title: Loss in body weight is an independent prognostic factor for mortality in chronic heart failure: insights from the GISSI-HF and Val-HeFT trials.
abstract: OBJECTIVE
  Uncertainties remain on the biological and prognostic significance and therapeutic implications of loss in body weight (W-LOSS) in chronic heart failure (HF) patients. We assessed whether W-LOSS added additional prognostic value to classical clinical risk factors in two separate and large cohorts of patients with chronic HF. The factors associated with W-LOSS were studied.
  
  
  RESULTS
  W-LOSS and estimated plasma volume changes were measured serially in the GISSI-HF (n = 6820) and Val-HeFT trials (n = 4892). In both studies, experiencing at least one episode of ≥5% W-LOSS during the first year of follow-up was considered a sign of wasting. In GISSI-HF, self-reported unintentional W-LOSS ≥2 kg between two consecutive clinical visits within 1 year was also considered a sign of wasting. W-LOSS occurred in 16.4% and 15.7% of the patients enrolled in GISSI-HF and Val-HeFT, respectively (unintentional ≥2 kg W-LOSS occurred in 18.9% in GISSI-HF). In multivariable analyses adjusting for a number of baseline covariates as well as for plasma volume changes, W-LOSS was found to be independently associated with mortality and adverse cardiovascular and non-cardiovascular outcomes, with a significant net reclassification improvement (cfNRI) and an increase in integrated discrimination improvement (IDI). W-LOSS was independently associated with several features representing the severity of HF, including baseline NT-proBNP and high sensitivity C-reactive protein (hsCRP) in Val-HeFT.
  
  
  CONCLUSIONS
  W-LOSS was a frequent finding in the GISSI-HF and Val-HeFT trials, associated with multiple patient features, and added additional prognostic information beyond clinical variables of HF severity, including estimated plasma volume changes.
authors.affiliation: INSERM, Centre d'Investigations Cliniques-Plurithématique 1433, Nancy, France; Université de Lorraine, France; INSERM U1116, Nancy, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Rossignol
authors.forename: Serge
authors.initials: S
authors.lastname: Masson
authors.forename: Simona
authors.initials: S
authors.lastname: Barlera
authors.forename: Nicolas
authors.initials: N
authors.lastname: Girerd
authors.forename: Angelo
authors.initials: A
authors.lastname: Castelnovo
authors.forename: Faiez
authors.initials: F
authors.lastname: Zannad
authors.forename: Francesco
authors.initials: F
authors.lastname: Clemenza
authors.forename: Gianni
authors.initials: G
authors.lastname: Tognoni
authors.forename: Inder S
authors.initials: IS
authors.lastname: Anand
authors.forename: Jay N
authors.initials: JN
authors.lastname: Cohn
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
authors.forename: Roberto
authors.initials: R
authors.lastname: Latini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002100:Cachexia / Q000378:metabolism; D002986:Clinical Trials as Topic; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D010953:Plasma Volume / Q000502:physiology*; D011379:Prognosis; D011446:Prospective Studies; D015431:Weight Loss / Q000502:physiology*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein
keywords: Cachexia; Heart failure; Plasma volume; Prognosis