P4539Android to gynoid fat ratio and its association with functional capacity in male patients with heart failure

Background Obesity may have a protective role in patients with heart failure with reduced ejection fraction (HFrEF), a phenomenon known as obesity paradox. However, some patients can also present sarcopenic obesity with similar exercise intolerance as lean patients with muscle wasting. However, the impact of body fat distribution on exercise intolerance in HFrEF is unknown. Purpose To study the association between android to gynoid fat ratio and functional capacity (VO2 peak) in male patients with HFrEF. Methods We enrolled 118 male with HFrEF with left ventricular ejection fraction (LVEF) <40%, mean age of 56±7 years old. Body composition was measured with dual x-ray absorptiometry. Android and gynoid fat were measured and the ratio between them was calculated (A/G ratio). Appendicular lean mass (ALM) was calculated as the lean muscle mass of both arms and legs divided by the height squared. Sarcopenic obesity was defined according to Foundation for the National Institutes of Health criteria (ALM adjusted for body mass index <0.789 for men). Muscle strength was assessed using the handgrip dynamometer (cutoff point for sarcopenia was defined as proposed by European Working Group on Sarcopenia in Older People). Blood sample was used to measure metabolic and hormonal parameters. Results Of those 118 patients, 15 (12.7%) showed sarcopenic obesity. In our cohort, the median A/G ratio was 0.55. A/G ratio >0.55 was detected in 60 patients. Weight and BMI were higher in patients with A/G ratio >0.55 (P<0.001). Absolute peak VO2 was similar between patients with A/G ratio lower or higher than 0.55 (1.48±0.40 vs. 1.43±0.40 L/min, P=0.559), while relative peak VO2 was lower in patients with A/G ratio >0.55 (18.7±5.3 vs. 22.5±6.1 mL/kg/min, P<0.001). LVEF, total cholesterol, LDL, haemoglobin, and IGF-1 were similar between patients with A/G ratio lower or higher than 0.55 (P>0.05). On the other hand, HDL, total testosterone, free testosterone, and DHEA were lower in patients with A/G ratio >0.55 (P<0.05). Logistic regression analysis showed A/G Ratio >0.55 to be independently associated with reduced peak VO2 (L/min) adjusted for age, BMI, LVEF, presence of sarcopenia, anabolic hormones, and haemoglobin (odds ratio 3.895, 95% CI 1.030–14.730, p=0.045). Conclusion Our data suggest that body fat distribution, particularly android and gynoid fat composition, might have an important adverse role on functional capacity in male patients with HFrEF. Acknowledgement/Funding FAPESP #2016/24306-0 and 2016/24833-0