Body composition, muscle strength and novel biomarkers in acute heart failure patients: a comprehensive frailty assessment.

BACKGROUND AND AIMS: Malnutrition, sarcopenia, and frailty are increasingly recognized as relevant determinants of outcomes in heart failure (HF), yet comprehensive evaluation of body composition and circulating biomarkers is still not routinely implemented. We aimed to characterize body composition, physical function, and selected novel biomarkers in patients with HF and to compare these findings with those of healthy controls.

METHODS AND

RESULTS

In this single-centre, observational, cross-sectional study, consecutive patients admitted with acute HF between July 2020 and May 2021 were prospectively enrolled. Participants underwent a comprehensive assessment including dual-energy X-ray absorptiometry (DEXA) for bone mineral density and body composition, isometric handgrip dynamometry, the Short Physical Performance Battery (SPPB), and measurement of circulating Klotho and growth differentiation factor-15 (GDF-15). Healthy individuals served as the control group. Of 202 enrolled patients, 39 completed the full evaluation (mean age 66.3 years; 33.3% women). Frailty prevalence was 46.2%. Frail HF patients showed lower bone mineral density (p = 0.016) and reduced handgrip strength (p = 0.002) compared with non-frail HF patients. Trends toward lower Klotho and higher GDF-15 were also observed. Relative to controls, HF patients exhibited higher GDF-15 (p < 0.001), lower Klotho (p < 0.01), and poorer physical performance, whereas differences in muscle strength did not reach statistical significance.

CONCLUSION

This multimodal evaluation suggests a substantial burden of frailty and metabolic-nutritional alterations in HF. Integrating DEXA-derived metrics with emerging biomarkers such as Klotho and GDF-15 may help refine frailty characterization and inform future hypothesis-generating interventional studies.