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The primary goal of this study is to improve our understanding of changes in skeletal muscle mass in the arms and the legs during a hospitalization for advanced HF. We plan to measure muscle thickness with an ultrasound machine in two locations on the body (the outer thigh and the upper arm muscle, of the dominant side) from the time a patient is first admitted to the ICU with HF as well as before and after any surgical HF therapies.

Severe skeletal muscle loss (wasting) and catabolic weight loss are highly common among patients with heart failure with reduced ejection fraction (HFrEF). This prospective randomized controlled trial will compare changes in the muscle mass in the arms and the legs (appendicular lean mass) in patients with HFrEF randomized between 3 groups of no, low or high dose protien supplementation. The dietary protein supplementation will be Ensure(R) products manufactured by Abbott Nutrition.