Author + information
- Received March 18, 2020
- Revision received July 21, 2020
- Accepted July 23, 2020
- Published online September 16, 2020.
- Senthil Selvaraj, MD, MAa,b,
- Jessica Kim, BSa,b,
- Bilal A. Ansari, MDa,
- Lei Zhao, MD, PhDc,
- Mary Ellen Cvijic, PhDc,
- Matthew Fronheiser, PhDc,
- Jagan Mohan-Rao Vanjarapu, MDa,
- Anupam A. Kumar, MDd,
- Arpita Suri, MDa,
- Sowjanya Yenigalla, MDa,
- Vaibhav Satija, MDa,
- Armghan Haider Ans, MDa,
- Offdan Narvaez-Guerra, MDa,
- Karela Herrera-Enriquez, MDa,
- Mary Jo Obeid, MD, MPHa,
- Jonathan J. Lee, BAa,b,
- Qasim Jehangir, MDa,
- Dietmar A. Seiffert, MDc,
- Bruce D. Car, PhDc,
- David A. Gordon, PhDc and
- Julio A. Chirinos, MD, PhDa,b,e,∗ ()
- aHospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- bUniversity of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- cBristol-Myers Squibb Company, Lawrenceville, New Jersey
- dVanderbilt University Medical Center, Nashville, Tennessee
- eCorporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania
- ↵∗Address for correspondence:
Dr. Julio A. Chirinos, South Tower, Rm. 11–138, Perelman Center for Advanced Medicine, 3400 Civic Center Blvd. Philadelphia, Pennsylvania 19104.
Objectives The purpose of this study was to determine the relationship between body composition, N-terminal B-type natriuretic peptide (NT-proBNP) levels, and heart failure (HF) phenotypes and outcomes.
Background Abnormalities in body composition can influence metabolic dysfunction and HF severity; however, data assessing fat distribution and skeletal muscle (SM) size in HF with reduced (HFrEF) and preserved EF (HFpEF) are limited. Further, whether NPs relate more closely to axial muscle mass than measures of adiposity is not well studied.
Methods We studied 572 adults without HF (n = 367), with HFrEF (n = 113), or with HFpEF (n = 92). Cardiac magnetic resonance was used to assess subcutaneous and visceral abdominal fat, paracardial fat, and axial SM size. We measured NT-proBNP in 334 participants. We used Cox regression to analyze the relationship between body composition and mortality.
Results Compared with controls, pericardial and subcutaneous fat thickness were significantly increased in HFpEF, whereas patients with HFrEF had reduced axial SM size after adjusting for age, sex, race, and body height (p < 0.05 for comparisons). Lower axial SM size, but not fat, was significantly predictive of death in unadjusted (standardized hazard ratio: 0.63; p < 0.0001) and multivariable-adjusted analyses (standardized hazard ratio = 0.72; p = 0.0007). NT-proBNP levels more closely related to lower axial SM rather than fat distribution or body mass index (BMI) in network analysis, and when simultaneously assessed, only SM (p = 0.0002) but not BMI (p = 0.18) was associated with NT-proBNP. However, both NT-proBNP and axial SM mass were independently predictive of death (p < 0.05).
Conclusions HFpEF and HFrEF have distinct abnormalities in body composition. Reduced axial SM, but not fat, independently predicts mortality. Greater axial SM more closely associates with lower NT-proBNP rather than adiposity. Lower NT-proBNP levels in HFpEF compared with HFrEF relate more closely to muscle mass rather than obesity.
This study was supported by National Institutes of Health (NIH) grants R01 HL 121510–01A1 (Dr. Chirinos), 5-R21-AG-043802–02 (Dr. Chirinos), and a VISN-4 research grant from the department of Veterans Affairs (Dr. Chirinos). NT-proBNP measurements were supported by a research grant from Bristol-Myers Squibb. Dr. Selvaraj has received research grant support the National Institutes of Health (Training Grant 5-T32HL007843–23), the Doris Duke Charitable Foundation (Physician Scientist Fellowship Award 2020061), the Measey Foundation, Institute for Translational Medicine and Therapeutics (Junior Investigator Preliminary/Feasibility Grant Program award), and the American Society of Nuclear Cardiology (Institute for the Advancement of Nuclear Cardiology award). Dr. Chirinos has been supported by NIH grants R01-HL 121510–01A1, R61-HL-146390, R01-AG058969, 1R01-HL104106, P01-HL094307, R03-HL146874–01, and R56-HL136730; has received consulting honoraria from Sanifit, Microsoft, Fukuda-Denshi, Bristol-Myers Squibb, OPKO Healthcare, Ironwood Pharmaceuticals, Pfizer, Akros Pharma, Merck, Edwards Lifesciences, Bayer, and JNJ and has received research grants from the NIH, Microsoft, Fukuda-Denshi, and Bristol-Myers Squibb and has been named as inventor in a UPenn patent for the use of inorganic nitrates/nitrites for the treatment of heart failure and preserved ejection fraction and a patent application for the use of novel neo-epitope biomarkers of tissue fibrosis in heart failure. All other authors have reported that they have no relationships relevant to the contents of the paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Imaging author instructions page.
- Received March 18, 2020.
- Revision received July 21, 2020.
- Accepted July 23, 2020.
- 2020 American College of Cardiology Foundation
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