Scientific letter
Body composition in acute heart failure patients: Relationship with gender and left ventricular ejection fraction
Composición corporal en pacientes con insuficiencia cardíaca aguda; relación con el género y la fracción de eyección ventricular izquierda
a Servicio de Cardiología y Unidad Coronaria, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Santiago de Compostela, A Coruña, Spain
b Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), SERGAS, Santiago de Compostela, A Coruña, Spain
c CIBER de Enfermedades Cardiovasculares, Spain
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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" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Box plot of visceral fat in men and female patients. (B) Pearson correlation between LVEF and visceral adiposity in male (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.383; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>83). (C) Pearson correlation between LVEF and visceral adiposity in females (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.056; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.659; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>51).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">1</span></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"><span class="elsevierStyleSup">2</span></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"><span class="elsevierStyleSup">3</span></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"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">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.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Patients were classified based on left ventricular ejection fraction (LVEF) according to the recent European Society of Cardiology Guidelines.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></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.</p><p id="par0020" class="elsevierStylePara elsevierViewall">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.</p><p id="par0025" class="elsevierStylePara elsevierViewall">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 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.005). There were 13 female patients with LVEF<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>40%, 12 with LVEF 40–49% and 27 with LVEF<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>50%; we did not find differences in body composition in female patients.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">After testing the association between LVEF and visceral adiposity, our results showed that in males there was a positive correlation between these two variables (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.383; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001) as <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B shows. Similar association was found regarding total fat mass (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.271; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.013) and BMI (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.193; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>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 (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.056; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.659) is shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Also there was a negative correlation between proBNP visceral adiposity and (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleInf">s</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−0.365; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.001) and between proBNP and BMI (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleInf">s</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−0.285; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.007) in males. Those associations were not observed in females.</p><p id="par0040" class="elsevierStylePara elsevierViewall">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.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Our results could be interpreted as reflections of the underlying sex disparities in pathophysiology and natural development of heart failure over time.</p><p id="par0050" class="elsevierStylePara elsevierViewall">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.</p><p id="par0055" class="elsevierStylePara elsevierViewall">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.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => 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" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Box plot of visceral fat in men and female patients. (B) Pearson correlation between LVEF and visceral adiposity in male (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.383; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>83). (C) Pearson correlation between LVEF and visceral adiposity in females (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.056; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.659; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>51).</p>" ] ] ] "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. Larson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa020245" "Revista" => array:7 [ "tituloSerie" => "N Engl J Med" "fecha" => "2002" "volumen" => "347" "paginaInicial" => "305" "paginaFinal" => "313" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12151467" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0002939414007156" "estado" => "S300" "issn" => "00029394" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Body mass index in acute heart failure: association with clinical profile, therapeutic management and in-hospital outcome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Parissis" 1 => "D. Farmakis" 2 => "N. Kadoglou" 3 => "I. Ikonomidis" 4 => "E. Fountoulaki" 5 => "E. Hatziagelaki" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ejhf.489" "Revista" => array:6 [ "tituloSerie" => "Eur J Heart Fail" "fecha" => "2016" "volumen" => "18" "paginaInicial" => "298" "paginaFinal" => "305" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26817848" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of two bioelectrical impedance devices and dual-energy X-ray absorptiometry to evaluate body composition in heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "F.D. Alves" 1 => "G.C. Souza" 2 => "A. Biolo" 3 => "N. 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" => "<p id="par0060" class="elsevierStylePara elsevierViewall">We would like to acknowledge the patients’ participation. This study was supported by <span class="elsevierStyleGrantSponsor" id="gs1">Complejo Hospitalario Universitario de Santiago de Compostela</span> (Santiago de Compostela, Spain), <span class="elsevierStyleGrantSponsor" id="gs2">Red de Investigación Cardiovascular (RIC)</span> (<span class="elsevierStyleGrantNumber" refid="gs2">RD12/0042/0039</span>) <span class="elsevierStyleGrantSponsor" id="gs3">Fondo de Investigaciones Sanitarias</span> (<span class="elsevierStyleGrantNumber" refid="gs3">PIE13/00024</span>) from Plan Estatal de I+D+I 2013–2016 and cofounded by <span class="elsevierStyleGrantSponsor" id="gs4">ISCIII-Subdirección General de Evaluación y Fomento de la Investigación el Fondo Europeo de Desarrollo Regional (FEDER)</span>.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015100000007/v1_201810260641/S2387020618303668/v1_201810260641/en/main.assets" "Apartado" => array:4 [ "identificador" => "43311" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015100000007/v1_201810260641/S2387020618303668/v1_201810260641/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020618303668?idApp=UINPBA00004N" ]
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