ArticleJACC. Cardiovascular imaging2021
Body Composition, Natriuretic Peptides, and Adverse Outcomes in Heart Failure With Preserved and Reduced Ejection Fraction.
Article in JACC. Cardiovascular imaging, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 44 papers, 4 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
44 citing papers in PubMed, 4 syntheses or guidelines pooled it, 69 citations in OpenAlex.
- Comparing exercise modalities during caloric restriction: a systematic review and network meta-analysis on body composition.Frontiers in nutrition · 2025Pooled it
- Comparison of the impact of exercise training combined with dietary intervention vs. dietary intervention alone in patients with obesity and metabolic syndrome-a systematic review.Frontiers in nutrition · 2025Pooled it
- Effects of Different Exercises Combined with Different Dietary Interventions on Body Composition: A Systematic Review and Network Meta-Analysis.Nutrients · 2024Pooled it
- A systematic review exploring the significance of measuring epicardial fat thickness in correlation to B-type natriuretic peptide levels as prognostic and diagnostic markers in patients with or at risk of heart failure.Heart failure reviews · 2022Pooled it
- Targeted Metabolomic Profiling of Dapagliflozin in Heart Failure With Preserved Ejection Fraction: The PRESERVED-HF Trial.JACC. Heart failure · 2024Trial
- A Randomized, Controlled Trial of Resistance Training Added to Caloric Restriction Plus Aerobic Exercise Training in Obese Heart Failure With Preserved Ejection Fraction.Circulation. Heart failure · 2023Trial
- Adipose Tissue, Natriuretic Peptides, and HFpEF: Clinical Implications of the Obesity Paradox.Biomedicines · 2026Review
- Diabetes-related differences in body composition and their prognostic value among patients with heart failure and preserved ejection fraction: a cardiac-MRI-based study.Cardiovascular diabetology · 2026Article
- Redefining heart failure subtypes according to skeletal muscle mass.Nature reviews. Cardiology · 2026Article
- The fat-heart entanglement and the role of 'osteopontin mechanics' in cardiometabolic senescence.European journal of clinical investigation · 2026Review
- Application and evidence gaps of sarcopenia diagnostic criteria in patients with heart failure: a scoping review.Frontiers in medicine · 2026Review
- Rationale and Design of the HeartShare/AMP-HF Deep Phenotyping Study to Improve Understanding of Heart Failure With Preserved Ejection Fraction.JACC. Heart failure · 2025Review
- Limited Ventilatory Reserve During Exercise in Heart Failure with Preserved Ejection Fraction: Impact of Lung Size and Adiposity.CHEST pulmonary · 2025Article
- Evaluation of potential mechanisms for skeletal muscle mass recovery early after left ventricular assist device implantation.JHLT open · 2025Article
- Heart failure and obesity: Translational approaches and therapeutic perspectives. A scientific statement of the Heart Failure Association of the ESC.European journal of heart failure · 2025Article
- Review
- Association of body composition with left ventricular remodeling and outcomes in diabetic heart failure with reduced ejection fraction: assessment of sarcopenic obesity using cardiac MRI.Cardiovascular diabetology · 2025Article
- Article
- Increased epicardial adipose tissue is associated with left ventricular reverse remodeling in dilated cardiomyopathy.Cardiovascular diabetology · 2024Article
- Cardiac MRI Pectoralis Muscle Thickness as a Measure of Sarcopenia: Prognostic Significance, Interreader Agreement, and Physiologic Correlation.Radiology. Cardiothoracic imaging · 2024Article
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Authors and funding
21 authors at 3 institutions in 1 country.
Funding
Abstract
objectivesThe 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.
backgroundAbnormalities 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.
methodsWe 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.
resultsCompared 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).
conclusionsHFpEF 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.
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