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Abstract   Aims  We studied the association between android (A) to gynoid (G) fat ratio and functional capacity (peak VO 2 ) in male patients with heart failure with reduced ejection fraction (HFrEF).    Methods and results  We enrolled 118 male patients with HFrEF with left ventricular ejection fraction (LVEF) &lt;40%. Body composition (by using dual x‐ray absorptiometry) and peak VO 2  (by cardiopulmonary exercise testing) were measured. Sarcopenic obesity was defined according to the Foundation for the National Institutes of Health criteria (FNIH). Blood sample for metabolic and hormonal parameters were measured. Fifteen patients (12.7%) showed sarcopenic obesity (body mass index &gt; 25 kg/m 2  with FNIH index &lt; 0.789). The median A/G ratio was 0.55. A/G ratio &gt; 0.55 was detected in 60 patients. Relative peak VO 2  was lower in patients with A/G ratio &gt; 0.55 than in patients with A/G ratio &lt;0.55 (18.7 ± 5.3 vs. 22.5 ± 6.1 mL/kg/min,  P  &lt; 0.001). Logistic regression analysis showed A/G ratio &gt;0.55 to be independently associated with reduced peak VO 2  adjusted for age, body mass index, LVEF, presence of sarcopenia, anabolic hormones, and haemoglobin (odds ratio 3.895, 95% confidence interval 1.030–14.730,  P  = 0.045).    Conclusions  Body fat distribution, particularly android and gynoid fat composition, together with other cofactors, might have an important adverse role on functional capacity in male patients with HFrEF. Future studies are needed to address possible mechanisms involved in this relationship.

Android to gynoid fat ratio and its association with functional capacity in male patients with heart failure