Author + information
- Received March 8, 2013
- Revision received May 9, 2013
- Accepted June 11, 2013
- Published online October 29, 2013.
- Vojtech Melenovsky, MD, PhD∗,†∗ (, )
- Martin Kotrc, MD∗,
- Barry A. Borlaug, MD†,
- Tomas Marek, MD, PhD∗,
- Jan Kovar, PhD‡,
- Ivan Malek, MD, PhD∗ and
- Josef Kautzner, MD, PhD∗
- ∗Department of Cardiology, Institute of Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
- †Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota
- ‡Center of Experimental Medicine, Institute of Clinical and Experimental Medicine (IKEM), Prague, Czech Republic.
- ↵∗Reprint requests and correspondence to:
Dr. Vojtech Melenovsky, Department of Cardiology, Institute of Clinical and Experimental Medicine, IKEM, Videnska 1958/9, Prague 4, 140 28, Czech Republic.
Objectives This study sought to examine the relationships between right ventricular (RV) function, body composition, and prognosis in patients with advanced heart failure (HF).
Background Previous studies investigating HF-related cachexia have not examined the impact of RV function on body composition. We hypothesized that RV dysfunction is linked to weight loss, abnormal body composition, and worsened prognosis in advanced HF.
Methods Subjects with advanced HF (n = 408) underwent prospective assessment of body composition (skinfold thickness, dual-energy X-ray absorptiometry), comprehensive echocardiography, and blood testing. Subjects were followed up for adverse events (defined as death, transplantation, or circulatory assist device).
Results Subjects with RV dysfunction (51%) had lower body mass index, lower fat mass index, and were more likely to display cachexia (19%). The extent of RV dysfunction correlated with greater antecedent weight loss and a lower fat/lean body mass ratio. Over a median follow-up of 541 days, there were 150 events (37%). Risk of event was greater in subjects with RV dysfunction (hazard ratio: 3.09 [95% confidence interval (CI): 2.18 to 4.45]) and cachexia (hazard ratio: 2.90 [95% CI: 2.00 to 4.12]) in univariate and multivariate analyses. Increased body mass index was associated with a lower event rate (HR per kg/m2: 0.92 [95% CI: 0.88 to 0.96]), and this protection was mediated by a higher fat mass (0.91 [95% CI: 0.87 to 0.96]) but not a fat-free mass index (0.97 [95% CI: 0.92 to 1.03]).
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.
This work was supported by a project of the Ministry of Health for Development of Research Organization 00023001 (IKEM, institutional support), by the EU Operational Program Prague–Competitiveness project CEVKOON (CZ.2.16/3.1.00/22126), by grant MSMT LK12052 (project KONTAKT II), and by grant IGA MZCR NT14050-3/2013. The scholarship of Dr. Melenovsky at the Mayo Clinic is supported by the Fulbright Foundation. Dr. Kautzner is a member of advisory board for GE Healthcare; has received honoraria for advisory board membership from Biosense Webster, Boston Scientific, St. Jude Medical; and has received honoraria for lectures from Biotronik, Biosense Webster, Boston Scientific, Medtronic, Hansen Medical, and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 8, 2013.
- Revision received May 9, 2013.
- Accepted June 11, 2013.
- 2013 American College of Cardiology Foundation