Association of body mass index with cardiopulmonary efficiency and ventricular remodeling in advanced heart failure
N Andjelkovic, D Kosevic, J Stefanovic Neskovic, J Miladinovic, B Milovanovic, U Radak, N Jovicic, M Bojic, S BorovicAbstract
Background
Low body mass index (BMI) is frequently observed in patients with advanced heart failure (HF) and may reflect adverse metabolic and hemodynamic profiles. The relationship between nutritional status, functional capacity, and biventricular structural remodeling assessed by cardiac magnetic resonance (CMR) remains incompletely defined.
Purpose
To investigate the association between BMI, cardiopulmonary functional capacity, and biventricular remodeling in patients with advanced HF using an integrated functional and CMR-based approach.
Methods
We retrospectively analyzed 39 consecutive patients with advanced HF referred to a tertiary HF center. BMI was recorded at admission. Functional capacity was assessed using cardiopulmonary exercise testing, including oxygen uptake efficiency slope (OUES). Left and right ventricular end-diastolic volumes (EDV) were quantified by CMR. Correlation and multivariable linear regression analyses were performed to evaluate associations between BMI, OUES, and ventricular volumes.
Results
Mean BMI was 19.0 ± 5.6 kg/m², reflecting a predominantly lean population. BMI showed a significant positive correlation with OUES (r = 0.41, p = 0.010), indicating reduced cardiopulmonary efficiency in patients with lower BMI. Conversely, BMI was inversely correlated with right and left ventricular end-diastolic volumes assessed by CMR (RV EDV: r = −0.38, p = 0.018; LV EDV: r = −0.34, p = 0.032). OUES demonstrated a trend toward inverse association with LV EDV (r = −0.29, p = 0.07). In multivariable analysis adjusted for age and sex, BMI remained independently associated with OUES (β = +0.06, p = 0.021).
Conclusion
In patients with advanced HF, lower BMI is associated with impaired cardiopulmonary efficiency and more pronounced biventricular dilatation. These findings highlight the strong connection between nutritional status, functional limitation, and structural remodeling and may support integrated phenotyping in advanced HF management.