Heart Failure Population Research Articles

Renal Assessment in Acute Cardiorenal Syndrome.

Cardiorenal syndrome (CRS) is a complex, heterogeneous spectrum of symptoms that has kept cardiologists awake for decades. The heart failure (HF) population being burdened with multimorbidity poses diagnostic and therapeutic challenges even for experienced clinicians. Adding deteriorated renal function to the equation, which is one of the strongest predictors of adverse outcome, we measure ourselves against possibly the biggest problem in modern cardiology. With the rapid development of new renal assessment methods, we can treat CRS more effectively than ever. The presented review focuses on explaining the pathophysiology, recent advances and current practices of monitoring renal function in patients with acute CRS. Understanding the dynamic interaction between the heart and the kidney may improve patient care and support the selection of an effective and nephroprotective treatment strategy.

Association between triglyceride and all-cause mortality and cardiovascular outcomes in heart failure patients: a territory-wide study in Hong Kong

Abstract Funding Acknowledgements Type of funding sources: None. Objectives To determine the association between levels of triglyceride (TG) and all-cause mortality and cardiovascular outcomes. To evaluate the concentration of TG associated with the lower range and lowest risk of adverse outcomes in heart failure (HF) patients. Methods Using a previously validated territory-wide clinical information registry, all eligible patients with HF (N=147 396) from 1996 to 2020 were enrolled. Levels of time-weighted TG associated with risk of mortality were evaluated on a continuous scale using restricted cubic spline curves and by categories of TG with Cox proportional hazards regression model. The primary outcomes were all-cause mortality and cardiovascular death (CVD). Secondary outcomes include cause-specific mortality and incident cardiovascular events. Results Among 147 396 HF patients, the mean age was 70.0±12.5 years and 73 571 (49.9%) were male. The association between levels of time-weighted TG and the risk of all-cause mortality was J-shaped, with low and high levels associated with an increased risk of all-cause mortality, CVD and cause-specific mortality. Compared with individuals with levels of TG between 1.14 to 2.85 mmol/L, the multivariable-adjusted hazard ratio (HR) for all-cause mortality was 1.39 (95% confidence interval [CI] 1.35 to 1.44) for individuals with TG concentrations of less than 0.71 mmol/L and 1.97 (95% CI, 1.67 to 2.32) for TG concentrations of more than 5.60 mmol/L. The concentration of TG associated with the lowest risk of all-cause mortality was 1.84 mmol/L. Similar results were seen in males and females, in patients with or without lipid-lowering treatment, and for cardiovascular events. Conclusion In the HF population, low and high levels of TG were associated with an increased risk of all-cause mortality and cardiovascular outcomes. The lowest risk of all-cause mortality was found at a TG concentration of 1.84 mmol/L.

Predicting Six-Month Re-Admission Risk in Heart Failure Patients Using Multiple Machine Learning Methods: A Study Based on the Chinese Heart Failure Population Database.

Since most patients with heart failure are re-admitted to the hospital, accurately identifying the risk of re-admission of patients with heart failure is important for clinical decision making and management. This study plans to develop an interpretable predictive model based on a Chinese population for predicting six-month re-admission rates in heart failure patients. Research data were obtained from the PhysioNet portal. To ensure robustness, we used three approaches for variable selection. Six different machine learning models were estimated based on selected variables. The ROC curve, prediction accuracy, sensitivity, and specificity were used to evaluate the performance of the established models. In addition, we visualized the optimized model with a nomogram. In all, 2002 patients with heart failure were included in this study. Of these, 773 patients experienced re-admission and a six-month re-admission incidence of 38.61%. Based on evaluation metrics, the logistic regression model performed best in the validation cohort, with an AUC of 0.634 (95%CI: 0.599-0.646) and an accuracy of 0.652. A nomogram was also generated. The established prediction model has good discrimination ability in predicting. Our findings are helpful and could provide useful information for the allocation of healthcare resources and for improving the quality of survival of heart failure patients.

Prognostic benefit of catheter ablation of atrial fibrillation in heart failure: An updated meta-analysis of randomized controlled trials.

The prognostic role of catheter ablation of atrial fibrillation (AF) in patients with heart failure (HF) remains uncertain, with guideline recommendations largely based on a single trial. We conducted a meta-analysis of randomized controlled trials (RCTs) assessing the prognostic impact of AF ablation in patients with HF. Electronic databases were searched for RCTs comparing 'AF ablation' versus 'other care' (medical therapy and/or atrioventricular node ablation with pacing) in patients with HF. Primary endpoints were ≥1-year mortality, HF hospitalization and change in left ventricular ejection fraction (LVEF). Meta-analyses were performed using random-effects modelling. Nine RCTs (n= 1462) met inclusion criteria. Compared to 'other care', AF ablation significantly reduced ≥1-year mortality (relative risk [RR] 0.65; 95% confidence intervals [CI], 0.49-0.87) and HF hospitalization (RR 0.64; 95% CI, 0.51-0.81). AF ablation demonstrated significantly greater improvement in LVEF (mean difference [MD] 5.4; 95% CI, 4.4-6.4), 6-min walk test distance (MD 21.5 meters; 95% CI, 4.6-38.4) and quality of life as measured by Minnesota Living with Heart Failure Questionnaire score (MD 7.2; 95% CI, 2.8-11.7). Meta-regression analyses showed the beneficial impact of AF ablation on LVEF was significantly blunted by higher prevalence of ischaemic cardiomyopathy. Our meta-analysis demonstrates AF ablation is superior to 'other care' in improving mortality, HF hospitalization, LVEF and quality of life in patients with HF. However, the highly selected study populations in included RCTs and effect modification mediated by etiology of HF suggests these benefits do not uniformly apply across the HF population.

Levosimendan in outpatients with advanced heart failure: Single-center experience of 200 intermittent perfusions

Patients with advanced heart failure (HF) have high morbidity and mortality, with only a small proportion being eligible for advanced therapies. Intermittent outpatient levosimendan infusion has been shown to provide symptomatic relief and reduce the rate of HF events. Our aim was to assess the safety and efficacy of outpatient levosimendan administration in an advanced HF population. This is a report of a single-center experience of consecutive advanced HF patients referred for intermittent intravenous outpatient administration of levosimendan, between January 2018 and March 2021. Baseline and follow-up evaluation included clinical assessment, laboratory tests, transthoracic echocardiography and cardiopulmonary exercise testing. Baseline and clinical follow-up data were compared using the Wilcoxon signed-rank test. A total of 24 patients (60.8 years, 83% male, mean left ventricular ejection fraction [LVEF] 24%), with a median of 1.5 HF hospitalizations in the previous six months, were referred for outpatient levosimendan pulses, the majority as a bridge to transplantation or due to clinical deterioration. At six-month follow-up there was a significant reduction in HF hospitalizations to 0.4±0.7 (p<0.001). NYHA class IV (52.2% to 12.5%, p=0.025) and NT-proBNP (8812.5 to 3807.4 pg/ml, p=0.038) were also significantly reduced. Exercise capacity was significantly improved, including peak oxygen uptake (p=0.043) and VE/VCO2 slope (p=0.040). LVEF improved from 24.0% to 29.7% (p=0.008). No serious adverse events were reported. Repeated levosimendan administration in advanced HF patients is a safe procedure and was associated with a reduction in HF hospitalizations, functional and LVEF improvement, and reduction in NT-proBNP levels during follow-up.

Frailty phenotype in heart failure: A condition that transcends age

Studies on younger frail and pre-frail subjects suffering from heart failure (HF) are scarce, except for those focusing on the critically ill. This work aims to describe differences between younger (<65 years) and older (≥65 years) pre-frail and frail HF outpatients regarding their nutritional, functional and clinical statuses. In this cross-sectional study, a sample of 99 HF frail and pre-frail patients (aged 24-81 years, 38.4% women, 21.2% frail, 59.6% <65 years) was recruited from an HF outpatients' clinic in northern Portugal. Muscle mass was estimated from mid-upper arm muscle circumference. Weight status was assessed using body mass index. Hand grip strength and gait speed were measured. Medical records were reviewed. Associations between participants' characteristics and age were calculated using binary logistic regression. Age was associated with hand grip strength (OR=0.90), gait speed (OR=0.01) and diabetes (OR=4.95). Obesity, muscle mass or heart failure functional classes were not associated with age categories. There is an overall lack of differentiation between younger and older HF patients with the frailty phenotype. Therefore, frailty phenotype should be assessed in all patients, regardless of age. Hand grip strength seems to be a good predictor for older age and more studies are needed to define age-specific hand grip strength cut-offs for HF populations.

The Utility of Home Sleep Apnea Testing in the Advanced Heart Failure Populations

Untreated sleep disorders form a risk of coronary artery disease, hypertension, obesity, and diabetes mellitus. Access to polysomnography is limited, especially during the COVID-19 pandemic, with home sleep apnea testing (HSAT) being a potentially viable alternative. We describe an HSAT protocol in patients with advanced heart failure (HF). In a single-center, observational analysis between 2019 and 2021 in patients with advanced HF and heart transplant (HT), 135 screened positive on the STOP-Bang sleep survey and underwent a validated HSAT (WatchPAT, ZOLL-Itamar). HSAT was successful in 123 patients (97.6%), of whom 112 (91.1%; 84 HF and 28 HT) tested positive for sleep apnea. A total of 91% of sleep apnea cases were obstructive, and 63% were moderate to severe. Multivariable linear regression showed that the apnea hypopnea index was 34% lower in the HT group than in the HF group (p=0.046) after adjusting for gender, and that this effect persisted in White patients but not among African-Americans. Patient characteristics were similar between groups, with coronary artery disease, diabetes mellitus, and hypertension as the most prevalent co-morbidities. In conclusion, sleep apnea remains prevalent in patients with HF with a high co-morbidity burden. HSAT is a feasible and effective tool for screening and diagnosis in this population.

Activation of the HeartLogic algorithm on top of heart failure care: a multicenter propensity-matched cohort analysis

Abstract Background Hospitalization for decompensated heart failure may be prevented by early detection of fluid retention. The multisensory HeartLogic™ algorithm, incorporated in a cardiac implantable electronic device (CIED) aims to detect impending fluid retention and thereby enables timely adjustment of medical therapy. However, it is to be investigated whether HeartLogic™ provides clinical benefit compared to heart failure care with conventional telemonitoring. This analysis investigates the effects of activating HeartLogic™ on top of heart failure care with telemonitoring on the number of episodes with fluid retention and heart failure related hospitalizations. Methods Heart failure patients with a CIED were recruited from the outpatient clinics of four European cardiology departments. All patients were included from January 2017 until December 2020, and followed-up for 365 days. Patients with a CIED and an activated HeartLogic™ algorithm were compared to a 1:1 propensity score-based matched control group consisting of patients with CIED on routine telemonitoring. Data of all episodes of (impending) fluid retention with ≥2 signs and symptoms of congestion were included for analyses. Results Data of 127 patients with an activated HeartLogic™ algorithm were adequately matched with 127 heart failure patients with a CIED on routine telemonitoring. Median age was 68 [59–75], majority of patients were male (80%), 46% had an ischemic etiology of heart failure. Total follow-up consisted of 254 patient years. During follow up, 77 (61%) individual patients with HeartLogic™ experienced an episode of fluid retention, compared to 85 (67%) induvial patients on routine telemonitoring. Patients with an activated HeartLogic™ algorithm had 1.62±1.78 events of fluid retention per patient year (PPY) compared to 2.61±3.71 events PPY in patients on routine telemonitoring, p&amp;lt;0.01 (Figure 1). Hospitalization for fluid retention occurred in 7 (6%) HeartLogic™ patients (0.06±0.27 hospitalizations PPY) compared to 13 (10%) patients on routine telemonitoring (0.15±0.45 PPY), p=0.07 (Figure 2A). Mean length of hospitalization in days PPY was 0.29±1.46 in patients with HeartLogic™ and 1.59±6.30 in patients on routine telemonitoring, p=0.02 (Figure 2B). Conclusion In a real-world multicenter heart failure population, activation of the HeartLogic™ algorithm was associated with a lower number of episodes of fluid retention per patient and a shorter duration of hospitalization for congestive heart failure. Funding Acknowledgement Type of funding sources: None.

Escalation from intra-aortic balloon pump to axillary impella 5.5 support: Staged removal of the femoral access.

Background: With the growing population of advanced heart failure, the use of Impella 5.5 has been increasing. Here, we report an effective strategy of removing the intra-aortic balloon pump (IABP) in the setting of escalation of support to Impella 5.5.Results: From January 1, 2022 to June 30, 2022, a total of 6 patients have undergone IABP removal during Impella 5.5 insertion. The IABP was subsequently removed over the long wire with manual compression on the femoral artery to control bleeding. An 8 or 9 Fr short sheath is inserted over the wire. Staged hemostasis was successfully performed in 4 patients, and the remaining two patients required escalation of support to veno-arterial membrane oxygenation as EC-PELLA utilizing the femoral arterial sheath.Conclusion: This does not only achieve secured hemostasis but also enables a smooth transition to further escalate support such as extracorporeal membrane oxygenation support, if necessary.

Getting ahead of the game: in-hospital initiation of HFrEF therapies.

Hospitalizations for heart failure (HF) have become a global problem worldwide. Each episode of HF decompensation may lead to deleterious short- and long- term consequences, but on the other hand is an unique opportunity to adjust the heart failure pharmacotherapy. Thus, in-hospital and an early post-discharge period comprise an optimal timing for initiation and optimization of the comprehensive management of HF. This timeframe affords clinicians an opportunity to up titrate and adjust guideline-directed medical therapies (GDMT) to potentially mitigate poor outcomes associated post-discharge and longer-term. This review will cover this timely concept, present the data of utilization of GDMT in HF populations, discuss recent evidence for in-hospital initiation and up-titration of GDMT with a need for post-discharge follow-up and implementation this into clinical practice in patients with heart failure and reduced ejection fraction.

The Impact of Self-efficacy and Health Literacy on Medication Adherence and Health-related Quality of Life in Patients with Heart Failure: A Systematic Review

Context: Effective implementation of self-care programs can reduce the treatment costs and the risk of severe complications of heart failure. However, people with low health literacy fail to properly conduct the complex care techniques. The control of chronic, progressive, and complex diseases largely depends on self-efficacy, adherence to treatment, and health-related quality of life. The purpose of this systematic review is to study research literature to explore the impact of self-efficacy and health literacy on medication adherence and health-related quality of life in patients with heart failure. Evidence Acquisition: Considering the PRISMA guideline, this systematic review study the articles published between 1999 and 2022. The articles written in the English language were recruited from PubMed, Scopus and Web of Science, CINAHL Plus, Embase, Cochrane, PsycINFO and google scholar databases. The quality of the studies was assessed by the organization Agency for Healthcare Research and Quality (AHRQ) and then the data was collected based on the designed checklists. Results: A total of 27 articles met the inclusion and exclusion criteria. The studies were conducted on range of 44 to 705 patients with heart failure. Inadequate health literacy was observed to have a high prevalence in heart failure patients. Health literacy had a direct impact on quality of life and treatment adherence in all studies. Several studies have shown that interventions to increase patient self-efficacy led to greater adherence to treatment, higher quality of life, and lower hospitalization rates in the heart failure population. Low self-efficacy in patients was linked to high rates of comorbidity. Conclusions: Self-efficacy and health literacy have a positive effect on the quality of life, adherence to treatment, and reduction of mortality in patients with heart failure. Therefore, the implementation of training programs to improve these areas should be formulated by the health systems.

842 PREVALENCE AND MECHANISMS OF SEVERE MITRAL AND TRICUSPID RECURGITATION IN A HEART FAILURE OUTPATIENTS POPULATION

Abstract Introduction Mitral regurgitation (MR) and tricuspid regurgitation (TR) are an established cause of morbidity and mortality in heart failure (HF) patients. The development of successful transcatheter therapies for mitral and tricuspid diseases have opened new therapeutic opportunities, in addition to guideline-directed medical therapy (GDMT) for HF. However, an accurate evaluation of the mechanisms of valve regurgitation is key to tailor the best treatment for each patient. This study aims at evaluating the prevalence and underlying mechanisms of at least moderate-to-severe (≥3+/4+) MR and/or TR in a cohort of HF outpatients. Methods We retrospectively analyzed the medical records of 1260 outpatients evaluated by our HF Unit between January 2020 and June 2021. All patients with echocardiographic evidence of at least moderate-to-severe MR and/or TR were included in the registry and a thorough review of echocardiographic images and collection of clinical data were also performed. Results Of the 1260 analyzed patients, 173 (13.7%) presented with at least moderate-to-severe MR and/or TR and were included in the registry. The mean age was 80±7 years and median ejection fraction was 45% (IQR 33; 55%) and 77 (45%) had HF of ischemic etiology. All patients were treated with maximal tolerated doses of GDMT and, when appropriate, with devices and myocardial revascularization. At least moderate-to-severe MR and TR was observed in 7.3% (92/1260) and 9.3% (117/1260) patients, respectively. Patients with significant isolated MR were 56 (4.4%), with isolated TR were 81 (6.4%), while with both significant MR and TR were 36 (2.8%). Among patients with significant MR, 54% (50/92) had functional valvular defect, of whom 82% (41/50) had a ventricular etiology (18/41 with asymmetric tethering), while the 18%(9/50) an atrial one (3/9 with atriogenic tethering). Among patients with significant TR, 72.6% (85/117) had functional valvular defect, of whom 35.3% (30/85) had a ventricular etiology while 64.7% (55/85) presented with an atrial one. Conclusion Despite optimized GDMT, the prevalence of patients presenting with significant MR and TR was considerably high in our ambulatory HF population. This registry is the first study to comprehensively detail the mechanisms of atrioventricular valve regurgitations in a wide cohort of HF outpatients. Further studies are needed to assess the reasons for a potential undertreatment and to identify the patients who would benefit the most from the percutaneous correction of their valvular defects.

Predicting Alzheimer's Disease and Related Dementias in Heart Failure and Atrial Fibrillation

The Framingham Heart Study Dementia Risk Score (FDRS) was developed in a general population of older persons. It is unknown how the FDRS variables predict Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD) in heart failure and atrial fibrillation populations. We aimed to evaluate the predictive ability of the FDRS variables in population-based cohorts of heart failure and atrial fibrillation and to determine whether the addition of other comorbidities and risk factors improves risk prediction for AD/ADRD. Residents aged ≥50 years from 7 southeastern Minnesota counties with a first diagnosis of heart failure or atrial fibrillation between January 1, 2013, and December 31, 2017, were identified. Patients with AD/ADRD before or within 6 months after index atrial fibrillation or heart failure and patients who died within 6 months after index were excluded. For both cohorts, models were constructed to predict AD/ADRD after index including the variables in the FDRS. Additional comorbidities and risk factors were added to the models. For all models, c-statistics using 5-fold cross-validation were calculated. Among 3052 patients with heart failure (mean age 75 years, 53% male), 626 developed AD/ADRD; among 4107 patients with atrial fibrillation (mean age 74 years, 57% male), 736 developed AD/ADRD. Among patients with heart failure, the FDRS variables predicted AD/ADRD with c-statistic=0.69. Adding comorbidities and risk factors improved the c-statistic slightly to 0.70. The FDRS variables also performed well (c-statistic=0.73) in patients with atrial fibrillation; adding comorbidities and risk factors slightly improved performance (c-statistic=0.75). The variables from the FDRS predict AD/ADRD well in both heart failure and atrial fibrillation populations. The addition of comorbidities and risk factors only modestly improved prediction, indicating that the FDRS variables are appropriate to predict AD/ADRD in patients with heart failure and atrial fibrillation.

Prevalence and treatment of diabetes and pre-diabetes in a real-world heart failure population: a single-centre cross-sectional study

AimsThe aim of this study was to investigate a real-world heart failure (HF) cohort regarding (1) prevalence of known diabetes mellitus (DM), undiagnosed DM and pre-diabetes, (2) if hf treatment...

Beyond Simpson's Rule: Accounting for Orientation and Ellipticity Assumptions.

Simpson's biplane rule (SBR) is considered the gold standard method for left ventricle (LV) volume quantification from echocardiography but relies on a summation-of-disks approach that makes assumptions about LV orientation and cross-sectional shape. We aim to identify key limiting factors in SBR and to develop a new robust standard for volume quantification. Three methods for computing LV volume were studied: (i) SBR, (ii) addition of a truncated basal cone (TBC) to SBR and (iii) a novel method of basal-oriented disks (BODs). Three retrospective cohorts representative of the young, adult healthy and heart failure populations were used to study the impact of anatomical variations in volume computations. Results reveal how basal slanting can cause over- and underestimation of volume, with errors by SBR and TBC >10 mL for slanting angles >6°. Only the BOD method correctly accounted for basal slanting, reducing relative volume errors by SBR from -2.23 ± 2.21% to -0.70 ± 1.91% in the adult population and similar qualitative performance in the other two cohorts. In conclusion, the summation of basal oriented disks, a novel interpretation of SBR, is a more accurate and precise method for estimating LV volume.

Impact of Heart Failure Medication Therapy Adherence Clinic (HF-MTAC) in Hospital Serdang on utilisation of guideline-directed medical therapy and clinical outcomes

Heart failure (HF) is associated with recurrent hospitalisations and high mortality. Guideline-directed medical therapy (GDMT) has been shown to improve prognosis in HF with reduced ejection fraction (HFrEF). Despite proven benefits of GDMT, there is still a substantial gap in its optimal use among Malaysian HF population. HF Medication Therapy Adherence Clinic (HF-MTAC) is a multidisciplinary programme involving trained pharmacists to provide care to HFrEF patients, which require resources for its implementation.

A Methodological Perspective on the Function and Assessment of Peripheral Chemoreceptors in Heart Failure: A Review of Data from Clinical Trials

Augmented peripheral chemoreceptor sensitivity (PChS) is a common feature of many sympathetically mediated diseases, among others, and it is an important mechanism of the pathophysiology of heart failure (HF). It is related not only to the greater severity of symptoms, especially to dyspnea and lower exercise tolerance but also to a greater prevalence of complications and poor prognosis. The causes, mechanisms, and impact of the enhanced activity of peripheral chemoreceptors (PChR) in the HF population are subject to intense research. Several methodologies have been established and utilized to assess the PChR function. Each of them presents certain advantages and limitations. Furthermore, numerous factors could influence and modulate the response from PChR in studied subjects. Nevertheless, even with the impressive number of studies conducted in this field, there are still some gaps in knowledge that require further research. We performed a review of all clinical trials in HF human patients, in which the function of PChR was evaluated. This review provides an extensive synthesis of studies evaluating PChR function in the HF human population, including methods used, factors potentially influencing the results, and predictors of increased PChS.

Association between energy intake patterns and outcome in US heart failure patients

The association between dietary energy patterns, calories, and the outcomes of heart failure (HF) is still unclear. To evaluate the proper energy intake patterns and daily calorie intake in patients with heart failure among US adults. The data were derived from the 2001-2014 National Health and Nutrition Examination Survey (NHANES). A calorie intake pattern variable was created using latent class analysis (LCA) based on the calorie ratio of three major nutrients. Cox proportional hazard regression models were used to evaluate the hazard ratios (HR) and 95% confidence intervals (CI) of the association between calorie intake and energy patterns. The primary endpoint was all-cause mortality. Among 991 participants (mean age 67.3 ± 12.9 years; 55.7% men) who suffered from heart failure; the median calorie intake was 1,617 kcal/day [interquartile range (IQR): 1,222-2,154 kcal/day]. In the multivariable-adjusted model, moderate malnutrition was more frequent to death (HR: 2.15; 95% CI: 1.29-3.56). Low-carbohydrate pattern (LCP) and median-carbohydrate pattern (MCP) had lower risks of death compared to high-carbohydrate pattern (HCP) (LCP: HR: 0.76; 95% CI: 0.59-0.97; MCP: HR: 0.77; 95% CI: 0.60-0.98). No association between different amounts of calorie intake and all-cause mortality was found. There was an adjusted significant interaction between calorie intake and energy intake patterns (p = 0.019). There was a linear relationship between energy intake through HCP and all-cause mortality (p for non-linear = 0.557). A non-linear relationship between energy intake through MCP and all-cause mortality (p for non-linear = 0.008) was observed. Both LCP and MCP, compared to HCP, were associated with better outcomes in the HF population. The relationship between energy intake and all-cause death may be influenced by energy intake patterns in HF patients.

Abstract 15795: Connections Between the Western Diet and Inflammation in Heart Failure

Introduction: The Western Diet (WD) is associated with deleterious processes linked with chronic disease and may play a role in the pathophysiology of heart failure (HF). Trimethylamine-N-oxide (TMAO) is a diet-linked metabolite that contributes to inflammation and is associated with higher TNF-α, especially in HF populations. The dietary inflammatory index (DII) score measures the inflammatory potential of a diet and the inflammatory effects of foods. More studies are needed to determine how the WD impacts immunological pathways and cytokines in the context of clinical and population characteristics. Purpose: The aim of this study was to explore associations between the WD, DII, TMAO, and TNF-α in Black patients living with HF. Methods: Thirty Black participants (mean age 55.3, 67.7% women) with HF were included in this study. TMAO and TNF-α levels were analyzed from dried blood spots using immunoassays. Participants completed a Food Frequency Questionnaire (FFQ) from which a DII score was derived. Food groups and nutrients, like choline, were measured with the FFQ. Sociodemographic variables were measured. Analyses included correlational and inferential statistics. Results: Mean DII score was -.38 revealing an overall anti-inflammatory diet with higher inflammatory scores among men (-.23) as compared to women (-.43). Women consumed greater kilocalories with more saturated fat, sodium, dairy, sugar, and fruit while men consumed more cholesterol, choline, proteins, alcohol, legumes, poultry, red meats, eggs, and phosphatidylcholine. DII score was negatively correlated with dietary choline (r= -.73, p&lt;.001), but did not correlate with TMAO or TNF-α. TNF-α and TMAO were positively related (r=.30, p=.057). Conclusions: This sample of well-educated HF patients from a busy HF referral center did not consume a highly pro-inflammatory diet, yet our findings provide insight for specific food groups such as those with choline. In patients with HF, it is important to monitor intake of inflammatory foods and appreciate that increasing age may play a role in the retention of dietary metabolites. Further study of these relationships in patients with HF could lead to tailored dietary educational interventions based on dietary patterns, age, and cultural relevance.

Abstract 14090: Measures of Discrepancy Between Cystatin C and Creatinine Are Associated With Body Composition in the General Population and in Heart Failure

Background: Sarcopenia is associated with disability and mortality. Coexistence of sarcopenia and obesity (sarcopenic obesity) relates to particularly poor outcomes. The prevalence of sarcopenia is increased in heart failure (HF) up to ~50%. Dual-energy x-ray absorptiometry (DXA) is the gold standard for body composition assessment but is limited by cost and radiation exposure. We studied whether the relationship between two renal biomarkers (ie, serum creatinine (sCr) - muscle mass dependent, and cystatin C (CysC) - muscle mass independent) could be used to reliably estimate body composition in the general population and in HF. Methods: We included National Health and Nutritional Examination Surveys participants who underwent DXA between 1999 and 2002. Multivariable linear models assessed the association between sCr/CysC and CysC- and sCr-based estimated glomerular filtration rate difference (eGFRdiff) with DXA-derived appendicular skeletal muscle index (ASMI m 2 ) and total body fat percentage (TBF%). Sample weights were used to account for complex survey design to ensure that estimates were representative of the general US population. Results: Among 3280 participants (44±22.9yo,49%F,190 with HF), 440, 1241, and 359 met criteria for sarcopenia, obesity and sarcopenic obesity. Overall and in HF, mean ASMI and TBF% were 7.4m 2 and 32.5% and 7.0m 2 and 36.9%, respectively. Overall and in HF, higher sCr/CysC and eGFRdiff were associated with increased ASMI and decreased TBF% ( Table ). sCr/CysC was the lowest in patients with lowest ASMI tertile (&lt;6.26 m 2 ) and highest TBF% tertile (&gt;40.3%) ( Fig ). A similar pattern was also seen in HF. Conclusions: Measures of discrepancy between sCr and CysC are strongly associated with gold-standard measures of body composition both in the general and HF populations. This biomarker approach is easy and inexpensive, allowing clinicians new opportunities for timely recognition and possibly early treatment of sarcopenic obesity.