Evidence Supporting the Existence of a Distinct Obese Phenotype of Heart Failure With Preserved Ejection Fraction

Article

关键词: LEFT-VENTRICULAR HYPERTROPHY;    INSULIN-RESISTANCE;    EXERCISE HEMODYNAMICS;    EUROPEAN ASSOCIATION;    NATRIURETIC PEPTIDES;    CENTRAL ADIPOSITY;    SYSTOLIC FUNCTION;    AMERICAN SOCIETY;    PERIVASCULAR FAT;    COMMUNITY;   

DOI  :  10.1161/CIRCULATIONAHA.116.026807

来源: SCIE

【 摘 要 】

BACKGROUND: Heart failure (HF) with preserved ejection fraction (HFpEF) is a heterogeneous syndrome. Phenotyping patients into pathophysiologically homogeneous groups may enable better targeting of treatment. Obesity is common in HFpEF and has many cardiovascular effects, suggesting that it may be a viable candidate for phenotyping. We compared cardiovascular structure, function, and reserve capacity in subjects with obese HFpEF, those with nonobese HFpEF, and control subjects. METHODS: Subjects with obese HFpEF (body mass index >= 35 kg/m(2); n=99), nonobese HFpEF (body mass index < 30 kg/m(2); n=96), and nonobese control subjects free of HF (n=71) underwent detailed clinical assessment, echocardiography, and invasive hemodynamic exercise testing. RESULTS: Compared with both subjects with nonobese HFpEF and control subjects, subjects with obese HFpEF displayed increased plasma volume (3907 mL [3563-4333 mL] versus 2772 mL [2555-3133 mL], and 2680 mL [2380-3006 mL]; P<0.0001), more concentric left ventricular remodeling, greater right ventricular dilatation (base, 34+/-7 versus 31+/-6 and 30+/-6 mm, P=0.0005; length, 66+/-7 versus 61+/-7 and 61+/-7 mm, P< 0.0001), more right ventricular dysfunction, increased epicardial fat thickness (10+/-2 versus 7+/-2 and 6+/-2 mm; P< 0.0001), and greater total epicardial heart volume (945 mL [831-1105 mL] versus 797 mL [643-979 mL] and 632 mL [517-768 mL]; P< 0.0001), despite lower N-terminal pro-B-type natriuretic peptide levels. Pulmonary capillary wedge pressure was correlated with body mass and plasma volume in obese HFpEF (r=0.22 and 0.27, both P< 0.05) but not in nonobese HFpEF (P >= 0.3). The increase in heart volumes in obese HFpEF was associated with greater pericardial restraint and heightened ventricular interdependence, reflected by increased ratio of right-to left-sided heart filling pressures (0.64+/-0.17 versus 0.56+/-0.19 and 0.53+/-0.20; P=0.0004), higher pulmonary venous pressure relative to left ventricular transmural pressure, and greater left ventricular eccentricity index (1.10+/-0.19 versus 0.99+/-0.06 and 0.97+/-0.12; P< 0.0001). Interdependence was enhanced as pulmonary artery pressure load increased (P for interaction < 0.05). Compared with those with nonobese HFpEF and control subjects, obese patients with HFpEF displayed worse exercise capacity (peak oxygen consumption, 7.7+/-2.3 versus 10.0+/-3.4 and12.9+/-4.0 mL/min . kg; P< 0.0001), higher biventricular filling pressures with exercise, and depressed pulmonary artery vasodilator reserve. CONCLUSIONS: Obesity-related HFpEF is a genuine form of cardiac failure and a clinically relevant phenotype that may require specific treatments.

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