Body Composition in Heart Failure: A Magnetic Resonance Imaging and Dual X-Ray Absorptiometry Assessment in the UK
Javed Butler1, Francesco Fioretti2, Stefan D Anker3
1Baylor Scott & White Research Institute, Dallas, Texas, USA; University of Mississippi, Jackson, Mississippi, USA.
Insights
Heart failure patients exhibit increased visceral fat and adverse muscle changes like lower muscle volume and higher fat infiltration, not fully captured by BMI. Sarcopenia definitions vary, highlighting discrepancies in assessing body composition derangements in heart failure.
Area of Science:
- Cardiology
- Metabolic Health
- Musculoskeletal Health
Background:
- Body mass index (BMI) may not adequately represent metabolic and musculoskeletal abnormalities in heart failure (HF).
- Understanding body composition is crucial for managing HF patients.
- Advanced imaging techniques offer better insights into body composition than traditional measures.
Purpose of the Study:
- To compare body composition in heart failure (HF) patients versus matched controls.
- To analyze body composition differences among HF subtypes: reduced ejection fraction (HFrEF), mildly reduced ejection fraction (HFmrEF), and preserved ejection fraction (HFpEF).
Main Methods:
- Utilized UK Biobank Imaging Study data, matching 185 HF patients with 925 controls by age, sex, and BMI.
- Assessed whole-body magnetic resonance imaging (MRI) for visceral adipose tissue (VAT), liver fat, thigh fat-free muscle volume (MV), and muscle fat infiltration (MFI).
- Defined adverse muscle composition (AMC) as low MV and high MFI; used dual-energy x-ray absorptiometry (DXA) for total fat and lean mass.
Main Results:
- HF patients showed significantly higher VAT, MFI, and AMC, with lower MV compared to controls.
- Sarcopenia prevalence varied widely based on diagnostic criteria, indicating definition discrepancies.
- HF subtypes displayed distinct body composition profiles: HFmrEF had highest VAT/lowest MV, HFpEF had greater fat/MFI, and HFrEF had highest AMC/weakest grip strength.
Conclusions:
- Heart failure patients present with elevated visceral fat and adverse muscle changes, including reduced muscle volume and increased fat infiltration.
- Current sarcopenia definitions show substantial variability, complicating accurate diagnosis and assessment.
- Traditional anthropometric indices like BMI underestimate the extent of body composition abnormalities in heart failure.
Background:
Metabolic and musculoskeletal abnormalities in patients with heart failure (HF) may not be fully captured by body mass index.
Objectives:
Body composition was studied in participants with HF and matched control subjects in the UK Biobank Imaging Study, and findings were compared among those with HF with reduced ejection fraction, HF with mildly reduced ejection fraction, and HF with preserved ejection fraction.
Methods:
Participants with HF and available ejection fraction (n = 185) were matched 1:5 to age-, sex-, and body mass index-matched control subjects (n = 925). Whole-body magnetic resonance-quantified visceral adipose tissue (VAT), abdominal subcutaneous adipose tissue, liver fat, thigh fat-free muscle volume (MV), and muscle fat infiltration (MFI) were assessed. Personalized z-scores adjusted for sex and body size were derived. Adverse muscle composition (AMC) was defined as low MV z-score and high MFI. Dual-energy x-ray absorptiometry was used to measure total fat and appendicular lean mass.
Results:
Compared with control subjects, HF participants had higher VAT (z-score = 0.46 ± 1.1 vs 0.07 ± 1.0; P < 0.001), MFI (8.4 ± 2.3% vs 7.6 ± 2.0%; P < 0.001), and AMC (36% vs 17%; P < 0.001) and lower MV (z-score = -0.7 ± 1.0 vs -0.1 ± 0.9; P < 0.001). Despite the muscle derangements identified by magnetic resonance imaging assessment, the prevalence of sarcopenia diagnosed using combined grip strength and dual-energy x-ray absorptiometry-derived lean mass parameters varied considerably depending on the criteria applied. Among HF subtypes, HF with mildly reduced ejection fraction showed the highest VAT and lowest MV, HF with preserved ejection fraction had greater fat and MFI, and HF with reduced ejection fraction had the greatest prevalence of AMC and the weakest grip strength.
Conclusions:
Participants with HF showed higher VAT and adverse muscle changes, with weaker grip strength. Sarcopenia prevalence varied substantially across definitions, reflecting substantial variability and discrepancies among current sarcopenia definitions and criteria. Traditional anthropometric indexes underestimate the burden of body composition derangements in HF.
