 (25.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e50 (89.3%)\u003c/p\u003e\n \u003cp\u003e6 (10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e17 (50%)\u003c/p\u003e\n \u003cp\u003e17 (50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026Chi;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e=15.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003eMRSA-7 (classification)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Sarcopenia\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Non-sarcopenia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e53 (58.9%)\u003c/p\u003e\n \u003cp\u003e37 (41.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e42 (75%)\u003c/p\u003e\n \u003cp\u003e14 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e11 (32.4%)\u003c/p\u003e\n \u003cp\u003e23 (67.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026Chi;\u003csup\u003e2 =\u003c/sup\u003e14.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*p value \u0026le; 0.05 \u0026nbsp;is significant, \u0026nbsp;\u0026Chi;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e; chi square test, *; p value is significant \u0026lt; 0.05, t; independent t test. Data are presented as mean \u0026plusmn; SD or counts (percentages), kgf; kilogram-force. Comparisons between sarcopenia and non-sarcopenia groups were performed using t-tests and chi-square tests as appropriate. HG (Hand Grip measured by dynamometer in kilograms), 6-MWT(6-minute walk test), BIA (Bio-electrical impedance measured by IN body device measured in kg/m2 body surface area)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Diagnostic Performance of SARC-F, MRSA-5, and MRSA-7 in Detecting Sarcopenia (EWGSOP2 Criteria)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"614\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eTest\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eSensitivity (%)\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eSpecificity (%)\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003ePPV (%)\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eNPV (%)\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eAccuracy (%)\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eSARC-F\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e55.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e97.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e96.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e56.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e71.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eMRSA-5\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e89.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e50.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e74.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e73.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e74.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eMRSA-7\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e75.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e67.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e79.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e62.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e72.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSensitivity, specificity, PPV (positive predictive value), NPV (negative predictive value), and accuracy are calculated at the EWGSOP2 recommended cut-offs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003eReceiver Operating Characteristic (ROC) Analysis of SARC-F, MRSA-5, and MRSA-7 for Sarcopenia Detection\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003eTEST\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003eAUC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eCut-off point\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eSensitivity%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eSpecificity%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003eSARC-F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.754\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e0.653 - 0.856\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e55.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e98.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003eMRSA-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.753\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e0.646 - 0.859\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e89.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003eMRSA-7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.754\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e0.638 - 0.842\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e67.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAUC; area under the curve, CI; confidence interval.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Chronic Heart Failure, SARC-F, MRSA-5, MRSA-7, Sarcopenia","lastPublishedDoi":"10.21203/rs.3.rs-7998770/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7998770/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Sarcopenia is a significant comorbidity in patients with chronic heart failure (CHF) and contributes to poor outcomes and increased healthcare utilization. Early and accurate detection via simple clinical tools is essential. This study compared the diagnostic performance of three commonly used sarcopenia screening questionnaires—the SARS-F, MRSA-5, and MRSA-7—in Egyptian patients with CHF.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA cross-sectional study involving 90 Egyptian CHF (EF\u0026lt;50%) patients was conducted. The participantswere assessed for sarcopenia using the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria as the reference standard. Demographic, clinical, and echocardiographic parameters were collected. SARC-F, MRSA-5, and MRSA-7 scores were calculated. Diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the ROC curve (AUC) were compared.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Of the 90 participants, 56 (62.2%) were classified as sarcopenic patients. The SARC-F score demonstrated the highest specificity (97.1%) and PPV (96.9%) but had a sensitivity of only 55.4%. The MRSA-5 score exhibited the highest sensitivity (89.3%) and accuracy (74.4%), whereas the MRSA-7 score showed a balance between sensitivity (75%) and specificity (67.6%). The AUCs for all three tools were comparable: SARC-F (0.754), MRSA-5 (0.753), and MRSA-7 (0.754).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eAmong CHF patients, MRSA-5 offers the best sensitivity for detecting sarcopenia and is suitable for initial screening. Owing to its high specificity, the SARC-F score is valuable for confirming the diagnosis. MRSA-7 provides balanced diagnostic performance. A tiered approach using MRSA-5 followed by the SARC-F may optimize sarcopenia screening in clinical practice.\u003c/p\u003e","manuscriptTitle":"Comparison of SARC-F, MRSA-5, and MRSA-7 Questionnaires for detecting sarcopenia among Egyptian patients with chronic heart failure with left ventricular systolic dysfunction","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-26 09:17:28","doi":"10.21203/rs.3.rs-7998770/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ede2dde6-bcde-4c93-b435-7d5057fba35b","owner":[],"postedDate":"November 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-17T13:23:33+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-26 09:17:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7998770","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7998770","identity":"rs-7998770","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}