Sarcopenic obesity is associated with reduced cardiorespiratory fitness compared with nonsarcopenic obesity in patients with heart failure with reduced ejection fraction
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Background: Sarcopenia impairs cardiorespiratory fitness (CRF) in patients with heart failure with reduced ejection fraction (HFrEF). Obesity has also been shown to impair CRF; however, the effects of sarcopenia on CRF in patients with obesity and HFrEF are unknown. The aim of this analysis was to examine differences in CRF between patients with sarcopenic obesity (SO) and non-SO (NSO) with HFrEF. We also assessed associations between skeletal muscle mass index (SMMI) and CRF. Methods: Forty patients with HFrEF and obesity underwent cardiopulmonary exercise testing to collect measures of CRF including peak oxygen consumption (VO 2 ), circulatory power, oxygen uptake efficiency slope, O 2 pulse, and exercise time. Body composition was performed in all patients using bioelectrical impedance analysis to quantify fat mass index and divide patients into SO and NSO based on SMMI cutoffs. Results are presented as mean (SD) or median [interquartile range] as appropriate. Results: Nearly half (43% [n=17]) of patients had SO. Patients with SO had a lower SMMI than those with NSO, and no differences in fat mass index were observed between groups. Those with SO achieved a lower absolute peak VO 2 (NSO, 1.62±0.53 L·min -1 versus SO, 1.27±0.44 L·min -1 , P =0.035), oxygen uptake efficiency slope (NSO, 1.92±0.59 versus SO, 1.54±0.48, P =0.036), and exercise time (NSO, 549±198 seconds versus SO, 413±140 seconds, P =0.021) compared to those with NSO. On multivariate analysis, SMMI remained a significant predictor of absolute peak VO 2 when adjusted for age, sex, adiposity, and HF severity. Conclusions: In patients with HFrEF and obesity, sarcopenia, defined as low SMMI, is associated with a clinically significant reduction in CRF, independent of adiposity.
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Sarcopenic obesity is increasingly recognized and may incur a distinct phenotype of low physical functioning and higher mortality, especially in older adults with heart failure.
“In fact, sarcopenic obesity, when lean mass wasting and fat mass expansion occur concurrently, is increasingly recognized and may incur a distinct phenotype of low physical functioning and higher mortality rates, especially in older adults with HF.87,88”
From Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association (2026) · cites this paper as [88]
The Introduction (page unavailable) defines sarcopenic obesity as excess fat mass with reduced skeletal muscle mass and describes greater functional impairment. The Discussion (page unavailable) reports poorer cardiorespiratory fitness in patients with obesity and heart failure with reduced ejection fraction. The paper does not establish higher mortality rates from sarcopenic obesity in older adults with heart failure; its Introduction links low peak oxygen consumption to mortality risk in heart failure more generally. (LLM, conf=0.87)
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Self-citationObesity and Heart Failure With Reduced Ejection Fraction
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- Authors
- Billingsley, H. E., Del Buono, M. G., Canada, J. M., Kim, Y., Damonte, J. I., Trankle, C. R., Halasz, G., Mihalick, V., Vecchié, A., Markley, R. R., Kadariya, D., Bressi, E., Medina de Chazal, H., Chiabrando, J. G., Mbualungu, J., Turlington, J., Arena, R., Van Tassell, B. W., Abbate, A., & Carbone, S.
- Affiliations
- Virginia Commonwealth University (US)
- VCU Pauley Heart Center (H.E.B., M.G.D.B., J.M.C., J.I.D., C.R.T., V.M., A.V., R.R.M., D.K., E.B., H.M.d.C., J.G.C., J.M., J.T., B.W.V.T., A.A., S.C.), Virginia Commonwealth University, Richmond.
- Cardiac Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Italy (G.H.).
- University of Illinois Chicago (US)
- ORCID
- Venue
- Circulation: Heart Failure
- Published
- 2022-10
- Volume
- 15
- Issue
- 10
- Pages
- e009518-e009518
- ISSN
- 1941-3289 (ISSN-L)
- 1941-3297
- PMC
- PMC9588574
- OpenAlex
- W4295512286
- Cited by
- 52
- References
- 48
- Citations by year
- 2026: 14 · 2025: 16 · 2024: 10 · 2023: 11 · 2022: 1
- FWCI
- 9.93
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation Heart Failure (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (UL1TR002649)
- National Heart, Lung, and Blood Institute (R61HL139943, R33HL139943)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Keywords
- sarcopenic obesity, sarcopenia, heart failure with reduced ejection fraction, cardiorespiratory fitness, skeletal muscle index, peak oxygen uptake, oxygen uptake efficiency slope, exercise capacity, body composition, fat mass index, cardiopulmonary exercise testing
- MeSH terms
- Cardiorespiratory Fitness, Exercise Test, Heart Failure, Humans, Obesity, Oxygen, Oxygen Consumption, Stroke Volume, Sarcopenia
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