Abstract 15863: Relationships Between Right Ventricular Function, Body Composition and Prognosis in Advanced Heart Failure
Objectives: To examine previously unstudied relationships between right ventricular (RV) function, body composition and prognosis in patients with heart failure (HF).
Methods: Subjects with advanced HF (n=408) underwent prospective assessment of body composition (skinfold thickness, DEXA), echocardiography and hemodynamics. Cachexia was defined by body weight loss >5% in 6 months and laboratory abnormality (albumin, hemoglobin or CRP). Subjects were followed for adverse events defined as death, transplantation or VAD.
Results: Subjects with RV dysfunction (51%) had lower body mass index (BMI), lower fat mass index and were more likely to display cachexia (19%). The extent of RV dysfunction correlated with greater antecedent weight loss and lower fat/lean body mass ratio (DEXA). Cachectic subjects displayed greater RV dilatation and dysfunction, while prevalence of tricuspid regurgitation, pulmonary hypertension and right atrial pressures were similar to non-cachectic subjects.Only RV, but not LV characteristics, discriminated between cachectic and non-cachetic patients. Cachectic subjects had lower leptin and markedly higher adiponectin and BNP (despite similar hemodynamics). Over a median follow-up of 541 days, there were 150 events (37%). Risk of event was greater in subjects with RV dysfunction (HR 3.09, 2.18-4.45) and cachexia (HR 2.90, 2.00-4.12) in both univariate and multivariate analysis (Fig. A). Increased BMI was associated with lower event rate (HR per kg.m-2: 0.92, 0.88-0.96) and this protection was mediated by higher fat mass (0.91, 0.87-0.96) but not fat-free mass index (0.97, 0.92-1.03) (Fig. B).
Conclusions: RV dysfunction and cardiac cachexia often coexist, have additive adverse impact and might be mechanistically interrelated. Wasting of fat but not of lean mass was predictive of adverse outcome, suggesting that fat loss is either a surrogate of enhanced catabolism or adipose tissue is cardioprotective in the context of HF.
- © 2013 by American Heart Association, Inc.