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Updated: Jun 27, 2025
Author Spotlight: Exploring the Relationship Between Lipotoxicity and HFpEF
Published on: March 29, 2024
Obesity and heart failure with preserved ejection fraction
Tetyana M Ternushchak1, Marianna I Tovt-Korshynska1, Oksana M Moskal1
1UZHHOROD NATIONAL UNIVERSITY, UZHHOROD, UKRAINE.
Insights
Central obesity in heart failure with preserved ejection fraction (HFpEF) patients is linked to worse diastolic dysfunction and increased cardiovascular risk factors. These patients exhibit higher inflammatory markers and lipid profiles despite lower NT-proBNP levels.
Area of Science:
- Cardiology
- Obesity Medicine
- Cardiovascular Research
Background:
- Heart failure with preserved ejection fraction (HFpEF) is a growing clinical challenge.
- Central obesity is increasingly recognized as a significant comorbidity impacting cardiovascular health.
- Understanding the specific effects of central obesity on HFpEF is crucial for risk stratification and management.
Purpose of the Study:
- To comprehensively assess the clinical and echocardiographic characteristics of HFpEF patients with central obesity.
- To compare these characteristics against HFpEF patients without obesity and healthy controls.
- To identify specific cardiovascular risks associated with central obesity in the HFpEF population.
Main Methods:
- Enrolled 73 HFpEF patients with central obesity and 70 HFpEF patients without obesity, alongside 69 age-matched healthy controls.
- Conducted physical examinations and collected data on fasting glucose, insulin, lipid profiles, inflammatory markers (hs CRP), NT-proBNP, and renal function.
- Performed standard transthoracic echocardiography (2D and Doppler) to evaluate cardiac structure and function, including left and right ventricular parameters.
Main Results:
- Obese HFpEF patients showed significantly higher diastolic blood pressure, glucose, lipid profiles, uric acid, and hs CRP compared to non-obese HFpEF patients.
- Despite more severe HF symptoms, obese HFpEF patients had lower NT-proBNP levels.
- Echocardiography revealed more pronounced obesity-related left ventricular diastolic dysfunction, increased LV dimensions and mass, and greater right ventricular dilatation and dysfunction in obese HFpEF patients.
Conclusions:
- Obese patients with HFpEF present with elevated cardiovascular risk factors including higher diastolic BP, atherogenic dyslipidemia, and insulin resistance.
- These patients exhibit increased systemic inflammation and echocardiographic evidence of significant left and right ventricular diastolic dysfunction.
- Central obesity in HFpEF portends a higher risk for future cardiovascular events, necessitating targeted interventions.
Objective:
Aim: To perform an overall assessment of heart failure with preserved ejection fraction (HFpEF) adults with central obesity.
Patients And Methods:
Materials and Methods: We enrolled HFpEF patients with central obesity (n =73, mean age 52.4 ± 6.3 years) and without obesity (n =70, mean age 51.9 ± 7.1 years) and compared with an age-matched healthy subjects who had not suffered from HF (n = 69, mean age 52.3 ± 7.5 years). Physical examination, routine laboratory tests such as fasting blood glucose, fasting insulin, insulin resistance (HOMA) index, serum lipids, haemoglobin, creatinine, ALT, AST, uric acide, hs CRP, TSH, N-terminal proB-type natriuretic peptide (NT-proBNP) and standard transthoracic echocardiogram (2D and Doppler) examinations were performed and assessed.
Results:
Results: The average values of diastolic blood pressure (DBP), glucose and lipid profiles, uric acide, hs CRP were found to be significantly higher among obese patients with HFpEF than non-obese. Despite more severe symptoms and signs of HF, obese patients with HFpEF had lower NT-proBNP values than non-obese patients with HFpEF (129±36.8 pg/ml, 134±32.5 pg/ml vs 131±30.4 pg/ml, 139±33.8 pg/ml respectively; p < 0.05). However, it was found that patients with high central (visceral) adiposity have more pronounced obesity-related LV diastolic dysfunction, lower E/e' ratio, lower mitral annular lateral e' velocity, an increased LV diastolic dimension and LV mass index. Compared with non-obese HFpEF and control subjects, obese patients displayed greater right ventricular dilatation (base, 35±3.13 mm, 36±4.7 mm vs 33±2.8 mm, 34±3.2 mm and 29±5.3 mm, 30±3.9 mm; length, 74±5 mm, 76±8 mm vs 67±4 mm, 69±6 mm and 60±3 mm, 61±5 mm respectively; p < 0.05), more right ventricular dysfunction (TAPSE 16±2 mm, 15±3 mm vs 17±2 mm, 17±1 mm and 19±2 mm, 20±3 mm respectively; p < 0.05).
Conclusion:
Conclusions: Obese patients with HFpEF have higher diastolic BP, atherogenic dyslipidemia, insulin resistance index values and greater systemic inflammatory biomarkers, despite lower NT-proBNP values, which increase the risk of cardiovascular events in future. Echocardiography examination revealed not only significant LV diastolic dysfunction, but also displayed greater RV dilatation and dysfunction.
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