Triceps Skinfold as a Prognostic Predictor in Outpatient Heart Failure

Background

Most reports regarding the obesity paradox have focused on body mass index (BMI)to classify obesity and the prognostic values of other indirect measurements ofbody composition remain poorly examined in heart failure (HF).

Objective

To evaluate the association between BMI and other indirect, but easily accessible,body composition measurements associated with the risk of all-cause mortality inHF.

Methods

Anthropometric parameters of body composition were assessed in 344 outpatientswith a left ventricular ejection fraction (LVEF) of ≤50% from a prospective HFcohort that was followed-up for 30 ± 8.2 months. Survival was evaluated using theKaplan-Meier method and Cox proportional hazard regression analysis.

Results

HF patients were predominantly male, of non-ischemic etiology, and had moderate tosevere LV systolic dysfunction (mean LVEF = 32 ± 9%). Triceps skinfold (TSF) wasthe only anthropometric index that was associated with HF prognosis and hadsignificantly lower values in patients who died (p = 0.047). A TSF ≥ 20 mm waspresent in 9% of patients that died and 22% of those who survived (p = 0.027).Univariate analysis showed that serum creatinine level, LVEF, and NYHA class wereassociated with the risk of death, while Cox proportional hazard regressionanalysis showed that TSF ≥ 20 was a strong independent predictor of all-causemortality (hazard ratio = 0.36; 95% CI = 0.13-0.97, p = 0.03).

Conclusion

Although BMI is the most widely used anthropometric parameter in clinicalpractice, our results suggested that TSF is a better predictive marker ofmortality in HF outpatients.