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BACKGROUND Heart failure (HF) is a hypercatabolic state that promotes branched-chain amino acid (BCAA) catabolic task within the heart and skeletal muscle mass and reduces protein synthesis in the liver. Consequently, plasma free fragrant proteins (AAAs) are increased. We investigated the prognostic worth of the BCAA/AAA ratio (Fischer's proportion, FR) in patients with HF. TECHNIQUES We enrolled 157 consecutive patients hospitalized for worsening HF (81 men, 76 women; mean ± SD age 75 ± 14