Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Feb 17;24(1):79.
doi: 10.1186/s12933-025-02639-2.

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

Ke Shi  1 , Ge Zhang  1   2 , Rong Xu  3 , Xue-Ming Li  1   2 , Li Jiang  1 , Yue Gao  1 , Hua-Yan Xu  3 , Yuan Li  1 , Ying-Kun Guo  3 , Zhi-Gang Yang  4
Affiliations

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

Ke Shi et al. Cardiovasc Diabetol. .

Abstract

Background: Obesity is common in the heart failure (HF) population and is regarded as an important risk factor for developing HF. Greater skeletal muscle mass has shown to be the underlying protective factor against cardiac failure. Since diabetic mellitus (DM) can impair muscle protein metabolism, leading to skeletal muscle wasting, accompanied by adipose tissue accumulation, sarcopenic obesity (SO) may be a high-risk phenotype with poor outcomes in this specific population, especially in HF with reduced ejection fraction (HFrEF). Thus, the aim of this study was to clarify the clinical profiles, left ventricular (LV) remodeling, and prognostic implications of SO in patients with HFrEF and DM.

Methods: A total of 283 patients who underwent cardiac MRI were included. Thoracic skeletal muscle index (SMI) was served as a surrogate of skeletal muscle mass. Patients were stratified according to the median thoracic SMI (42.75 cm2/m2) and body mass index (25 kg/m2). Obesity in conjunction with a SMI lower than the median is referred to as SO. The LV volume and function, as well as the systolic strain, were measured. The clinical characteristics and cardiovascular outcomes (heart failure readmission, cardiovascular mortality and heart transplantation) were recorded.

Results: Patients with SO had a greater level of amino-terminal pro-B-type natriuretic peptide and were more likely than nonsarcopenic patients with obesity to present with hypoproteinemia. Among patients with obesity, those with sarcopenia displayed greater LV expansion and more profound LV dysfunction, together with an increase in LV mass. During a median follow-up duration of 35.1 months, a total of 73 (25.8%) subjects reached the composite endpoint, with a worst outcome in the group of patients with SO (log-rank P = 0.04). Multivariable Cox analysis revealed that patients with SO had an approximately 3-fold greater risk of experiencing adverse outcomes than did those with neither sarcopenia nor obesity (hazard ratio: 3.03, 95% confidence interval: 1.39 to 6.63; P = 0.005).

Conclusions: SO is a potentially high-risk phenotype with adverse LV remodeling and poor clinical outcomes in diabetic patients with HFrEF that may require more attention.

Keywords: Diabetes mellitus; Heart failure with reduced ejection fraction; Left ventricular remodeling; Outcome; Sarcopenic obesity.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the Biomedical Research Ethics Committees of West China Hospital and was complied with the Declaration of Helsinki. Written informed consent was waived because of the retrospective nature of the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study cohort. MRI Magnetic resonance imaging, BMI Body mass index, SMI Skeletal muscle index
Fig. 2
Fig. 2
Examples of four patients referred to cardiac MRI. The area of thoracic skeletal muscle size measured in this study was marked with red (pectoralis major), green (pectoralis minor), blue (serratus anterior), yellow (periscapular), cyan (paraspinal), and purple (trapezius muscles), respectively. MRI Magnetic resonance imaging, BMI Body mass index, SMI Skeletal muscle index
Fig. 3
Fig. 3
Survival analysis according to the SO status. Kaplan–Meier survival curves demonstrating the overall survival rates among the four subgroups (A). The composite event rate per 100 person-year (B). SO Sarcopenic obesity
See this image and copyright information in PMC

References

    1. Wang H, Li Y, Chai K, et al. Mortality in patients admitted to hospital with heart failure in China: a nationwide cardiovascular association database-heart failure centre registry cohort study. Lancet Glob Health. 2024;12(4):e611–22. - PubMed
    1. Savarese G, Becher PM, Lund LH, Seferovic P, Rosano GMC, Coats AJS. Global burden of heart failure: a comprehensive and updated review of epidemiology. Cardiovasc Res. 2023;118(17):3272–87. - PubMed
    1. Powell-Wiley TM, Poirier P, Burke LE, et al. Obesity and cardiovascular disease: a scientific statement from the American heart association. Circulation. 2021;143(21):e984–1010. - PMC - PubMed
    1. Selvaraj S, Kim J, Ansari BA, et al. Body composition, natriuretic peptides, and adverse outcomes in heart failure with preserved and reduced ejection fraction. JACC Cardiovasc Imaging. 2021;14(1):203–15. - PMC - PubMed
    1. Souza ACDAH, Rosenthal MH, Moura FA, et al. Body composition, coronary microvascular dysfunction, and future risk of cardiovascular events including heart failure. JACC Cardiovasc Imaging. 2024;17(2):179–91. - PMC - PubMed

MeSH terms

LinkOut - more resources