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Wang P, Zhao Y, Wang D, Wang B, Liu H, Fu G, Tao L, Tian G. Relationship between waist-to-height ratio and heart failure outcome: A single-centre prospective cohort study. ESC Heart Fail 2024. [PMID: 39287135 DOI: 10.1002/ehf2.15029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 08/02/2024] [Accepted: 08/06/2024] [Indexed: 09/19/2024] Open
Abstract
AIMS This study sought to evaluate the correlation between waist-to-height ratio (WHtR) and heart failure (HF) outcomes across different ejection fraction (EF) categories. METHODS AND RESULTS A prospective cohort study was conducted at a comprehensive tertiary hospital in China. The participants were categorized by WHtR and EF quartiles. Outpatient or telephone follow-up occurred every 6 months after the diagnosis of heart failure. The primary endpoint was all-cause mortality at 48 months. Cox proportional hazard regression analyses were employed to evaluate the association between WHtR and all-cause mortality. Among 859 enrolled participants, 545 (63.4%) were male, and the mean age was 65.2 ± 11.1 years. After adjusting for age and sex, WHtR demonstrated a strong correlation with both BMI (correlation = 0.703, P = 0.000) and WHR (correlation = 0.609, P = 0.000). Individuals with a high WHtR (≥0.50) had a higher prevalence of hypertension (56.4% vs. 39.6%) and diabetes (26.5% vs. 13.7%), higher levels of TC (3.61 ± 1.55 vs. 3.36 ± 0.90 mmol/L), TG (1.40 ± 0.81 vs. 1.06 ± 0.59 mmol/L), and LDL-C (2.03 ± 0.85 vs. 1.86 ± 0.76 mmol/L) compared with patients with low WHtR (<0.50). NT-proBNP levels were inversely correlated with EF values in both low and high WHtR groups. A total of 149 (18.9%) patients died at the conclusion of the follow-up period. The incidence of all-cause and cardiovascular death was higher in the low WHtR group compared with the high WHtR group [HRs = 1.83 (1.30-2.58), 1.96 (1.34-2.88), respectively]. There was no significant difference in noncardiovascular mortality or rehospitalization rates between the two groups. Patients with HFrEF/low WHtR exhibited a markedly elevated risk of all-cause mortality [HR = 2.31; (95% CI: 1.24-4.30)], heart failure mortality [HR = 3.52; (95% CI: 2.92-8.80)], and noncardiovascular mortality [HR = 4.59; (95% CI: 1.19-17.76)] compared with patients with HFrEF/high WHtR. WHtR has a negligible effect on the risk of all-cause and cardiovascular mortality in heart failure patients with preserved EFs. CONCLUSIONS The obesity paradox, as delineated by WHtR, is observed in patients with HFrEF, yet absent in those with HFpEF.
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Affiliation(s)
- Ping Wang
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Yang Zhao
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Danni Wang
- Department of Cardiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Boxiang Wang
- Department of Cardiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hange Liu
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Guotao Fu
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Ling Tao
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Gang Tian
- Department of Cardiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Karakasis P, Fragakis N, Patoulias D, Theofilis P, Sagris M, Koufakis T, Vlachakis PK, Rangraze IR, El Tanani M, Tsioufis K, Rizzo M. The Emerging Role of Glucagon-like Peptide-1 Receptor Agonists in the Management of Obesity-Related Heart Failure with Preserved Ejection Fraction: Benefits beyond What Scales Can Measure? Biomedicines 2024; 12:2112. [PMID: 39335625 PMCID: PMC11429383 DOI: 10.3390/biomedicines12092112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Revised: 09/09/2024] [Accepted: 09/12/2024] [Indexed: 09/30/2024] Open
Abstract
Obesity is a significant predisposing factor for heart failure with preserved ejection fraction (HFpEF). Although a substantial proportion of individuals with HFpEF also have obesity, those with obesity are under-represented in clinical trials for heart failure. In turn, current guidelines provided limited recommendations for the medical management of this patient population. Both obesity and diabetes induce a pro-inflammatory state that can contribute to endothelial dysfunction and coronary microvascular impairment, finally resulting in HFpEF. Additionally, obesity leads to increased epicardial and chest wall adiposity, which enhances ventricular interdependence. This condition is further aggravated by plasma and blood volume expansion and excessive vasoconstriction, ultimately worsening HFpEF. Despite the well-documented benefits of GLP-1 receptor agonists in subjects with diabetes, obesity, or both, their role in obesity-related HFpEF remains unclear. In light of the recently published literature, this review aims to investigate the potential mechanisms and synthesize the available clinical evidence regarding the role of GLP-1 receptor agonists in patients with obesity-related HFpEF.
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Affiliation(s)
- Paschalis Karakasis
- Second Department of Cardiology, Hippokration General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece
| | - Nikolaos Fragakis
- Second Department of Cardiology, Hippokration General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece
| | - Dimitrios Patoulias
- Second Propedeutic Department of Internal Medicine, Faculty of Medicine, School of Health Sciences Aristotle, University of Thessaloniki, 54642 Thessaloniki, Greece
| | - Panagiotis Theofilis
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Marios Sagris
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Theocharis Koufakis
- Second Propedeutic Department of Internal Medicine, Faculty of Medicine, School of Health Sciences Aristotle, University of Thessaloniki, 54642 Thessaloniki, Greece
| | - Panayotis K Vlachakis
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Imran Rashid Rangraze
- Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah P.O. Box 11172, United Arab Emirates
| | - Mohamed El Tanani
- Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah P.O. Box 11172, United Arab Emirates
| | - Konstantinos Tsioufis
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Manfredi Rizzo
- Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah P.O. Box 11172, United Arab Emirates
- School of Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (Promise), University of Palermo, 90100 Palermo, Italy
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Fu K, Dong Y, Wang Z, Teng J, Cheng C, Su C, Ji X, Lu H. The role of body composition in left ventricular remodeling, reverse remodeling, and clinical outcomes for heart failure with mildly reduced ejection fraction: more knowledge to the "obesity paradox". Cardiovasc Diabetol 2024; 23:334. [PMID: 39261931 PMCID: PMC11391770 DOI: 10.1186/s12933-024-02430-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Accepted: 09/03/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND Although the "obesity paradox" is comprehensively elucidated in heart failure (HF) with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF), the role of body composition in left ventricular (LV) remodeling, LV reverse remodeling (LVRR), and clinical outcomes is still unclear for HF with mildly reduced ejection fraction (HFmrEF). METHODS Our study is a single-centre, prospective, and echocardiography-based study. Consecutive HFmrEF patients, defined as HF patients with a left ventricular ejection fraction (LVEF) between 40 and 49%, between January 2016 to December 2021 were included. Echocardiography was re-examined at 3-, 6-, and 12-month follow-up to assess the LVRR dynamically. Body mass index (BMI), fat mass, fat-free mass, percent body fat (PBF), CUN-BAE index, and lean mass index (LMI) were adopted as anthropometric parameters in our study to assess body composition. The primary outcome was LVRR, defined as: (1) a reduction higher than 10% in LV end-diastolic diameter index (LVEDDI), or a LVEDDI < 33 mm/m2, (2) an absolute increase of LVEF higher than 10 points compared with baseline echocardiogram, or a follow-up LVEF ≥50%. The secondary outcome was a composite of re-hospitalization for HF or cardiovascular death. RESULTS A total of 240 HFmrEF patients were enrolled in our formal analysis. After 1-year follow-up based on echocardiography, 113 (47.1%) patients developed LVRR. Patients with LVRR had higher fat mass (21.7 kg vs. 19.3 kg, P = 0.034) and PBF (28.7% vs. 26.6%, P = 0.047) compared with those without. The negative correlation between anthropometric parameters and baseline LVEDDI was significant (all P < 0.05). HFmrEF patients with higher BMI, fat mass, PBF, CUN-BAE index, and LMI had more pronounced and persistent increase of LVEF and decline in LV mass index (LVMI). Univariable Cox regression analysis revealed that higher BMI (HR 1.042, 95% CI 1.002-1.083, P = 0.037) and fat mass (HR 1.019, 95% CI 1.002-1.036, P = 0.026) were each significantly associated with higher cumulative incidence of LVRR for HFmrEF patients, while this relationship vanished in the adjusted model. Mediation analysis indicated that the association between BMI and fat mass with LVRR was fully mediated by baseline LV dilation. Furthermore, higher fat mass (aHR 0.957, 95% CI 0.917-0.999, P = 0.049) and PBF (aHR 0.963, 95% CI 0.924-0.976, P = 0.043) was independently associated with lower risk of adverse clinical events. CONCLUSIONS Body composition played an important role in the LVRR and clinical outcomes for HFmrEF. For HFmrEF patients, BMI and fat mass was positively associated with the cumulative incidence of LVRR, while higher fat mass and PBF predicted lower risk of adverse clinical events but not LMI.
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Affiliation(s)
- Kang Fu
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Jinan, China
- Department of Cardiology, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Shandong University, Jinan, China
| | - Youran Dong
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Jinan, China
- Department of Cardiology, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Shandong University, Jinan, China
| | - Zhiyuan Wang
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Jinan, China
- Department of Cardiology, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Shandong University, Jinan, China
| | - Junlin Teng
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Jinan, China
- Department of Cardiology, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Shandong University, Jinan, China
| | - Congyi Cheng
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Jinan, China
- Department of Cardiology, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Shandong University, Jinan, China
| | - Cong Su
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Jinan, China
- Department of Cardiology, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Shandong University, Jinan, China
| | - Xiaoping Ji
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Jinan, China.
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Jinan, China.
- Department of Cardiology, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Shandong University, Jinan, China.
| | - Huixia Lu
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Jinan, China.
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Jinan, China.
- Department of Cardiology, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Shandong University, Jinan, China.
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Salvino NFA, de Sousa LT, Abrahao FM, Spineti PPDM, Sales ALF, Neves de Albuquerque F, Bittencourt MI, de Moraes PCB, Esporcatte R, Mourilhe-Rocha R. Is the obesity paradox in outpatients with heart failure reduced ejection fraction real? Front Cardiovasc Med 2023; 10:1239722. [PMID: 38149266 PMCID: PMC10750383 DOI: 10.3389/fcvm.2023.1239722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/20/2023] [Indexed: 12/28/2023] Open
Abstract
Background The obesity occurrence has achieved epidemic levels worldwide and several studies indicate a paradoxical similarity among obesity and the prognosis in heart failure (HF). The primary objective was to understand the association between body mass index (BMI) and heart failure with reduced ejection fraction (HFREF) of ischemic etiology in outpatients, using mortality as a parameter. The secondary objectives were to determine the differences in HF functional class, pharmacological therapy and evaluate the prognostic value of MAGGIC Score in this population. Methods We analyzed 1,556 medical records from the HF outpatient clinic of a quaternary hospital and 242 were selected according to the criteria. Most were male, average age 62.6 (56-70), BMI 18.5-24.9 = 35.1%, 25-29.9 = 37.2%, 30-34.9 = 17.8%, 35-39.9 = 7%; BMI <18.5 and >40 groups were eliminated from the central analyzes because of scarce testing. Results BMI 30-34.9 and BMI 18.5-24.9 had the best prognosis, BMI 25-29.9 had an average performance, and BMI -39.9 group provided the worst outcome (p = 0.123). In the subcategory analysis, BMI 30-34.9 group had a better prognosis compared to the BMI 35-39.9 group (p = 0.033). In the multivariate analysis The MAGGIC score was not able to foretell mortality in this population according to BMI. Conclusion In not hospitalized patients with HFREF of ischemic etiology, obesity was not a protective factor.
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Affiliation(s)
- Nathália Felix Araujo Salvino
- Serviço e Disciplina de Cardiologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- Complexo Hospital Americas - Vitória e Samaritano - Barra da Tijuca, Rio de Janeiro, Brazil
| | | | - Fabio Maia Abrahao
- Serviço e Disciplina de Cardiologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Ana Luiza Ferreira Sales
- Serviço e Disciplina de Cardiologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Pedro Castello Branco de Moraes
- Serviço e Disciplina de Cardiologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- Complexo Hospital Americas - Vitória e Samaritano - Barra da Tijuca, Rio de Janeiro, Brazil
| | - Roberto Esporcatte
- Serviço e Disciplina de Cardiologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ricardo Mourilhe-Rocha
- Serviço e Disciplina de Cardiologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- Complexo Hospital Americas - Vitória e Samaritano - Barra da Tijuca, Rio de Janeiro, Brazil
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Huang L, Zhao X, Liang L, Tian P, Chen Y, Zhai M, Huang Y, Zhou Q, Zhang Y, Zhang J. Obesity Paradox in Heart Failure Revisited: Etiology as Effect Modifier. Am J Cardiol 2023; 207:294-301. [PMID: 37769574 DOI: 10.1016/j.amjcard.2023.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 08/27/2023] [Accepted: 09/06/2023] [Indexed: 10/03/2023]
Abstract
The prognostic value of overweight/obesity in heart failure (HF) may vary according to HF etiologies. We aim to determine whether body mass index has differential impacts on survival among hospitalized HF patients with varying etiologies. Consecutive hospitalized HF patients between December 2006 and December 2017 were included. Multivariable analyses, including Cox proportional hazard models and restricted cubic splines, were used to investigate the impact of body mass index on mortality by HF etiology. Among the 3,836 patients included (mean age 57.1 years, 28.4% women), 1,475 (38.5%) were identified as having ischemic etiology. Of the remaining 2,361 patients with non-ischemic etiologies, dilated cardiomyopathy (DCM) accounted for 45.6% (n = 1,077). The rest of the patients were uniformly classified as having non-ischemic-non-DCM HF. The unadjusted data demonstrated an adiposity-related survival paradox in HF across all etiologies. However, the paradox holds only among non-ischemic-non-DCM HF patients after multivariate adjustment, wherein overweight patients exhibit the lowest mortality compared with their normal-weight counterparts (adjusted hazard ratio [aHR] 0.69, 95% confidence interval [CI] 0.52 to 0.91), with a nadir in mortality risk at 28.18 kg/m2. Similar survival benefits of overweight were not demonstrated in ischemic or DCM HF patients (ischemic etiology: aHR 1.07, 95% CI 0.84 to 1.36; DCM etiology: aHR 0.97, 95% CI 0.74 to 1.28). In conclusion, being overweight or obese does not confer better survival in HF patients of ischemic or DCM etiology, and the prognostic benefit of being overweight is maintained only in non-ischemic-non-DCM HF patients. Pathophysiologic interpretations are warranted, and whether patients of certain etiologies would benefit from weight reduction needs to be explored.
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Affiliation(s)
- Liyan Huang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Xuemei Zhao
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Lin Liang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Pengchao Tian
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Yuyi Chen
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Mei Zhai
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Yan Huang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Qiong Zhou
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Yuhui Zhang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, China.
| | - Jian Zhang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, China.
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Abumayyaleh M, Demmer J, Krack C, Pilsinger C, El-Battrawy I, Aweimer A, Lang S, Mügge A, Akin I. Incidence of atrial and ventricular arrhythmias in obese patients with heart failure with reduced ejection fraction treated with sacubitril/valsartan. Diabetes Obes Metab 2023; 25:2999-3011. [PMID: 37417372 DOI: 10.1111/dom.15198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/11/2023] [Accepted: 06/13/2023] [Indexed: 07/08/2023]
Abstract
AIM To compare clinical outcomes among patients with heart failure and reduced ejection fraction (HFrEF) according to body mass index (BMI) after initiating treatment with an angiotensin-receptor neprilysin inhibitor (ARNI). METHODS We gathered data from 2016 to 2020 at the University Medical Center Mannheim; 208 consecutive patients were divided into two groups according to BMI (< 30 kg/m2 ; n = 116, ≥ 30 kg/m2 ; n = 92). Clinical outcomes, including mortality rate, all-cause hospitalizations and congestion, were systematically analysed. RESULTS At the 12-month follow-up, the mortality rate was similar in both groups (7.9% in BMI < 30 kg/m2 vs. 5.6% in BMI ≥ 30 kg/m2 ; P = .76). All-cause hospitalization before ARNI treatment was comparable in both groups (63.8% in BMI < 30 kg/m2 vs. 57.6% in BMI ≥ 30 kg/m2 ; P = .69). After ARNI treatment, the hospitalization rate was also comparable in both groups at the 12-month follow-up (52.2% in BMI < 30 kg/m2 vs. 53.7% in BMI ≥ 30 kg/m2 ; P = .73). Obese patients experienced more congestion compared with non-obese patients at follow-up, without statistical significance (6.8% in BMI < 30 kg/m2 vs. 15.5% in BMI ≥ 30 kg/m2 ; P = .11). Median left ventricular ejection fraction (LVEF) improved in both groups, but significantly more in non-obese compared with obese patients at the 12-month follow-up (from 26% [3%-45%] [min.-max.] vs. 29% [10%-45%] [min.-max.] [P = .56] to 35.5% [15%-59%] [min.-max.] vs. 30% [13%-50%] [min.-max.] [P = .03], respectively). The incidence of atrial fibrillation (AF), non-sustained (ns) and sustained ventricular tachycardia (VT) and ventricular fibrillation (VF) was less in non-obese than in obese patients after initiation of sacubitril/valsartan at the 12-month follow-up (AF: 43.5% vs. 53.7%; P = .20; nsVT: 9.8% vs. 28.4%; P = .01; VT: 14.1% vs. 17.9%; P = .52; VF: 7.6% vs. 13.4%; P = .23). CONCLUSIONS The incidence of congestion in obese patients was higher compared with non-obese patients. LVEF improved significantly more in non-obese compared with obese HFrEF patients. Furthermore, AF and the ventricular tachyarrhythmia rate were revealed more in obesity compared with those without obesity at the 12-month follow-up.
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Affiliation(s)
- Mohammad Abumayyaleh
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Jonathan Demmer
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Carina Krack
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Christina Pilsinger
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Ibrahim El-Battrawy
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
- Department of Molecular and Experimental Cardiology, Institut für Forschung und Lehre (IFL), Ruhr University of Bocham, Bochum, Germany
| | - Assem Aweimer
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
| | - Siegfried Lang
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Andreas Mügge
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
- Department of Molecular and Experimental Cardiology, Institut für Forschung und Lehre (IFL), Ruhr University of Bocham, Bochum, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
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Prausmüller S, Weidenhammer A, Heitzinger G, Spinka G, Goliasch G, Arfsten H, Abdel Mawgoud R, Gabler C, Strunk G, Hengstenberg C, Hülsmann M, Bartko PE, Pavo N. Obesity in heart failure with preserved ejection fraction with and without diabetes: risk factor or innocent bystander? Eur J Prev Cardiol 2023; 30:1247-1254. [PMID: 37210596 DOI: 10.1093/eurjpc/zwad140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/28/2023] [Accepted: 05/04/2023] [Indexed: 05/22/2023]
Abstract
AIMS Heart failure with preserved ejection fraction (HFpEF) is a condition that commonly coexists with type 2 diabetes mellitus (T2DM) and obesity. Whether the obesity-related survival benefit generally observed in HFpEF extends to individuals with concomitant T2DM is unclear. This study sought to examine the prognostic role of overweight and obesity in a large cohort of HFpEF with and without T2DM. METHODS AND RESULTS This large-scale cohort study included patients with HFpEF enrolled between 2010 and 2020. The relationship between body mass index (BMI), T2DM, and survival was assessed. A total of 6744 individuals with HFpEF were included, of which 1702 (25%) had T2DM. Patients with T2DM had higher BMI values (29.4 kg/m2 vs. 27.1 kg/m2, P < 0.001), higher N-terminal pro-brain natriuretic peptide values (864 mg/dL vs. 724 mg/dL, P < 0.001), and a higher prevalence of numerous risk factors/comorbidities than those without T2DM. During a median follow-up time of 47 months (Q1-Q3: 20-80), 2014 (30%) patients died. Patients with T2DM had a higher incidence of fatal events compared with those without T2DM, with a mortality rate of 39.2% and 26.7%, respectively (P < 0.001). In the overall cohort, using the BMI category 22.5-24.9 kg/m2 as the reference group, the unadjusted hazard ratio (HR) for all-cause death was increased in patients with BMI <22.5 kg/m2 [HR: 1.27 (confidence interval 1.09-1.48), P = 0.003] and decreased in BMI categories ≥25 kg/m2. After multivariate adjustment, BMI remained significantly inversely associated with survival in non-T2DM, whereas survival was unaltered at a wide range of BMI in patients with T2DM. CONCLUSION Among the various phenotypes of HFpEF, the T2DM phenotype is specifically associated with a greater disease burden. Higher BMI is linked to improved survival in HFpEF overall, while this effect neutralises in patients with concomitant T2DM. Advising BMI-based weight targets and weight loss may be pursued with different intensity in the management of HFpEF, particularly in the presence of T2DM.
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Affiliation(s)
- Suriya Prausmüller
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria
| | - Annika Weidenhammer
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria
| | - Gregor Heitzinger
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria
| | - Georg Spinka
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria
| | - Georg Goliasch
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria
| | - Henrike Arfsten
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria
| | - Ramy Abdel Mawgoud
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria
| | - Cornelia Gabler
- IT Systems and Communications, Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria
| | - Guido Strunk
- Complexity Research, Schönbrunner Straße 32, Vienna 1050, Austria
| | - Christian Hengstenberg
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria
| | - Martin Hülsmann
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria
| | - Philipp E Bartko
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria
| | - Noemi Pavo
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria
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8
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Aga YS, Radhoe SP, Aydin D, Linssen GCM, Rademaker PC, Geerlings PR, van Gent MWF, Aksoy I, Oosterom L, Brunner-La Rocca HP, van Dalen BM, Brugts JJ. Heart failure treatment in patients with and without obesity with an ejection fraction below 50. Eur J Clin Invest 2023:e13976. [PMID: 36841951 DOI: 10.1111/eci.13976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND The aim of this study was to assess heart failure (HF) treatment in patients with and without obesity in a large contemporary real-world Western European cohort. METHODS Patients with a left ventricular ejection fraction (LVEF) <50% and available information on body mass index (BMI) were selected from the CHECK-HF registry. The CHECK-HF registry included chronic HF patients in the period between 2013 and 2016 in 34 Dutch outpatient clinics. Patients were divided into BMI categories. Differences in HF medical treatment were analysed, and multivariable logistic regression analysis (dichotomized as BMI <30 kg/m2 and ≥30 kg/m2 ) was performed. RESULTS Seven thousand six hundred seventy-one patients were included, 1284 (16.7%) had a BMI ≥30 kg/m2 , and 618 (8.1%) had a BMI ≥35 kg/m2 . Median BMI was 26.4 kg/m2 . Patients with obesity were younger and had a higher rate of comorbidities such as diabetes mellitus, hypertension and obstructive sleep apnoea (OSAS). Prescription rates of guideline-directed medical therapy (GDMT) increased significantly with BMI. The differences were most pronounced for mineralocorticoid receptor antagonists (MRAs) and diuretics. Patients with obesity more often received the guideline-recommended target dose. In multivariable logistic regression, obesity was significantly associated with a higher likelihood of receiving ≥100% of the guideline-recommended target dose of beta-blockers (OR 1.34, 95% CI 1.10-1.62), renin-angiotensin system (RAS)-inhibitors (OR 1.34, 95% CI 1.15-1.57) and MRAs (OR 1.40, 95% CI 1.04-1.87). CONCLUSIONS Guideline-recommended HF drugs are more frequently prescribed and at a higher dose in patients with obesity as compared to HF patients without obesity.
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Affiliation(s)
- Yaar S Aga
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Cardiology, Thoraxcenter, Franciscus Gasthuis & Vlietland, Rotterdam, Rotterdam, The Netherlands
| | - Sumant P Radhoe
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Dilan Aydin
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - G C M Linssen
- Department of Cardiology, Ziekenhuisgroep Twente, Almelo and Hengelo, Almelo, The Netherlands
| | - Philip C Rademaker
- Department of Cardiology, ZorgZaam Ziekenhuis, Terneuzen, The Netherlands
| | | | - Marco W F van Gent
- Department of Cardiology, Albert Schweitzer Ziekenhuis, Dordrecht, The Netherlands
| | - Ismail Aksoy
- Department of Cardiology, Admiraal De Ruyter Ziekenhuis, Goes, The Netherlands
| | - Liane Oosterom
- Department of Cardiology, Noordwest Ziekenhuis Groep, Alkmaar, The Netherlands
| | | | - Bas M van Dalen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Cardiology, Thoraxcenter, Franciscus Gasthuis & Vlietland, Rotterdam, Rotterdam, The Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
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9
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Gitto M, Villaschi A, Federici M, Condorelli G, Stefanini GG. The Emerging Role of Sodium-glucose Cotransporter 2 Inhibitors in Heart Failure. Curr Pharm Des 2023; 29:481-493. [PMID: 36799420 DOI: 10.2174/1381612829666230217143324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/24/2022] [Accepted: 12/30/2022] [Indexed: 02/18/2023]
Abstract
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are a relatively novel drug class that most cardiologists are becoming familiar with. By contrasting glucose reabsorption in the proximal convoluted tubule of the nephron, SGLT2 inhibition results in glycosuria with improved glycemic control. Although originally introduced as anti-diabetic medications, the cardiovascular effects of SGLT2i have progressively emerged, leading them to become one of the four pillars for the treatment of heart failure with reduced ejection fraction (HFrEF) according to the 2021 guidelines from the European Society of Cardiology. Also, two recent randomized trials have demonstrated SGLT2i as the first compounds with proven prognostic impact in heart failure with preserved ejection fraction (HFpEF), setting a milestone in the treatment for this condition. While the exact pathogenic mechanisms mediating the substantial reduction in cardiovascular death and heart failure (HF) hospitalizations are still controversial, there is growing clinical evidence on the efficacy and safety of SGLT2i in various subsets of patients with HF. As known, heart failure is a complex and heterogeneous clinical syndrome with a magnitude of phenotypes and a variety of underlying hemodynamic and physiological aspects which cannot be fully incorporated into the traditional left ventricular ejection fraction based classification adopted in clinical trials. The aim of this review is to provide an overview of the cardiovascular benefits and indications of SGLT2i across different HF patterns and to highlight current gaps in knowledge that should be addressed by future research.
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Affiliation(s)
- Mauro Gitto
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Alessandro Villaschi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Massimo Federici
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Center for Atherosclerosis, Policlinico Tor Vergata, Rome, Italy
| | - Gianluigi Condorelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Giulio G Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
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10
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Zhao H, Li P, Zhong G, Xie K, Zhou H, Ning Y, Xu D, Zeng Q. Machine learning models in heart failure with mildly reduced ejection fraction patients. Front Cardiovasc Med 2022; 9:1042139. [DOI: 10.3389/fcvm.2022.1042139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/14/2022] [Indexed: 12/05/2022] Open
Abstract
ObjectiveHeart failure with mildly reduced ejection fraction (HFmrEF) has been recently recognized as a unique phenotype of heart failure (HF) in current practical guideline. However, risk stratification models for mortality and HF re-hospitalization are still lacking. This study aimed to develop and validate a novel machine learning (ML)-derived model to predict the risk of mortality and re-hospitalization for HFmrEF patients.MethodsWe assessed the risks of mortality and HF re-hospitalization in HFmrEF (45–49%) patients enrolled in the TOPCAT trial. Eight ML-based models were constructed, including 72 candidate variables. The Harrell concordance index (C-index) and DeLong test were used to assess discrimination and the improvement in discrimination between models, respectively. Calibration of the HF risk prediction model was plotted to obtain bias-corrected estimates of predicted versus observed values.ResultsLeast absolute shrinkage and selection operator (LASSO) Cox regression was the best-performing model for 1- and 6-year mortality, with a highest C-indices at 0.83 (95% CI: 0.68–0.94) over a maximum of 6 years of follow-up and 0.77 (95% CI: 0.64–0.89) for the 1-year follow-up. The random forest (RF) showed the best discrimination for HF re-hospitalization, scoring 0.80 (95% CI: 0.66–0.94) and 0.85 (95% CI: 0.71–0.99) at the 6- and 1-year follow-ups, respectively. For risk assessment analysis, Kansas City Cardiomyopathy Questionnaire (KCCQ) subscale scores were the most important predictor of readmission outcome in the HFmrEF patients.ConclusionML-based models outperformed traditional models at predicting mortality and re-hospitalization in patients with HFmrEF. The results of the risk assessment showed that KCCQ score should be paid increasing attention to in the management of HFmrEF patients.
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11
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Halasz G, Piepoli MF. Focus on sport cardiology and exercise. Eur J Prev Cardiol 2022; 29:1579-1581. [PMID: 36070488 DOI: 10.1093/eurjpc/zwac165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Geza Halasz
- Cardiac Unit, G. da Saliceto Hospital, AUSL Piacenza, Piacenza, 29121, Italy
| | - Massimo F Piepoli
- Clinical Cardiology, Policlinico San Donato, University of Milan, San Donato Milanese, 20097, Italy.,Department of Preventive Cardiology, Wroclaw Medical University, Wroclaw, Poland
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12
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Zeng S, Cai X, Zheng Y, Liu X, Ye M. Associations of body mass index with mortality in heart failure with preserved ejection fraction patients with ischemic versus non-ischemic etiology. Front Cardiovasc Med 2022; 9:966745. [PMID: 35990945 PMCID: PMC9386382 DOI: 10.3389/fcvm.2022.966745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundObesity could paradoxically improve prognosis in patients with heart failure (HF), termed the “obesity paradox.” Whether HF etiology could modify the “obesity paradox” is still controversial. In the present study, we aimed to assess the relationship between obesity and death in patients with heart failure with preserved ejection fraction (HFpEF) with non-ischemic versus ischemic etiologies.MethodsWe analyzed 3,360 HFpEF patients from the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) trial. Cox regression models were used to assess the association of obesity assessed by body mass index (BMI) with short-term and long-term death risk.ResultsOverweight and obesity were associated with a lower risk of long-term all-cause death in patients with non-ischemic HFpEF, even in those with class III obesity (adjusted HR: 0.61, 95% CI 0.38–0.97). However, in the ischemic subgroup, as obesity advanced, this paradoxical relationship was gradually attenuated and disappeared in class III obesity (adjusted HR: 0.93, 95% CI 0.56–1.57). Restricted cubic spline analyses confirmed the differential relationship of baseline BMI with risk of long-term death with a BMI higher than 30 kg/m2 in non-ischemic versus ischemic HFpEF. In the short-term follow-up, the beneficial effects of overweight and obesity on survival were consistently observed in all the BMI categories, with the nadirs of all-cause death risk at class III obesity category both in non-ischemic and ischemic subgroups.Conclusion“Obesity paradox” was evident both in non-ischemic and ischemic HFpEF during short-term follow-up, even in those with class III obesity. However, the beneficial effect of class III obesity disappeared during long-term follow-up in ischemic HFpEF.Clinical Trial Registration[https://clinicaltrials.gov], identifier [NCT00094302].
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Affiliation(s)
- Shan Zeng
- Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases, Department of Cardiology, First Affiliated Hospital, Ministry of Education, Gannan Medical University, Ganzhou, China
| | - Xingming Cai
- Department of Geriatric, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuxiang Zheng
- Second Clinical Medical College, Nanchang University, Nanchang, China
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao Liu
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Xiao Liu,
| | - Min Ye
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Min Ye,
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13
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Prausmüller S, Heitzinger G, Pavo N, Spinka G, Goliasch G, Arfsten H, Gabler C, Strunk G, Hengstenberg C, Hülsmann M, Bartko PE. Malnutrition outweighs the effect of the obesity paradox. J Cachexia Sarcopenia Muscle 2022; 13:1477-1486. [PMID: 35352504 PMCID: PMC9178364 DOI: 10.1002/jcsm.12980] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/08/2022] [Accepted: 02/21/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND High body mass index (BMI) is paradoxically associated with better outcome in patients with heart failure (HF). The effects of malnutrition on this phenomenon across the whole spectrum of HF have not yet been studied. METHODS In this observational study, patients were classified by guideline diagnostic criteria to one of three heart failure subtypes: reduced (HFrEF), mildy reduced (HFmrEF), and preserved ejection fraction (HFpEF). Data were retrieved from the Viennese-community healthcare provider network between 2010 and 2020. The relationship between BMI, nutritional status reflected by the prognostic nutritional index (PNI), and survival was assessed. Patients were classified by the presence (PNI < 45) or absence (PNI ≥ 45) of malnutrition. RESULTS Of the 11 995 patients enrolled, 6916 (58%) were classified as HFpEF, 2809 (23%) HFmrEF, and 2270 HFrEF (19%). Median age was 70 years (IQR 61-77), and 67% of patients were men. During a median follow-up time of 44 months (IQR 19-76), 3718 (31%) of patients died. After adjustment for potential confounders, BMI per IQR increase was independently associated with better survival (adj. hazard ratio [HR]: 0.91 [CI 0.86-0.97], P = 0.005), this association remained significant after additional adjustment for HF type (adj. HR: 0.92 [CI 0.86-0.98], P = 0.011). PNI was available in 10 005 patients and lowest in HFrEF patients. PNI was independently associated with improved survival (adj. HR: 0.96 [CI 0.95-0.97], P < 0.001); additional adjustment for HF type yielded similar results (adj. HR: 0.96 [CI 0.96-0.97], P < 0.001). Although obese patients experienced a 30% risk reduction, malnutrition at least doubled the risk for death with 1.8- to 2.5-fold higher hazards for patients with poor nutritional status compared with normal weight well-nourished patients. CONCLUSIONS The obesity paradox seems to be an inherent characteristic of HF regardless of phenotype and nutritional status. Yet malnutrition significantly changes trajectory of outcome with regard to BMI alone: obese patients with malnutrition have a considerably worse outcome compared with their well-nourished counterparts, outweighing protective effects of high BMI alone. In this context, routine recommendation towards weight loss in patients with obesity and HF should generally be made with caution and focus should be shifted on nutritional status.
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Affiliation(s)
- Suriya Prausmüller
- Division of Cardiology, Department of Internal Medicine, IIMedical University of ViennaViennaAustria
| | - Gregor Heitzinger
- Division of Cardiology, Department of Internal Medicine, IIMedical University of ViennaViennaAustria
| | - Noemi Pavo
- Division of Cardiology, Department of Internal Medicine, IIMedical University of ViennaViennaAustria
| | - Georg Spinka
- Division of Cardiology, Department of Internal Medicine, IIMedical University of ViennaViennaAustria
| | - Georg Goliasch
- Division of Cardiology, Department of Internal Medicine, IIMedical University of ViennaViennaAustria
| | - Henrike Arfsten
- Division of Cardiology, Department of Internal Medicine, IIMedical University of ViennaViennaAustria
| | - Cornelia Gabler
- IT Systems and CommunicationsMedical University of ViennaViennaAustria
| | | | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine, IIMedical University of ViennaViennaAustria
| | - Martin Hülsmann
- Division of Cardiology, Department of Internal Medicine, IIMedical University of ViennaViennaAustria
| | - Philipp E. Bartko
- Division of Cardiology, Department of Internal Medicine, IIMedical University of ViennaViennaAustria
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14
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Li S, Zheng Y, Huang Y, He W, Liu X, Zhu W. Association of body mass index and prognosis in patients with HFpEF: A dose-response meta-analysis. Int J Cardiol 2022; 361:40-46. [PMID: 35568057 DOI: 10.1016/j.ijcard.2022.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although agreements regarding the negative effects of obesity on the development of heart failure with preserved ejection fraction (HFpEF) have been reached, the relationship between body mass index (BMI) and adverse outcomes in HFpEF patients are still debatable. Therefore, we conducted the dose-response meta-analysis to investigate this relationship. METHODS We searched the PubMed and Embase databases up to February 2022 for studies that evaluated the association between BMI and prognostic outcomes in patients with HFpEF. A cubic spline random-effects model was used to fit the potential dose-response curve. The effect estimates were expressed as adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS A total of 11 studies involving 69,273 patients with HFpEF were included. The summary HR for all-cause mortality was 0.90 (95% CI, 0.84-0.95) per 5 units increase in BMI, but the association was U-shaped (Pnonlinear < 0.01) with the nadir of risk at a BMI of 32-34 kg/m2. The summary HR for HF hospitalization was 1.12 (95% CI, 1.05-1.19) with a significant positive linear association (Pnonlinear = 0.54). CONCLUSIONS For patients with HFpEF, there was a positive linear association of BMI with HF hospitalization, while a U-shaped relationship between BMI and all-cause mortality was observed with the lowest event rate at a BMI of 32-34 kg/m2.
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Affiliation(s)
- Siyuan Li
- The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Yuxiang Zheng
- The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Yuwen Huang
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Wenfeng He
- Department of Medical Geneticsthe, Jiangxi Key Laboratory of Molecular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China.
| | - Xiao Liu
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510030, China.
| | - Wengen Zhu
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China.
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15
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Lin M, Zhan J, Luan Y, Li D, Shan Y, Xu T, Fu G, Zhang W, Wang M. Development and Validation of a Risk Score in Chinese Patients With Chronic Heart Failure. Front Cardiovasc Med 2022; 9:865843. [PMID: 35647038 PMCID: PMC9130568 DOI: 10.3389/fcvm.2022.865843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/13/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAcute exacerbation of chronic heart failure contributes to substantial increases in major adverse cardiovascular events (MACE). The study developed a risk score to evaluate the severity of heart failure which was related to the risk of MACE.MethodsThis single-center retrospective observational study included 5,777 patients with heart failure. A credible random split-sample method was used to divide data into training and validation dataset (split ratio = 0.7:0.3). Least absolute shrinkage and selection operator (Lasso) logistic regression was applied to select predictors and develop the risk score to predict the severity category of heart failure. Receiver operating characteristic (ROC) curves, and calibration curves were used to assess the model’s discrimination and accuracy.ResultsBody-mass index (BMI), ejection fraction (EF), serum creatinine, hemoglobin, C-reactive protein (CRP), and neutrophil lymphocyte ratio (NLR) were identified as predictors and assembled into the risk score (P < 0.05), which showed good discrimination with AUC in the training dataset (0.770, 95% CI:0.746–0.794) and validation dataset (0.756, 95% CI:0.717–0.795) and was well calibrated in both datasets (all P > 0.05). As the severity of heart failure worsened according to risk score, the incidence of MACE, length of hospital stay, and treatment cost increased (P < 0.001).ConclusionA risk score incorporating BMI, EF, serum creatinine, hemoglobin, CRP, and NLR, was developed and validated. It effectively evaluated individuals’ severity classification of heart failure, closely related to MACE.
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Affiliation(s)
- Maoning Lin
- Department of Cardiovascular Diseases, College of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Jiachen Zhan
- Department of Cardiovascular Diseases, College of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
- Department of Cardiology, Zhuji People’s Hospital, Zhuji, China
| | - Yi Luan
- Department of Cardiovascular Diseases, College of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Duanbin Li
- Department of Cardiovascular Diseases, College of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Yu Shan
- Department of Cardiovascular Diseases, College of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Tian Xu
- Department of Cardiovascular Diseases, College of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Guosheng Fu
- Department of Cardiovascular Diseases, College of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
- *Correspondence: Guosheng Fu,
| | - Wenbin Zhang
- Department of Cardiovascular Diseases, College of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
- Wenbin Zhang,
| | - Min Wang
- Department of Cardiovascular Diseases, College of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
- Min Wang,
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16
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Guo L, Liu X, Yu P, Zhu W. The "Obesity Paradox" in Patients With HFpEF With or Without Comorbid Atrial Fibrillation. Front Cardiovasc Med 2022; 8:743327. [PMID: 35087875 PMCID: PMC8787078 DOI: 10.3389/fcvm.2021.743327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 11/24/2021] [Indexed: 01/22/2023] Open
Abstract
Background: Overweight and mildly obese individuals have a lower risk of death than their normal-weight counterparts; this phenomenon is termed "obesity paradox." Whether this "obesity paradox" exists in patients with heart failure (HF) or can be modified by comorbidities is still controversial. Our current study aimed to determine the association of body mass index (BMI) with outcomes with patients with HF with preserved ejection fraction (HFpEF) with or without coexisting atrial fibrillation (AF). Methods: Patients with HFpEF from the Americas in the TOPCAT trial were categorized into the 3 groups: normal weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obesity (≥30 kg/m2). The Cox proportional-hazards models were used to calculate the adjusted hazard ratios (HRs) and CIs. Results: We identified 1,749 patients with HFpEF, 42.1% of which had baseline AF. In the total population of HFpEF, both overweight (HR = 0.59, 95% CI: 0.42-0.83) and obesity (HR = 0.49, 95% CI: 0.35-0.69) were associated with a reduced risk of all-cause death. Among patients with HFpEF without AF, overweight (HR = 0.51, 95% CI: 0.27-0.95) and obesity (HR = 0.64, 95% CI: 0.43-0.98) were associated with a lower risk of all-cause death. In those with AF, obesity (HR = 0.62, 95% CI: 0.40-0.95) but not overweight (HR = 0.81, 95% CI: 0.54-1.21) was associated with a decreased risk of all-cause death. Conclusions: The "obesity paradox" assessed by BMI exists in patients with HFpEF regardless of comorbid AF. Clinical Trial Registration: https://clinicaltrials.gov, identifier: NCT00094302.
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Affiliation(s)
- Linjuan Guo
- Department of Cardiology, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Xiao Liu
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Peng Yu
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wengen Zhu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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17
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Kifle ZD, Adugna M, Chanie GS, Mohammed A. Prevalence and associated factors of hypertension complications among hypertensive patients at University of Gondar Comprehensive Specialized Referral Hospital. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2021.100951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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18
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Yan J, Li X, Long W, Yuan T, Xian S. Association Between Obesity and Lower Short- and Long-Term Mortality in Coronary Care Unit Patients: A Cohort Study of the MIMIC-III Database. Front Endocrinol (Lausanne) 2022; 13:855650. [PMID: 35444615 PMCID: PMC9013888 DOI: 10.3389/fendo.2022.855650] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/11/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Obesity has long been considered an independent risk factor for cardiovascular diseases (CVD), even in the COVID-19 pandemic. However, recent studies have found that a certain degree of obesity may be beneficial for patients who have already suffered from CVD, which is called the "obesity paradox". Our objective was to investigate whether the obesity paradox existed in coronary care unit (CCU) patients and the relationship between body mass index (BMI) and short- and long-term mortality. METHODS We performed a cohort analysis of 3,502 adult CCU patients from the Medical Information Mart for Intensive Care III (MIMIC-III) database. The patients were divided into four groups according to the WHO BMI categories. Both multivariable logistic regression and Cox regression were used to reveal the relation between BMI and mortality. Subgroup analyses were performed based on Simplified Acute Physiology Score (SAPS) and age. RESULTS After adjusting for confounders, obese patients had 33% and 30% lower mortality risk at 30-day and 1-year (OR 0.67, 95% CI 0.51 to 0.89; HR 0.70, 95% CI 0.59 to 0.83; respectively) compared with normal-weight patients, while the underweight group were opposite, with 141% and 81% higher in short- and long-term (OR 2.41, 95% CI 1.37 to 4.12; HR 1.81, 95% CI 1.34 to 2.46; respectively). Overweight patients did not have a significant survival advantage at 30-day (OR 0.91, 95% CI 0.70 to 1.17), but did have a 22% lower mortality risk at 1-year (HR 0.78; 95% CI 0.67 to 0.91). The results were consistent after being stratified by SAPS and age. CONCLUSION Our study supports that obesity improved survival at both 30-day and 1-year after CCU admission, and the obesity paradox existed in CCU patients.
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Affiliation(s)
- Junlue Yan
- The First Clinical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xinyuan Li
- Department of Community Health, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Wenjie Long
- Geriatrics Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Tianhui Yuan
- Geriatrics Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
- *Correspondence: Shaoxiang Xian, ; Tianhui Yuan,
| | - Shaoxiang Xian
- Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
- Cardiovascular Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- *Correspondence: Shaoxiang Xian, ; Tianhui Yuan,
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19
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Moura B, Aimo A, Al-Mohammad A, Flammer A, Barberis V, Bayes-Genis A, Brunner-La Rocca HP, Fontes-Carvalho R, Grapsa J, Hülsmann M, Ibrahim N, Knackstedt C, Januzzi JL, Lapinskas T, Sarrias A, Matskeplishvili S, Meijers WC, Messroghli D, Mueller C, Pavo N, Simonavičius J, Teske AJ, van Kimmenade R, Seferovic P, Coats AJS, Emdin M, Richards AM. Integration of imaging and circulating biomarkers in heart failure: a consensus document by the Biomarkers and Imaging Study Groups of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2021; 23:1577-1596. [PMID: 34482622 DOI: 10.1002/ejhf.2339] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/28/2021] [Accepted: 08/29/2021] [Indexed: 12/28/2022] Open
Abstract
Circulating biomarkers and imaging techniques provide independent and complementary information to guide management of heart failure (HF). This consensus document by the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) presents current evidence-based indications relevant to integration of imaging techniques and biomarkers in HF. The document first focuses on application of circulating biomarkers together with imaging findings, in the broad domains of screening, diagnosis, risk stratification, guidance of treatment and monitoring, and then discusses specific challenging settings. In each section we crystallize clinically relevant recommendations and identify directions for future research. The target readership of this document includes cardiologists, internal medicine specialists and other clinicians dealing with HF patients.
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Affiliation(s)
- Brenda Moura
- Faculty of Medicine, University of Porto, Porto, Portugal.,Cardiology Department, Porto Armed Forces Hospital, Porto, Portugal
| | - Alberto Aimo
- Scuola Superiore Sant'Anna, and Fondazione G. Monasterio, Pisa, Italy
| | - Abdallah Al-Mohammad
- Medical School, University of Sheffield and Sheffield Teaching Hospitals, Sheffield, UK
| | | | | | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Hans-Peter Brunner-La Rocca
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ricardo Fontes-Carvalho
- Cardiovascular Research and Development Unit (UnIC), Faculty of Medicine University of Porto, Porto, Portugal.,Cardiology Department, Centro Hospitalar de Vila Nova Gaia/Espinho, Espinho, Portugal
| | - Julia Grapsa
- Department of Cardiology, Guys and St Thomas NHS Hospitals Trust, London, UK
| | - Martin Hülsmann
- Department of Internal Medicine, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Nasrien Ibrahim
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Christian Knackstedt
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - James L Januzzi
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Tomas Lapinskas
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Axel Sarrias
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | - Daniel Messroghli
- Department of Internal Medicine-Cardiology, Deutsches Herzzentrum Berlin and Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Mueller
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Noemi Pavo
- Department of Internal Medicine, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Justas Simonavičius
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands.,Vilnius University Hospital Santaros klinikos, Vilnius, Lithuania
| | - Arco J Teske
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roland van Kimmenade
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Petar Seferovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | | | - Michele Emdin
- Scuola Superiore Sant'Anna, and Fondazione G. Monasterio, Pisa, Italy
| | - A Mark Richards
- Christchurch Heart Institute, University of Otago, Dunedin, New Zealand.,Cardiovascular Research Institute, National University of Singapore, Singapore
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20
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Ghionzoli N, Gentile F, Del Franco AM, Castiglione V, Aimo A, Giannoni A, Burchielli S, Cameli M, Emdin M, Vergaro G. Current and emerging drug targets in heart failure treatment. Heart Fail Rev 2021; 27:1119-1136. [PMID: 34273070 PMCID: PMC9197912 DOI: 10.1007/s10741-021-10137-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 12/11/2022]
Abstract
After initial strategies targeting inotropism and congestion, the neurohormonal interpretative model of heart failure (HF) pathophysiology has set the basis for current pharmacological management of HF, as most of guideline recommended drug classes, including beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and mineralocorticoid receptor antagonists, blunt the activation of detrimental neurohormonal axes, namely sympathetic and renin–angiotensin–aldosterone (RAAS) systems. More recently, sacubitril/valsartan, a first-in-class angiotensin receptor neprilysin inhibitor, combining inhibition of RAAS and potentiation of the counter-regulatory natriuretic peptide system, has been consistently demonstrated to reduce mortality and HF-related hospitalization. A number of novel pharmacological approaches have been tested during the latest years, leading to mixed results. Among them, drugs acting directly at a second messenger level, such as the soluble guanylate cyclase stimulator vericiguat, or other addressing myocardial energetics and mitochondrial function, such as elamipretide or omecamtiv-mecarbil, will likely change the therapeutic management of patients with HF. Sodium glucose cotransporter 2 inhibitors, initially designed for the management of type 2 diabetes mellitus, have been recently demonstrated to improve outcome in HF, although mechanisms of their action on cardiovascular system are yet to be elucidated. Most of these emerging approaches have shifted the therapeutic target from neurohormonal systems to the heart, by improving cardiac contractility, metabolism, fibrosis, inflammation, and remodeling. In the present paper, we review from a pathophysiological perspective current and novel therapeutic strategies in chronic HF.
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Affiliation(s)
- Nicolò Ghionzoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | | | - Anna Maria Del Franco
- Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1 - 56124, Pisa, Italy
| | | | - Alberto Aimo
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Alberto Giannoni
- Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1 - 56124, Pisa, Italy
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | | | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Michele Emdin
- Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1 - 56124, Pisa, Italy
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Giuseppe Vergaro
- Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1 - 56124, Pisa, Italy.
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.
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21
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Gentile F, Ghionzoli N, Borrelli C, Vergaro G, Pastore MC, Cameli M, Emdin M, Passino C, Giannoni A. Epidemiological and clinical boundaries of heart failure with preserved ejection fraction. Eur J Prev Cardiol 2021; 29:1233-1243. [PMID: 33963839 DOI: 10.1093/eurjpc/zwab077] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/20/2021] [Indexed: 12/19/2022]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is highly prevalent and is associated with relevant morbidity and mortality. However, an evidence-based treatment is still absent. The heterogeneous definitions, differences in aetiology/pathophysiology, and diagnostic challenges of HFpEF made it difficult to define its epidemiological landmarks so far. Several large registries and observational studies have recently disclosed an increasing incidence/prevalence, as well as its prognostic significance. An accurate definition of HFpEF epidemiological boundaries and phenotypes is mandatory to develop novel effective and rational therapeutic approaches.
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Affiliation(s)
- Francesco Gentile
- Department of Cardiology and Cardiovascular Medicine, Fondazione Toscana G. Monasterio, Pisa 56124, Italy.,Cardiothoracic Department, Cardiology Division, University Hospital of Pisa, Pisa 56124, Italy
| | - Nicolò Ghionzoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena 53100, Italy
| | - Chiara Borrelli
- Department of Cardiology and Cardiovascular Medicine, Fondazione Toscana G. Monasterio, Pisa 56124, Italy.,Institute of Life Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, Pisa 56127, Italy
| | - Giuseppe Vergaro
- Department of Cardiology and Cardiovascular Medicine, Fondazione Toscana G. Monasterio, Pisa 56124, Italy.,Institute of Life Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, Pisa 56127, Italy
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena 53100, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena 53100, Italy
| | - Michele Emdin
- Department of Cardiology and Cardiovascular Medicine, Fondazione Toscana G. Monasterio, Pisa 56124, Italy.,Institute of Life Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, Pisa 56127, Italy
| | - Claudio Passino
- Department of Cardiology and Cardiovascular Medicine, Fondazione Toscana G. Monasterio, Pisa 56124, Italy.,Institute of Life Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, Pisa 56127, Italy
| | - Alberto Giannoni
- Department of Cardiology and Cardiovascular Medicine, Fondazione Toscana G. Monasterio, Pisa 56124, Italy.,Institute of Life Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, Pisa 56127, Italy
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22
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Marcks N, Aimo A, Januzzi JL, Vergaro G, Clerico A, Latini R, Meessen J, Anand IS, Cohn JN, Gravning J, Ueland T, Bayes-Genis A, Lupón J, de Boer RA, Yoshihisa A, Takeishi Y, Egstrup M, Gustafsson I, Gaggin HK, Eggers KM, Huber K, Tentzeris I, Ripoli A, Passino C, Sanders-van Wijk S, Emdin M, Brunner-La Rocca HP. Re-appraisal of the obesity paradox in heart failure: a meta-analysis of individual data. Clin Res Cardiol 2021; 110:1280-1291. [PMID: 33704552 PMCID: PMC8318940 DOI: 10.1007/s00392-021-01822-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/11/2021] [Indexed: 12/15/2022]
Abstract
Background Higher body mass index (BMI) is associated with better outcome compared with normal weight in patients with HF and other chronic diseases. It remains uncertain whether the apparent protective role of obesity relates to the absence of comorbidities. Therefore, we investigated the effect of BMI on outcome in younger patients without co-morbidities as compared to older patients with co-morbidities in a large heart failure (HF) population. Methods In an individual patient data analysis from pooled cohorts, 5,819 patients with chronic HF and data available on BMI, co-morbidities and outcome were analysed. Patients were divided into four groups based on BMI (i.e. ≤ 18.5 kg/m2, 18.5–25.0 kg/m2; 25.0–30.0 kg/m2; 30.0 kg/m2). Primary endpoints included all-cause mortality and HF hospitalization-free survival. Results Mean age was 65 ± 12 years, with a majority of males (78%), ischaemic HF and HF with reduced ejection fraction. Frequency of all-cause mortality or HF hospitalization was significantly worse in the lowest two BMI groups as compared to the other two groups; however, this effect was only seen in patients older than 75 years or having at least one relevant co-morbidity, and not in younger patients with HF only. After including medications and N-terminal pro-B-type natriuretic peptide and high-sensitivity cardiac troponin concentrations into the model, the prognostic impact of BMI was largely absent even in the elderly group with co-morbidity. Conclusions The present study suggests that obesity is a marker of less advanced disease, but does not have an independent protective effect in patients with chronic HF. Graphic abstract Categories of BMI are only predictive of poor outcome in patients aged > 75 years or with at least one co-morbidity (bottom), but not in those aged < 75 years without co-morbidities (top). The prognostic effect largely disappears in multivariable analyses even for the former group. These findings question the protective effect of obesity in chronic heart failure (HF). ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00392-021-01822-1.
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Affiliation(s)
- Nick Marcks
- Department of Cardiology, Maastricht University Medical Centre, PO Box 5800, 6202AZ, Maastricht, The Netherlands
| | - Alberto Aimo
- Cardiology Division, University Hospital of Pisa, Pisa, Italy
| | - James L Januzzi
- Massachusetts General Hospital and Baim Institute for Clinical Research, Boston, USA
| | - Giuseppe Vergaro
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
- Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Aldo Clerico
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
- Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Roberto Latini
- Department of Cardiovascular Medicine, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - Jennifer Meessen
- Department of Cardiovascular Medicine, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - Inder S Anand
- Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, USA
- Department of Cardiology, VA Medical Centre, Minneapolis, USA
| | - Jay N Cohn
- Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, USA
| | - Jørgen Gravning
- Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway
- Centre for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Thor Ueland
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
- K. G. Jebsen Thrombosis Research and Expertise Centre, University of Tromsø, Tromsø, Norway
| | - Antoni Bayes-Genis
- Hospital Universitari Germans Trias I Pujol, Badalona (Barcelona), Spain
| | - Josep Lupón
- Hospital Universitari Germans Trias I Pujol, Badalona (Barcelona), Spain
| | - Rudolf A de Boer
- University Medical Centre Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Michael Egstrup
- Department of Cardiology, Bispebjerg University Hospital, København, Denmark
| | - Ida Gustafsson
- Department of Cardiology, Bispebjerg University Hospital, København, Denmark
| | - Hanna K Gaggin
- Massachusetts General Hospital and Baim Institute for Clinical Research, Boston, USA
| | - Kai M Eggers
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Kurt Huber
- Faculty of Internal Medicine, Wilhelminenspital and Sigmund Freud University Medical School, Vienna, Austria
| | - Ioannis Tentzeris
- Faculty of Internal Medicine, Wilhelminenspital and Sigmund Freud University Medical School, Vienna, Austria
| | | | - Claudio Passino
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
- Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Sandra Sanders-van Wijk
- Department of Cardiology, Maastricht University Medical Centre, PO Box 5800, 6202AZ, Maastricht, The Netherlands
| | - Michele Emdin
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
- Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Hans-Peter Brunner-La Rocca
- Department of Cardiology, Maastricht University Medical Centre, PO Box 5800, 6202AZ, Maastricht, The Netherlands.
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