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MULTIMODAL NUTRITIONAL RISK SCREENING IN HEART FAILURE PATIENTS
Session:
Comunicações Orais - Sessão 04 - Reabilitação cardíaca
Speaker:
Bruno Bragança
Congress:
CPC 2024
Topic:
J. Preventive Cardiology
Theme:
29. Rehabilitation and Sports Cardiology
Subtheme:
29.2 Cardiovascular Rehabilitation
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Bruno Bragança; Mauro Moreira; Rafaela G. Lopes; Inês G. Campos; Ricardo Barbosa; Patrícia Silva; Sónia Apolinário; Licínia Aguiar; Magda Silva; Aurora Andrade
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Background:</span></strong><span style="font-family:"Arial",sans-serif"> The heart failure (HF) trajectory evolves with the development of body composition abnormalities and malnutrition. Interventions targeting nutritional disorders may improve the prognosis of HF patients; nonetheless, they remain overlooked due to clinical unawareness and lack of standardized diagnostic tools<sup>1</sup>. Bioimpedance spectroscopy (BIS) through the estimation of body composition has been recognized as a valuable tool in diagnosing nutritional disorders, but more data is needed in the HF population.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Methods: </span></strong><span style="font-family:"Arial",sans-serif">Patients followed in an HF clinic were recruited for body composition evaluation by BIS (InBody BWA 2.0). BIS variables were correlated with other clinical and biochemical parameters. Gender-specific appendicular skeletal muscle index (ASMI) and geriatric nutrition risk index (GRNI) were used to diagnose sarcopenia and malnutrition, respectively<sup>2,3</sup>. Thirteen healthy subjects were recruited for comparison purposes. Regression models were used to explore associations between baseline characteristics, body composition, and 6-month composite outcome that included all-cause death, hospitalization/unplanned visit, or up-titration of diuretics due to HF. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Results: </span></strong><span style="font-family:"Arial",sans-serif">Fifty-six HF patients under guideline-medical therapy for HF with reduced ejection fraction (HFrEF) were included. Mean age of 65±12 years; 68% males; 52% non-ischemic HFrEF; left ventricular ejection fraction (LVEF) 34±13%; 38% diabetes. Compared with controls, HF patients showed body composition abnormalities: water (52.0±6.6 vs 61.9±5.5%; <em>p<0.001</em>), fat mass (29.3±9.0 vs 15.4±7.5%; <em>p<0.001</em>); protein (13.7±1.8 vs 16.5±1.6%; <em>p<0.001</em>) and minerals (5.1±0.7 vs 6.1±0.5%; <em>p<0.001</em>). HF patients had ASMI 7.47±1.3kg/m<sup>2</sup> (14.3% had sarcopenia); body mass index 26.9±4.1kg/m<sup>2</sup> (BMI, 25% with obesity); and GNRI score 107±9 (15.8% with malnutrition). NT-proBNP was negatively correlated with ASMI (r=-0.376; p=0.009) but not with GNRI (r=<em>-0.466; p=0.051)</em>. In contrast to obesity and GNRI-estimated malnutrition, sarcopenia was associated with the occurrence of the composite outcome (crude HR 17.9±16.0, <em>p</em>=0.001; adjusted HR 36.5±46.5, <em>p</em>=0.005). </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Conclusions:</span></strong><span style="font-family:"Arial",sans-serif"> Malnutrition and body composition abnormalities are prevalent in HF. BIS is a reliable tool in diagnosing sarcopenia that carries an unfavorable prognosis. Further studies are needed to address the impact of diagnostic strategies and specific interventions targeting nutrition disorders in HF patients.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:8.0pt"><span style="font-family:"Arial",sans-serif">1 – S. Mirzai, et al., Circulation Heart Failure, 2022 | 2 – S. Carbone, et al. Curr Probl Cardio, 2020 | 3 – E. Driggin, et al. JACC, 2022 </span></span></span></span></p>
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