Body composition in acute heart failure patients: Relationship with gender and left ventricular ejection fraction

Agra-Bermejo, Rosa; Eiras, Sonia; Varela-Román, Alfonso

doi:10.1016/j.medcle.2017.12.038

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BUN, blood urea nitrogen; Cr, creatinine; CysC, cystatin C; AHF, acute heart failure; NGAL, neutrophil gelatinase-associated lipocalin; eGFR, estimated glomerular filtration rate." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Lluís Llauger, Javier Jacob, Òscar Miró" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Lluís" "apellidos" => "Llauger" ] 1 => array:2 [ "nombre" => "Javier" "apellidos" => "Jacob" ] 2 => array:2 [ "nombre" => "Òscar" "apellidos" => "Miró" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775318303099" "doi" => "10.1016/j.medcli.2018.05.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775318303099?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020618303322?idApp=UINPBA00004N" "url" => "/23870206/0000015100000007/v1_201810260641/S2387020618303322/v1_201810260641/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "Scientific letter" "titulo" => "Body composition in acute heart failure patients: Relationship with gender and left ventricular ejection fraction" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "291" "paginaFinal" => "292" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Rosa Agra-Bermejo, Sonia Eiras, Alfonso Varela-Román" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Rosa" "apellidos" => "Agra-Bermejo" "email" => array:1 [ 0 => "rosinagra@msn.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Sonia" "apellidos" => "Eiras" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "Alfonso" "apellidos" => "Varela-Román" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Cardiología y Unidad Coronaria, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Santiago de Compostela, A Coruña, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), SERGAS, Santiago de Compostela, A Coruña, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "CIBER de Enfermedades Cardiovasculares, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Composición corporal en pacientes con insuficiencia cardíaca aguda; relación con el género y la fracción de eyección ventricular izquierda" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2190 "Ancho" => 2928 "Tamanyo" => 244353 ] ] "descripcion" => array:1 [ "en" => "(A) Box plot of visceral fat in men and female patients. (B) Pearson correlation between LVEF and visceral adiposity in male (r=0.383; p<0.001; n=83). (C) Pearson correlation between LVEF and visceral adiposity in females (r=0.056; p=0.659; n=51)." ] ] ] "textoCompleto" => "Obesity was found to be a risk of heart failure (HF) and the obese state is also characterized by an increased visceral adiposity that leads to cardiac remodeling and consequently HF.<a class="elsevierStyleCrossRef" href="#bib0030">1</a> However, a paradoxical behavior is observed in patients who are suffering HF because the reduced visceral adiposity is related to the severity of the disease this phenomenon is called “obesity paradox”.<a class="elsevierStyleCrossRef" href="#bib0035">2</a> Nowadays the analysis of body composition by dual-energy X-ray absorptiometry (DEXA), better than the body mass index (BMI), is recommended in HF patients because it may distinguish the fat and lean mass composition and improves to understand the role of the body composition in HF patients.<a class="elsevierStyleCrossRef" href="#bib0040">3</a> Traditionally, a sexual dimorphism was described in obesity and some studies suggested that female HF patients had a distinct clinical presentation and better outcomes compared with male patients.<a class="elsevierStyleCrossRef" href="#bib0045">4</a>A retrospective and observational study of 135 admitted consecutively patients in the HF Unit of the Cardiology Department of our hospital between May 2014 and August 2015 with the diagnosis of de novo HF or decompensated chronic HF was carried out with the aim of examine the role of gender differential visceral adiposity in acute HF (AHF) patients.Patients were classified based on left ventricular ejection fraction (LVEF) according to the recent European Society of Cardiology Guidelines.<a class="elsevierStyleCrossRef" href="#bib0050">5</a> Blood samples were obtained for local laboratory analysis (pro-Brain natriuretic peptide, proBNP). BMI was calculated as the weight in kilograms divided by the square of the height in meters, based on data of one week after the discharge. One week after the discharge a body scan composition was measured by DEXA performed with an X-ray Densitometer. Scans were analyzed using the whole body fan beam method to determine lean and fat mass.There were 83 male and 52 female patients; men tended to be younger, smokers, diabetics and with higher frequency HF with ischemic reduced LVEF; contrary women were older, with hypertension and HF with preserved LVEF.In the male group, 53 patients had LVEF<40%, 12 had LVEF 40–49% and 18 had LVEF>50%. Those patients with LVEF<40% were characterized for having lowest BMI, lowest body fat mass (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A) and high proBNP levels (p<0.005). There were 13 female patients with LVEF<40%, 12 with LVEF 40–49% and 27 with LVEF>50%; we did not find differences in body composition in female patients.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>After testing the association between LVEF and visceral adiposity, our results showed that in males there was a positive correlation between these two variables (r=0.383; p<0.001) as <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B shows. Similar association was found regarding total fat mass (r=0.271; p=0.013) and BMI (r=0.193; p=0.063). However, in the females group, none of these associations were found. Thus, the absence of correlation between visceral adiposity and LVEF in females (r=0.056; p=0.659) is shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C.Also there was a negative correlation between proBNP visceral adiposity and (rs=−0.365; p=0.001) and between proBNP and BMI (rs=−0.285; p=0.007) in males. Those associations were not observed in females.In our study, we found a different body composition in AHF male and female patients; the group of male patients with reduced LVEF had less BMI, fat mass and visceral adipose tissue suggesting that the biological state of heart failure at admission is less advanced in women compared with men.Our results could be interpreted as reflections of the underlying sex disparities in pathophysiology and natural development of heart failure over time.Also the sex differences in adipose tissue distribution could be due to the cardioprotective effect of adiposity that counteracts in inflammatory and neurohormonal activation by binding and neutralizing deleterious substances and mediators that is present in men but not in women.In conclusion, the sexual dimorphism regarding fat mass composition and ventricular function in AHF patients could explain why the obesity paradox in HF patients is followed only in male sex; although further studies are needed to confirm our hypotheses." 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(C) Pearson correlation between LVEF and visceral adiposity in females (r=0.056; p=0.659; n=51)." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obesity and the risk of heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Kenchaiah" 1 => "J.C. Evans" 2 => "D. Levy" 3 => "P.W. Wilson" 4 => "E.J. Benjamin" 5 => "M.G. 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Clausell" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "J Hum Nutr Diet" "fecha" => "2014" "volumen" => "27" "paginaInicial" => "6328" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neurohormonal and clinical sex differences in heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Meyer" 1 => "P. van der Meer" 2 => "V.M. van Deursen" 3 => "T. Jaarsma" 4 => "D.J. van Veldhuisen" 5 => "M.H. van der Wal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/eht152" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2013" "volumen" => "34" "paginaInicial" => "2538" "paginaFinal" => "2547" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23666250" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Ponikowski" 1 => "A.A. Voors" 2 => "S.D. Anker" 3 => "H. Bueno" 4 => "J.G. Cleland" 5 => "A.J. Coats" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehw128" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2016" "volumen" => "37" "paginaInicial" => "2129" "paginaFinal" => "2200" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27206819" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack373587" "titulo" => "Acknowledgements" "texto" => "We would like to acknowledge the patients’ participation. This study was supported by Complejo Hospitalario Universitario de Santiago de Compostela (Santiago de Compostela, Spain), Red de Investigación Cardiovascular (RIC) (RD12/0042/0039) Fondo de Investigaciones Sanitarias (PIE13/00024) from Plan Estatal de I+D+I 2013–2016 and cofounded by ISCIII-Subdirección General de Evaluación y Fomento de la Investigación el Fondo Europeo de Desarrollo Regional (FEDER)." 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