Body composition changes assessment by bioelectrical impedance vectorial analysis in right heart failure and left heart failure.

BACKGROUND: Heart Failure (HF) patients developed changes in body composition as overhydration, muscle-skeletal wear and cardiac cachexia (CC). The possible factors involved in the development of CC in Right Heart Failure (RHF) patients are venous congestion, nutrient malabsorption. However, in HF, the overhydration obscure the loss of fat-free mass and difficult the body composition assessment. Bioelectrical impedance vectorial analysis (BIVA) is a method validated and used for hydration status and body composition assessment in HF. The aim of this study was to investigate the body compositions changes assessment by BIVA in the subjects with and without RHF and evaluate the risk factors for devolvement CC in HF subjects. MATERIAL AND METHODS: Prospective cohort study. Subjects with confirmed diagnoses of HF, >18 years old without CC according to BIVA criteria were included. Subjects with congenital heart disease, cancer, HIV, and end-stage renal disease were excluded. Body composition was an assessment by BIVA. 288 HF patients were evaluated. RHF subjects had an impedance vector reduction (9.26 dR/H and -1.92 dXc/H, T2=14.9, D = 0.45, p<0.001), while subjects without RHF no-showed statistically significant changes (7.57 dR/H and 0.72 dXc/H, T2=3, D = 0.17, p = 0.200). The risks factors to development CC were age, RHF, phase angle < 5°, total body water were risks factors while handgrip strength was a protector factor. CONCLUSIONS: RHF has greater disturbances in body composition and is a risk factor to development CC.

Dietary intake of fatty acids and its relationship with FEV1/FVC in patients with chronic obstructive pulmonary disease.

BACKGROUND & AIMS: The deterioration of pulmonary function has been associated with increased levels of systemic inflammation that can be stimulated by consumption of saturated fatty acids and trans fats. We hypothesized that fatty acids intake impact on pulmonary function. However, evidence about the impact of different types of fatty acids on pulmonary function in patients with chronic obstructive pulmonary disease (COPD) is limited and heterogeneous. The aim of this study was to evaluate the association between intake of fatty acids and pulmonary function in patients with COPD. METHODS: Cross sectional study of patients diagnosed with COPD. The relationship between consumption of fatty acids and the FEV1/FVC ratio obtained by spirometry was assessed. Patients with exacerbations during the prior 2 months, diagnosis of asthma or administration of a dietary supplement were excluded. RESULTS: A simple linear regression showed that for each gram of carbohydrates and total l fatty acids intake, the FEV1/FVC ratio decreased -0.03 ml (ß: -0.03, 95% CI -0.06 to -0.01, p = 0.008) and -0.009 ml (ß: -0.00, 95% CI -0.02 to 0.00, p = 0.031) respectively. Pentadecanoic acid (C15:0) was associated with an increase of 0.47 ml in the FEV1/FVC ratio for each milligram intake (ß: 0.47, 95% CI 0.04 to 0.91, p = 0.031). Subsequently, when adjusted for calories intake, an increase of 0.53 ml was observed in the FEV1/FVC for each milligram of C15:0 fatty acid intake (ß:0.53, 95% CI 0.09 to 0.97, p = 0.018). CONCLUSION: A positive association was observed between pentadecanoic acid and the FEV1/FVC ratio with a beneficial effect on patients with COPD.

Right Heart Failure as a Risk for Stroke in Patients with Chronic Obstructive Pulmonary Disease: A Case-Control Study.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory condition characterized by complex lesions of the lungs and other organs as well as a progressive obstruction of the airway. In COPD patients, heart failure (HF) is associated with worse conditions such as inflammation, arterial stiffness, and increased risk mortality. However, the association of HF, COPD, and stroke are unclear; the examination of the role of HF, especially right HF, about increased risk of stroke in COPD patients has not been studied. We aimed to determine if right HF is a risk factor for stroke in patients with COPD. MATERIALS AND METHODS: A case-control study of patients with COPD was carried out. The cases were defined as COPD patients with ischemic stroke and control COPD patients without stroke. RESULTS: A total of 162 patients with COPD were analyzed: COPD with stroke (n = 35) and COPD alone (n = 127). COPD patients with right HF were at a greater risk of stroke compared with patients without right HF (odds ratio 3.03, 95% confidence interval 1.13-10.12, p = .044) adjusted for confounding factors. CONCLUSIONS: Right HF is an independent risk factor for stroke, probably because of cerebrovascular stasis secondary to congestion of the superior vena cava.

Association of cardiac cachexia and atrial fibrillation in heart failure patients.

BACKGROUND: Cachexia is a common complication in patients with advanced heart failure (HF) associated with inflammatory response activation. Atrial fibrillation (AF) is the most frequent arrhythmia (26%), probably both exacerbate the cardiac cachexia (CC). OBJECTIVES: Evaluate the association of cardiac cachexia and atrial fibrillation in heart failure patients. MATERIAL AND METHODS: In a case control study, CC was diagnosed by electrical bioimpedance with vectorial analysis (BIVA). Subjects with congenital heart disease, cancer, HIV, drug use and other causes than HF were excluded. RESULTS: Of the 359 subjects analyzed (men: 52.9%) median age 65years (55-74). Those with CC were older [72 (61-67)] vs. without [62 (52-70) years old, p<0.01]. During follow-up 47.8% of subjects developed CC and 17.27% AF, this was significantly more frequent in cachectic patients CC (23% vs 12.11%, OR: 2.17, 95% CI: 1.19-4.01, p=0.006). Subjects, with AF had lower left ventricular ejection fraction (25.49±12.96 vs. 32.01±15.02, p=0.08), lower posterior wall thickness (10.03±2.12 vs. 11.00±2.47, p=0.007), larger diameter of the left atrium (49.87±9.84 vs. 42.66±7.56, p<0.001), and a higher prevalence of CC (85.42% vs. 69.77%, p=0.028). The 50.58% of was in NYHA class I. In NYHA III, 22.95% were in AF vs. 12.10% with not AF (p=0.027). CONCLUSION: The frequent coexistence of CC and AF as HF complications indicate greater severity of HF, regardless of its type of HF.

Cachexia assessed by bioimpedance vector analysis as a prognostic indicator in chronic stable heart failure patients.

BACKGROUND: This study explored whether the cachectic state assessed by bioimpedance vector analysis provides additional prognostic information about mortality from all causes. METHODS: We included 519 consecutive patients with stable chronic heart failure (mean age 62.5 ± 16.4 y; 286 males). Cachexia was identified in those subjects who fell outside the right lower quadrant of the reference curve of 95% on the resistance/reactance graph [bioelectrical impedance vectorial analysis (BIVA)-cachexia]. Clinical, anthropometric, and biochemical data were also evaluated. RESULTS: Patients with BIVA-cachexia (n = 196, 37.8%) were older and had significantly lower ejection fraction, handgrip strength, serum albumin, total cholesterol, and triglycerides. The frequency of patients with body mass index < 20, decreased muscle strength, hypoalbuminemia, anemia, anorexia, New York Heart Association functional classes III/IV and edema, as well as creatinine levels, resistance/height, and impedance index was significantly higher in the cachexia group. During 29 ± 11 mo of follow-up, 39 (19.9%) patients with BIVA-cachexia and 38 (11.7%) patients without BIVA-cachexia (P < 0.0001) died. CONCLUSIONS: The cachectic state is an independent risk factor for mortality in chronic heart failure patients. BIVA could represent a valuable tool to assess presence of cachexia as changes in body cell mass in heart failure patients because provide information additional to weight loss.

The effect of L-arginine and citrulline on endothelial function in patients in heart failure with preserved ejection fraction.

BACKGROUND: To evaluate the effect of the amino acids L-arginine and citrulline on endothelial function in patients in stable diastolic and right heart failure using photoplethysmography. METHODS: Thirty patients from the Heart Failure Clinic of the Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" underwent photoplethysmography using the hyperemia technique. Index finger flow was assessed at baseline and after ischemia every 30 s by maximum amplitude time (MAT), total time of the curve (TT) and the index of the two (MAT/TT < 30 = normal) before and after the administration of L-arginine (8 g/day in two doses, n = 15) or citrulline (3 g/day in one dose, n = 15) for 60 days in addition to optimal pharmacological treatment. RESULTS: There were no statistically significant differences between the two groups at baseline. After the intervention, the MAT/TT index of all patients normalized in each evaluation period with statistically significant differences. Basal L-arginine group = 38.75 ± 11.52, final 23.32 ± 6.08, p = 0.007 and basal citrulline group = 41.4 ± 13.47, final 23.65 ± 6.74, p = 0.007 at 60-90 s. Post-ischemia: basal L-arginine 36.60 ± 11.51, final 18.81 ± 15.13, p = 0.004 and basal citrulline = 49.51 ± 15.17, final 27.13 ± 7.87, p = 0.003. CONCLUSIONS: The administration of L-arginine and citrulline has a beneficial effect on endothelial function as shown by the normalized MAT/TT index. It probably improves systemic and pulmonary hemodynamics, which could help in the treatment of diastolic heart failure.

Prognostic value of cardiac troponin T elevation is independent of renal function and clinical findings in heart failure patients.

BACKGROUND: The aim of this study is to determine the prevalence and prognostic value of elevated cardiac troponin (cTnT) and its association with clinical characteristics according to renal function status in patients with stable heart failure. METHODS: In a prospective observational study, 152 consecutive patients from the Heart Failure Clinic of the INCMNSZ were followed for a period of 42 months. All underwent clinical evaluation, echocardiography, and determination of body composition by electric bioimpedance to identify hypervolemia. Concentrations of cTnT were quantified by immunoassay with electrochemoluminescence and > or = 0.02 ng/mL levels were considered elevated. Also glomerular filtration rate (eGFR) was estimated using the Cockcroft-Gault equation. RESULTS: Elevated cTnT was significantly associated with increased all-cause mortality in the observational period even after adjusting for eGFR < 60 mL/min/1.73 m2 and clinical findings such as hypertension, functional class, loop diuretics, angiotensin converting enzyme inhibitors, pulmonary pressure and hypervolemia in Cox regression analysis with a hazard ratio of 4.58 (95% confidence interval: 1.84-11.45). CONCLUSIONS: Heart failure patients with elevated cardiac-specific troponin T are at increased risk of death independently of the presence of chronic kidney disease.