Sex-specific associations of obesity with exercise capacity and diastolic function in Koreans

Cardiopulmonary Exercise Testing in Heart Failure With Preserved Ejection Fraction: Technique Principles, Current Evidence, and Future Perspectives

Heart failure with preserved ejection fraction (HFpEF) is a multifactorial clinical syndrome involving a rather complex pathophysiologic substrate and quite a challenging diagnosis. Exercise intolerance is a major feature of HFpEF, and in many cases, diagnosis is suspected in subjects presenting with exertional dyspnea. Cardiopulmonary exercise testing (CPET) is a noninvasive, dynamic technique that provides an integrative evaluation of cardiovascular, pulmonary, hematopoietic, neuropsychological, and metabolic functions during maximal or submaximal exercise. The assessment is based on the principle that system failure typically occurs when the system is under stress, and thus, CPET is currently considered to be the gold standard for identifying exercise intolerance, allowing the differential diagnosis of underlying causes. CPET is used in observational studies and clinical trials in HFpEF; however, in most cases, only a few from a wide variety of CPET parameters are examined, while the technique is largely underused in everyday cardiology practice. This article discusses the basic principles and methodology of CPET and studies that utilized CPET in patients with HFpEF, in an effort to increase awareness of CPET capabilities among practicing cardiologists.

Heart Failure Preserved Ejection Fraction in Women: Insights Learned from Imaging

While the prevalence of heart failure, in general, is similar in men and women, women experience a higher rate of HFpEF compared to HFrEF. Cardiovascular risk factors, parity, estrogen levels, cardiac physiology, and altered response to the immune system may be at the root of this difference. Studies have found that in response to increasing age and hypertension, women experience more concentric left ventricle remodeling, more ventricular and arterial stiffness, and less ventricular dilation compared to men, which predisposes women to developing more diastolic dysfunction. A multi-modality imaging approach is recommended to identify patients with HFpEF. Particularly, appreciation of sex-based differences as described in this review is important in optimizing the evaluation and care of women with HFpEF.

Obesity-related hypertension and chronic kidney disease: from evaluation to management

With the recent obesity pandemic, obesity-related hypertension and its complications (e.g., heart failure, coronary disease, and chronic kidney disease [CKD]) are gaining attention in clinical and research fields. Obesity-related hypertension frequently precedes the onset of CKD and aggravates its progression. In this review, we discuss the role of visceral fat in the pathophysiology of obesity-related hypertension and the potential therapeutic strategies for its prevention and management. Various factors, including the sympathetic nervous system, renin-angiotensin-aldosterone system, and inflammatory pathways, are intricately involved in the pathogenesis of obesity-related hypertension. These factors individually and jointly contribute to the development of hypertension (usually sodium-sensitive or resistant hypertension) and, ultimately, to the progression of CKD. From a clinical standpoint, a decline in renal function in advanced CKD further makes blood pressure control challenging since only a few options are available for blood pressure-lowering medications. Proactive lifestyle modification, pharmacological treatment for obesity, and bariatric surgery can be considered for obesity control and management. Furthermore, intensive blood pressure control is required to prevent and halt the development and progression of CKD.

Exercise capacity and its determinants among postcardiac rehabilitation patients with coronary heart disease

AIM

To investigate the determinants of exercise capacity in postcardiac rehabilitation patients with coronary heart disease (CHD).

DESIGN

A cross-sectional design was used.

METHODS

This study analysed the cross-sectional data from the baseline assessment of 130 CHD patients who participated in a longitudinal randomized controlled trial of music-paced physical activity intervention for CHD patients (ChiCTR-IOR-17011015) (September 2017 to February 2019). Exercise capacity was measured by using the 10-metre incremental shuttle-walk test. The amount of physical activity, exercise self-determination and exercise self-efficacy were measured by validated instruments. Participants' anthropometric parameters (body mass index, body fat mass percentage and waist circumference) were measured. Hierarchical regression analyses were used to identify the factors influencing exercise capacity.

RESULTS

The mean incremental shuttle-walk test distance was 493.00 ± 180.04 m. The factors significantly associated with exercise capacity were age (β = -.42), female (β = -.35), body mass index (β = -.25) and exercise self-efficacy (β = -.20). These factors accounted for 56.5% of the total variance of exercise capacity.

Obesity-related heart failure with preserved ejection fraction: diagnostic and therapeutic challenges

The prevalence of heart failure with preserved ejection fraction (HFpEF) has increased in recent decades. In particular, obesity-related HFpEF is a distinct and frequently encountered phenotype; however, its diagnosis is complex. Furthermore, the management of obesity-related HFpEF has not been established despite the introduction of promising drugs. This review summarizes the diagnostic challenges, pathophysiology, and therapeutic options for obesity-related HFpEF.

Sinapic acid restores blood parameters, serum antioxidants, and liver and kidney functions in obesity

Obesity is an additional body fat that causes a harmful effect on human health while sinapic acid (SA) is a phyto-constituent presents in spices, citrus, berry fruits, and vegetables. This study evaluates SA to amend blood parameters, serum glucose, proteins, lipids, and antioxidants, and liver and kidney functions in obese rats. Thirty male albino rats were divided into 2 groups (normal and obese rats). The normal, non-obese rats subdivided into 2 subgroups; Control and SA (40 mg/kg) subgroup: daily oral intake of 1 ml saline and 40 mg/kg SA, respectively once a day. The obese rats subdivided also into 3 subgroups; Obese, Obese + SA (20 mg/kg), and Obese + SA (40 mg/kg)-treated groups which received no treatment, 20 mg/kg SA, and 40 mg/kg SA, respectively once a day. All treatments were orally administrated for 1 month. The results showed that obesity caused an increase in body and organ weight, serum total cholesterol, triglycerides, low density lipoproteins, malondialdehyde, nitric oxide, glucose, bilirubin and blood urea nitrogen while decrease serum superoxide dismutase, glutathione peroxidase, glutathione, glutathione reductase, glutathione-S-transferase, hemoglobin, hematocrite, red blood cells, white blood cells, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, urea, creatinine, and uric acid compared to control group. Obesity caused disappearance of prothrombin and fibrinogen proteins and damages to liver and kidney tissues. The oral administration with SA daily for 1 month in obese rats returned all these parameters to the control values where the higher dose of SA was more effective than the lower dose. In conclusion, SA restores body and organ weight, blood parameters, serum glucose, proteins, lipids, antioxidants, and liver and kidney functions in obesity.

Correlation between Cardiac Ultrasound Index and Cardiovascular Risk in Healthy Obese and Overweight Populations

OBJECTIVE

To investigate the correlation of obesity and overweight with cardiac ultrasound parameters and future cardiovascular risk among healthy populations.

METHODS

Basic clinical characteristics as well as cardiac ultrasound parameters were collected from healthy people. Firstly, all participants were divided into three groups: normal, overweight, and obese. Then the differences in cardiac ultrasound parameters between the three groups were calculated. Subsequently, those aged 35-60 years were screened to determine their cardiovascular risk according to the SCORE system. Finally, the correlation between cardiac ultrasound indices and cardiovascular risk was calculated.

RESULTS

A total of 1328 healthy participants were included, of whom 504 were normal, 580 were overweight and 244 were obese. Obesity and overweight significantly increased the aorta, left atrium, right atrium, right ventricle, the end-diastolic diameter of the left ventricle, main pulmonary artery, right ventricular outflow tract, interventricular septum, left ventricular posterior wall, and triglycerides and decreased E/A values and high-density lipoprotein-cholesterol. Ejection fraction, fractional shortening, low-density lipoprotein-cholesterol, and total cholesterol did not change between the three groups. A total of 781 participants were screened for SCORE scores. Obesity and being overweight significantly increased the incidence of future cardiovascular events, and lower E/A values were also associated with cardiovascular risk. All cardiac parameters were strongly associated with cardiovascular risk.

CONCLUSION

Our research demonstrates that obesity and overweight can damage heart shape and function and raise the risk of future cardiovascular events in people that are healthy. Cardiovascular risk and cardiac structural and functional impairments are significantly positively correlated.