Sarcopenic Obesity Linked to Worse Heart Failure Outcomes in Diabetic Patients: Study Finds

"Patients with SO exhibited greater left ventricular enlargement, dysfunction, and increased mass, along with a threefold higher risk of adverse events (HR: 3.03) compared to those without sarcopenia or obesity. These results highlight the importance of targeted interventions to manage this high-risk population effectively," the researchers reported in Cardiovascular Diabetology.

Obesity is common among heart failure patients and is a key risk factor for its development. Maintaining greater skeletal muscle mass has been shown to protect against cardiac failure. However, diabetes can disrupt muscle protein metabolism, leading to muscle loss and fat accumulation. This combination, known as sarcopenic obesity, maybe a high-risk condition with poor outcomes, particularly in patients with heart failure with reduced ejection fraction.

Against the above background, Zhi-Gang Yang, Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China, and colleagues aimed to examine the clinical characteristics, LV remodeling, and long-term impact of SO in individuals with HFrEF and diabetes.

For this purpose, the researchers analyzed 283 patients using cardiac MRI, with thoracic skeletal muscle index (SMI) as a measure of muscle mass. Patients were classified based on median SMI (42.75 cm²/m²) and body mass index (25 kg/m²), identifying those with obesity and low SMI as having SO. LV volume, function, and systolic strain were evaluated, while clinical characteristics and cardiovascular outcomes, including heart failure readmission, cardiovascular mortality, and heart transplantation, were recorded.

The investigation revealed the following findings:

• Patients with sarcopenic obesity had higher levels of amino-terminal pro-B-type natriuretic peptides and were more likely to have hypoproteinemia compared to those with obesity but no sarcopenia.
• Among patients with obesity, those with sarcopenia showed greater left ventricular (LV) enlargement, more severe LV dysfunction, and increased LV mass.
• Over a median follow-up of 35.1 months, 25.8% (73 patients) experienced adverse outcomes, with the worst prognosis observed in the SO group.
• Multivariable Cox analysis indicated that patients with SO had a nearly threefold higher risk of adverse outcomes compared to those without sarcopenia or obesity (HR: 3.03).

The findings showed that sarcopenic obesity appears to be a high-risk condition in diabetic patients with heart failure with reduced ejection fraction, contributing to adverse left ventricular remodeling and poor clinical outcomes. Patients with SO exhibited significant structural and functional deterioration of the heart, including greater myocardial dysfunction and a higher likelihood of unfavorable events.

"These findings highlight the need for increased awareness, closer monitoring, and more targeted medical interventions to improve outcomes in this vulnerable group," the authors concluded.

Reference:

Shi, K., Zhang, G., Xu, R. et al. Association of body composition with left ventricular remodeling and outcomes in diabetic heart failure with reduced ejection fraction: assessment of sarcopenic obesity using cardiac MRI. Cardiovasc Diabetol 24, 79 (2025). https://doi.org/10.1186/s12933-025-02639-2