Relationship of pathological phenotypes of body composition with adverse outcomes in elderly patients with chronic heart failure: opportunities for bioimpedance analysis

Introduction. Body structure abnormalities such as sarcopenia, sarcopenic obesity, and cachexia can play a key role in the development and progression of chronic heart failure (CHF). However, diagnosis of these conditions is challenging due to the lack of unified approaches to their definition. Previously proposed algorithms for identifying cachexia and sarcopenia in elderly patients are difficult to apply in clinical practice. Therefore, noninvasive body composition assessment in elderly patients with CHF, such as bioelectrical impedance analysis (BIA), is becoming relevant.

Aim: To determine the most frequent pathological phenotypes of body composition in elderly patients with CHF and establish their relationship with adverse disease outcomes.

Material and Methods. The prospective observational study included 250 patients (median age 83.0 [77.0-86.0] years) consecutively hospitalized in a multidisciplinary hospital for CHF decompensated. To assess body composition, a bioinformatics analyzer (BIA) (ABC-01 Medass analyzer, Russia) was performed on days 5-7 of hospitalization. According to the results, patients were divided into five body composition phenotypes: normal, obese, sarcopenic obesity (according to ESPEN/EASO 2022 criteria), sarcopenia (according to EWGSOP2 criteria), and cachexia (according to Ballyuzek MF, 2015 criteria). To study the prognostic significance of body composition abnormalities, a composite endpoint was assessed, including all-cause mortality and recurrent hospitalizations for CHF within 12 months.

Results. When analyzing body composition phenotypes according to BIA in elderly patients with CHF, the most common phenotype was obesity (48.0%, n = 120), less common were sarcopenic obesity (24.0%, n = 60), sarcopenia (6.0%, n = 15), and cachexia (2.0%, n = 5). Depending on body composition phenotypes, patients did not differ in left ventricular ejection fraction; a predominantly preserved ejection fraction was observed in all groups. Patients with cachexia, sarcopenia, and sarcopenic obesity were characterized by lower exercise tolerance, NYHA functional class III-IV, and a more severe stage of circulatory failure. The presence of sarcopenic obesity or sarcopenia increases the risk of the combined primary endpoint by 2.3 times (OR 2.3; 95% CI 1.2-4.4, p < 0.05) and in-hospital mortality by 2.9 times (OR 2.9; 95% CI 1.4-6.4, p < 0.05).

Conclusion. Muscle mass has a protective effect in elderly patients with CHF, whereas sarcopenic obesity and sarcopenia are associated with worse outcomes. Bioimpedance analysis of body composition is relatively simple and accurate in this patient cohort and allows for the detection of dual pathology in patients with CHF: hyperhydration typical of CHF decompensation and associated signs of progressive sarcopenia and cellular dysfunction.

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