Body Composition, Natriuretic Peptides, and Adverse Outcomes in Heart Failure With Preserved and Reduced Ejection Fraction.

Autor:	Selvaraj S; Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA., Kim J; Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA., Ansari BA; Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA., Zhao L; Bristol-Myers Squibb Company, Lawrenceville, New Jersey, USA., Cvijic ME; Bristol-Myers Squibb Company, Lawrenceville, New Jersey, USA., Fronheiser M; Bristol-Myers Squibb Company, Lawrenceville, New Jersey, USA., Mohan-Rao Vanjarapu J; Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA., Kumar AA; Vanderbilt University Medical Center, Nashville, Tennessee, USA., Suri A; Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA., Yenigalla S; Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA., Satija V; Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA., Ans AH; Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA., Narvaez-Guerra O; Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA., Herrera-Enriquez K; Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA., Obeid MJ; Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA., Lee JJ; Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA., Jehangir Q; Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA., Seiffert DA; Bristol-Myers Squibb Company, Lawrenceville, New Jersey, USA., Car BD; Bristol-Myers Squibb Company, Lawrenceville, New Jersey, USA., Gordon DA; Bristol-Myers Squibb Company, Lawrenceville, New Jersey, USA., Chirinos JA; Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA; Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania, USA. Electronic address: julio.chirinos@uphs.upenn.edu.
Jazyk:	angličtina
Zdroj:	JACC. Cardiovascular imaging [JACC Cardiovasc Imaging] 2021 Jan; Vol. 14 (1), pp. 203-215. Date of Electronic Publication: 2020 Sep 16.
DOI:	10.1016/j.jcmg.2020.07.022
Abstrakt:	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. Competing Interests: Author Disclosures 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. (Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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