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Meta-Analysis
. 2024 Feb;12(2):290-300.
doi: 10.1016/j.jchf.2023.06.013. Epub 2023 Jul 19.

The Metabolic Vulnerability Index: A Novel Marker for Mortality Prediction in Heart Failure

Katherine M Conners  1 , Joseph J Shearer  1 , Jungnam Joo  2 , Hoyoung Park  1 , Sheila M Manemann  3 , Alan T Remaley  4 , James D Otvos  4 , Margery A Connelly  5 , Maureen Sampson  6 , Suzette J Bielinski  3 , Anna Wolska  4 , Sarah Turecamo  1 , Véronique L Roger  7
Affiliations
Meta-Analysis

The Metabolic Vulnerability Index: A Novel Marker for Mortality Prediction in Heart Failure

Katherine M Conners et al. JACC Heart Fail. 2024 Feb.

Erratum in

  • Correction.
    [No authors listed] [No authors listed] JACC Heart Fail. 2024 Jun;12(6):1136-1140. doi: 10.1016/j.jchf.2024.04.004. JACC Heart Fail. 2024. PMID: 38839159 No abstract available.

Abstract

Background: Inflammation and protein energy malnutrition are associated with heart failure (HF) mortality. The metabolic vulnerability index (MVX) is derived from markers of inflammation and malnutrition and measured by nuclear magnetic resonance spectroscopy. MVX has not been examined in HF.

Objectives: The authors sought to examine the prognostic value of MVX in patients with HF.

Methods: The authors prospectively assembled a population-based cohort of patients with HF from 2003 to 2012 and measured MVX scores with a nuclear magnetic resonance scan from plasma collected at enrollment. Patients were divided into 4 MVX score groups and followed until March 31, 2021.

Results: The authors studied 1,382 patients (median age: 78 years; 48% women). The median MVX score was 64.6. Patients with higher MVX were older, more likely to be male, have atrial fibrillation, have higher NYHA functional class, and have HF duration of >18 months. Higher MVX was associated with mortality independent of Meta-analysis Global Group in Chronic Heart Failure score, ejection fraction, and other prognostic biomarkers. Compared to those with the lowest MVX, the HRs for MVX groups 2, 3, and 4 were 1.2 (95% CI: 0.9-1.4), 1.6 (95% CI: 1.3-2.0), and 1.8 (95% CI: 1.4-2.2), respectively (Ptrend < 0.001). Measures of model improvement document the added value of MVX in HF for classifying the risk of death beyond the Meta-analysis Global Group in Chronic Heart Failure score and other biomarkers.

Conclusions: In this HF community cohort, MVX was strongly associated with mortality independently of established clinical factors and improved mortality risk classification beyond clinically validated markers. These data underscore the potential of MVX to stratify risk in HF.

Keywords: NMR; heart failure; inflammation; malnutrition; metabolomics; mortality.

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Conflict of interest statement

Funding Support and Author Disclosures The investigators were supported by the Intramural Research program of the National Heart, Lung, and Blood Institute of the National Institutes of Health. This study also used in part the resources from the Rochester Epidemiology Project medical records linkage system, which is supported by the National Institute on Aging (AG 058738), by the Mayo Clinic Research Committee, and by fees paid annually by Rochester Epidemiology Project users. The funding institution did not play a role in the design, conduct, analysis, or reporting or in the decision to submit this manuscript for publication. The study was approved by the Mayo Clinic and Olmsted Medical Center Institutional Review Boards. Dr Connelly is an employee of and holds stock in LabCorp. Dr Otvos is a consultant, stockholder, and former employee of LabCorp. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

Central Illustration:
Central Illustration:. Study design to determine the prognostic value of the Metabolic Vulnerability Index (MVX) in HF.
MVX group 1: ≤50 (N = 171); MVX group 2: (50–60] (N = 339); MVX group 3: (60–70] (N = 445); MVX group 4: >70 (N = 427). Abbreviation: MAGGIC= Meta-analysis global group in chronic heart failure. Image created with BioRender.com
Figure 1.
Figure 1.
Distribution of Metabolic Vulnerability Index (MVX) Scores among 1,382 community-dwelling persons with HF.
Figure 2.
Figure 2.. Association between MVX and mortality using a cubic spline (left panel) or study defined cut-points (right panel).
Hazard ratios (HR) and 95% confidence intervals are shown on both plots.
Figure 3.
Figure 3.. Kaplan-Meier Survival Curves by Metabolic Vulnerability Index (MVX) Group
MVX group 1: ≤50 (N = 171); MVX group 2: (50–60] (N = 339); MVX group 3: (60–70] (N = 445); MVX group 4: >70 (N = 427).
Figure 4.
Figure 4.. Association of Metabolic Vulnerability Index (MVX) individual components with mortality adjusted for MAGGIC score.
Hazard ratios and 95% confidence intervals are shown per one standard deviation. All biomarker units are μmol/l. Abbreviations: MAGGIC: Meta-analysis group in chronic heart failure; IVX: Inflammation vulnerability index; MMX: Metabolic malnutrition index; S-HDLP: Small high-density lipoprotein particles
See this image and copyright information in PMC

Comment in

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