Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5

Association of congestion with body composition analysis in patients with heart failure
T. Garfias Macedo1, D. Al-Mudaris1, M. Vatic1, G. Loncar2, W. Döhner3, S. D. Anker4, S. von Haehling1, für die Studiengruppe: SICA-HF
1Herzzentrum, Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Göttingen; 2Deparment of Cardiac Surgery, Institute for Cardiovascular Diseases Dedinje, Belgrade, SRB; 3BIH Center für regenerative Therapien (BCRT), Charité - Universitätsmedizin Berlin, Berlin; 4CC11: Med. Klinik m.S. Kardiologie, Charité - Universitätsmedizin Berlin, Berlin;

Background: Heart failure (HF) patients present with a series of co-morbidities that have an impact on mobility such as edema and sarcopenia. A main concern in the past decades is how accurate the measurement of lean mass in the presence of edema can be. We aimed to analyze the relationship between two standard assessments of body composition, dual X-ray absorptiometry (DEXA) and bioelectrical impedance analysis (BIA), and the influence of congestion in their accuracy among HF patients.

Methods: We investigated 261 HF patients aged >40 years and with at least one of the two body component assessments at baseline (BL). DEXA data were available for 255 patients, BIA for 135 patients at BL. In a follow up (FU) visit six months later, DEXA and BIA were reassessed in 204 and 99 patients, respectively. The presence of oedema was assessed during clinical examination as none, mild, moderate, or severe.

Results: A comparison of patients with no edema (n=95) vs. any edema (n=166) showed no statistically significant difference with regards to age, gender, left ventricular ejection fraction (LVEF), creatinine and presence of sarcopenia (66±11 vs. 69±8 yrs; 19 vs. 23% female; 38±12 vs. 40±14%; 1.14±0.3 vs. 1.22±0.5 mg/dL; 22.1 vs. 14.4%; all p>0.1). Body mass, weight and body mass index (BMI) were higher in the edematous subgroup (81.4±15.3 vs. 91.0±17.9 kg; 27.0±4.4 vs. 30.5±5.3 kg/m2, both p<0.001). In the full cohort, total fat mass (total FM) was very similar under Bland-Altman analysis (mean difference [Mdiff] = 1.38, lower and upper limits of agreement [LLA, ULA] = [-7.9,10.7]) while total fat free mass (total FFM) was estimated higher in BIA analysis (Mdiff=-4.04; [LLA, ULA]=[-12.7,4.7]). The difference was slightly reduced within the subgroup without edema ( Mdiff=0.68 for FM; Mdiff=-3.24 for FFM) as with edema (Mdiff=1.70 for FM; Mdiff=-4.41 for FFM). Body components were all higher in the edematous subgroup with respect to both methods (legs FM: 7.2±3.1 vs. 8.8±3.6 kg; total FM: 25.4±9.8 vs. 30.9±9.7 kg; legs FFM: 17±3.1 vs.18.0±3.8 kg; total FFM: 52.9±8.8 vs. 56.2±11.3 kg by DEXA;  all p<0.001), as well as total FM, total FFM and water in litre by BIA (25.8±8.4 vs. 31.8±11.4 kg, p=0.003; 55.2±12.6 vs. 61.2±13.1 kg, p=0.014; 42.5±7.9 vs. 47.1±9.8 L, p=0.010). Comparison with respect to severy, an increase from no edema to severe edema was shown by both assessments. Tendency at the difference between edema status subgroups within FU was preserved by DEXA (p<0.005 for legs FM, total FM and total FFM) except for legs FFM (p=0.318). In the contrary, BIA showed no significant difference at all three body components (all p>0.2). At FU 24 of the patients without edema at BL were edematous and conversely 24 edematous patients at BL were found without edema at six months. We analyzed paired mean difference on these 48 patients from an edema status to a no edema status. From all body component only water by BIA was significantly difference (paired mean difference ± SD: -2.31±4.02, p = 0.022; p>0.1 for all other components in both methods).

Conclusions: There is a good correlation between measurements of fat mass and fat free mass done by DEXA scan vs. BIA analysis, regardless of the presence of edema. No statistically significant difference was found in patients developing edema with respect to any of the methods and components. The only significant difference found was at water level, whose clinical relevance requires further investigation.


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