Temporal Evaluation of the Metabolic Vulnerability Index and Its Components in a Heart Failure Clinical Trial Population

Abstract Background Heart failure (HF) is a complex syndrome with high mortality. The Metabolic Vulnerability Index (MVX) is a novel multimarker score derived from inflammation and malnutrition markers that has demonstrated prognostic value in patients with HF; however, changes in MVX over time have not been characterized. The purpose of this study was to evaluate change between baseline and 12-month measurements of the MVX and its components in an HF clinical trial population. Methods Nuclear magnetic resonance spectroscopy (NMR) MetaboProfile analyses (Labcorp) were performed on paired EDTA baseline and 12-month plasma samples collected from 46 HF patients with preserved ejection fraction (HFpEF) enrolled in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist Trial (TOPCAT) clinical trial to generate non-sex-specific MVX scores and component analytes. Paired t-tests were used to test the null hypothesis that the differences in paired population means between baseline and 12-months for MVX, or its components, were equal to 0. In sensitivity analyses, we evaluated whether differences in MVX or component values differed by drug status. Results In this sample, the mean (SD) age was 72.5 (9.2) years; 50% were female, and 89% were White. The prevalence of comorbidities was similar to the full TOPCAT population. MVX mean scores were not significantly different between baseline and 12-month measurements (mean difference = 1.52, 95% CI: −0.97 to 4.01, P = 0.225). Conclusions MVX scores appeared stable in this cohort over one year. Future studies should evaluate changes in serial measurements of MVX in a larger sample size.