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. 2023 Sep;29(9):1249-1256.
doi: 10.1016/j.cardfail.2023.02.016. Epub 2023 Mar 23.

Decoupling of Hemodynamics and Congestive Symptoms in Obese Patients With Heart Failure

Carson Keck  1 , Mathew Gregoski  2 , Sheldon Litwin  1 , Barry A Borlaug  3 , Marat Fudim  4 , Ryan J Tedford  1 , Brian A Houston  5
Affiliations

Decoupling of Hemodynamics and Congestive Symptoms in Obese Patients With Heart Failure

Carson Keck et al. J Card Fail. 2023 Sep.

Abstract

Background: Prior studies indicate significant physiological differences between obese and nonobese patients with heart failure (HF), but none have evaluated differences in hemodynamic patterns in these patient populations during treatment for acute decompensated HF (ADHF).

Objectives: In this study, we assessed differences in hemodynamic trends between obese and nonobese patients during treatment for ADHF.

Methods: Obese (body mass index (BMI) >30, n = 63) and nonobese (BMI < 25, n = 69) patients with ADHF in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) study who had pulmonary artery catheterization data available through the duration of treatment were evaluated. Hemodynamics were analyzed at baseline and optimal day. Changes in BNP levels, weight, creatinine, BUN, 6MWT, orthopnea and dyspnea scores were assessed.

Results: Despite similar baseline hemodynamics, obese patients had significantly less absolute and relative pulmonary arterial wedge pressure (PAWP) reduction (-16 ± 28 vs -32 ± 29%; P = 0.03) during treatment. Obese patients also had higher PAWPs (19.9 + 8 vs 15.5 + 6.8 mmHg; P = 0.01) and PA pressures at optimization compared with nonobese patients. Obese and nonobese patients had similar relative improvements in weight, BNP, 6-minute walk test distance, dyspnea and orthopnea scores, and similar changes in creatinine and BUN levels.

Conclusions: Obese patients treated for ADHF display less reduction in invasively measured left heart filling pressures, despite similar improvements in symptoms, weight loss, and noninvasive surrogates of congestion. Our findings suggest a degree of decoupling between left heart filling pressures and congestive symptoms in obese patients undergoing treatment for ADHF.

Keywords: Obesity; acute decompensated heart failure; hemodynamics.

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Conflict of interest statement

Disclosures The authors report no relationships that could be construed as a conflict of interest. SL serves on clinical trial committees and/or receives consulting fees from Alleviant, Axon, Corvia, CVRx, Eli Lilly, Occlutech, and Rivus. MF was supported by the National Heart, Lung, and Blood Institute (NHLBI) (K23HL151744), the American Heart Association (20IPA35310955), Doris Duke, Bayer, Bodyport, BTG Specialty Pharmaceuticals, and Verily and receives consulting fees from Abbott, Alleviant, Audicor, AxonTherapies, Bayer, Bodyguide, Bodyport, Boston Scientific, Cadence, Coridea, CVRx, Daxor, Deerfield Catalyst, Edwards LifeSciences, Feldschuh Foundation, Fire1, Gradient, Intershunt, Medtronic, NXT Biomedical, Pharmacosmos, PreHealth, Shifamed, Splendo, Sumacor, Vironix, Viscardia, Zoll. RJT reports no direct conflicts of interest related to this manuscript and reports general disclosures, including consulting relationships with Medtronic, Abbott, Aria CV, Acceleron, Alleviant, CareDx, Cytokinetics, Itamar, Edwards LifeSciences, Eidos Therapeutics, Lexicon Pharmaceuticals, and Gradient; he is the national principal investigator for the RIGHT-FLOW clinical trial (Edwards), serves on steering committees for Merck and Abbott as well as a research advisory board for Abiomed, and also does hemodynamic core lab work for Merck. BAB receives research support from the National Institutes of Health and the U.S. Department of Defense as well as research grant funding from AstraZeneca, Axon, GlaxoSmithKline, Medtronic, Mesoblast, Novo Nordisk, and Tenax Therapeutics and has served as a consultant for Actelion, Amgen, Aria, Axon Therapies, BD, Boehringer Ingelheim, Cytokinetics, Edwards Lifesciences, Eli Lilly, Imbria, Janssen, Merck, Novo Nordisk, NGM, NXT, and VADovations, and is named inventor (US Patent no. 10,307,179) for the tools and approach for a minimally invasive pericardial modification procedure to treat heart failure. BAH has consulting relationships with Edwards Lifesciences and Bioventrix and receives research grant funding from CVRx and Medtronic.

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