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The effects of skeletal muscle and adipose tissue on outcomes in patients with heart failure

Nature Reviews Cardiology (2026)Cite this article

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We read with interest the Comment by Navin Suthahar (Redefining heart failure subtypes according to skeletal muscle mass. Nat. Rev. Cardiol. 23, 79–80; 2026)1, in which he proposes a new classification for heart failure (HF) based on preserved or reduced muscle mass. This concept represents an important step towards individualized treatment, but we believe that its three central underlying assumptions are not consistent with clinical and pathophysiological evidence and therefore require critical reconsideration.

First, we challenge the assumption that reduced skeletal muscle mass alone explains the positive association between body mass index and mortality in patients with HF. On the contrary, several studies have shown that a higher body adipose tissue mass is independently associated with improved survival in patients with HF, regardless of the method used to measure adipose tissue mass, such as the skinfold technique2, bioelectrical impedance analysis3, dual-energy X-ray absorptiometry4 or computed tomography5.

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Authors and Affiliations

  1. Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, Berlin, Germany

    Wolfram Doehner

  2. Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany

    Wolfram Doehner

  3. German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany

    Wolfram Doehner

  4. Department of Geriatrics and Medical Gerontology, Charité-Universitätsmedizin Berlin, Berlin, Germany

    Henning T. Langner

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  1. Wolfram Doehner
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  2. Henning T. Langner
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Correspondence to Wolfram Doehner.

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Doehner, W., Langner, H.T. The effects of skeletal muscle and adipose tissue on outcomes in patients with heart failure. Nat Rev Cardiol (2026). https://doi.org/10.1038/s41569-026-01268-w

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