Abstract 13552: Prognostic Value of Modified Body Mass Index in Acute Decompensated Heart Failure Patients With Reduced, Mildly-Reduced and Preserved Left Ventricular Ejection Fraction

Abstract

Backgrounds: Malnutrition is associated with poor outcome in patients with acute decompensated heart failure (ADHF). Although conventional body mass index (cBMI) and serum albumin level are commonly used as indicators of malnutrition, these variables are influenced by fluid balance, and it has been recently reported that the modified BMI (mBMI, serum albumin х cBMI) would be a better prognostic marker than cBMI and serum albumin level in ADHF patients. However, it remains unclear whether mBMI on admission or discharge would have more prognostic information in patients admitted with ADHF after the discharge, and there is no information available on the prognostic impact of mBMI in ADHF patients, relating to reduced (HFrEF), mildly-reduced (HFmrEF), and preserved left ventricular ejection fraction (HFpEF). Methods and Results: We studied 263 ADHF patients (HFrEF:n=103, HFmrEF:n=59, HFpEF:n=101) discharged with survival. We calculated mBMI on admission and discharge. During a follow up period of 5.1±4.3 yrs, 67 patients had cardiovascular death (CVD). AUC of mBMI at discharge (0.697[0.625-0.769]) was greater than that on admission (0.661[0.585-0.737], p=0.055). At multivariate Cox analysis, mBMI at discharge (adjusted hazard ratio 0.965[0.948-0.982], p<0.001) was significantly associated with CVD, independently of prior heart failure hospitalization, systolic blood pressure, eGFR and serum sodium level. Patients with lower mBMI (<median value=75.4) had an increased risk of CVD than those with higher mBMI (≥75.4) in all three subgroups (HFrEF: 43% vs 21%, p=0.013, HFmrEF; 32% vs 11%, p=0.025, HFpEF: 41% vs 12%, p=0.008). Conclusion: Modified BMI at the discharge might be better prognostic marker than that on admission and provides long-term prognostic information in patients admitted for ADHF, regardless of reduced, mildly-reduced or preserved left ventricular ejection fraction.