Influence of Obesity on Invasive Hemodynamics and Prognosis in Patients With Heart Failure

BACKGROUND: Previous studies have suggested that obesity may cause heart failure with preserved left ventricular ejection and report strong association between body mass index (BMI) and invasive hemodynamics. However, sparse information exists in patients who have heart failure with reduced ejection fraction (HFrEF).

OBJECTIVES: This study aimed to investigate associations between BMI and invasive hemodynamics in patients with HFrEF and the influence of obesity on clinical outcomes.

METHODS: Referred patients with HFrEF evaluated for advanced heart failure were studied. All patients had right heart catheterization performed. Obesity was defined as BMI ≥30 kg/m2. Clinical events included death, heart transplantation, and durable left ventricular assist device implantation.

RESULTS: The study population comprises 578 patients with a mean age of 52 ± 13 years and BMI of 26 ± 5 kg/m2. Patients with obesity (BMI range: 30-45 kg/m2) counted 126 (22%) and had significantly higher cardiac output and slightly higher central venous pressure compared to patients without obesity. Cardiac output increased by 89 mL/min per 1-U increase in BMI. Vascular resistances were significantly inversely related to BMI. Pulmonary arterial pressure and pulmonary capillary wedge pressure were not associated with BMI. In patients with obesity, symptoms seem to be dissociated from filling pressures and cardiac index, whereas a clear association is observed in patients without. Obesity did not predict survival over a median follow-up of 5.9 years (Q1-Q3: 2.0-10.1 years).

CONCLUSIONS: In patients with HFrEF, BMI and CO correlate significantly. Symptoms and hemodynamics appear dissociated in patients with obesity. Finally, survival in patients with obesity did not differ from those without.