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Impact of global work index on obesity paradox in heart failure with advanced left ventricle remodeling

Roubai Pan1, Xierenayi Tudi1, Weiwei Jiang1

  • 1Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Frontiers in Cardiovascular Medicine
|March 5, 2026
PubMed

Insights

In heart failure patients with advanced left ventricular remodeling, higher myocardial work (global work index) modifies the obesity paradox, suggesting obesity may be protective. This highlights the importance of considering myocardial function when assessing prognosis.

Area of Science:

  • Cardiology
  • Heart Failure Research
  • Obesity Medicine

Background:

  • The obesity paradox in heart failure suggests lower body mass index (BMI) is associated with worse outcomes.
  • Advanced left ventricular remodeling is a key factor in heart failure prognosis.
  • The role of myocardial work in this paradox remains unclear.

Purpose of the Study:

  • To investigate the influence of myocardial work, specifically the global work index (GWI), on the obesity paradox in heart failure patients with advanced left ventricular remodeling.
  • To assess the prognostic impact of obesity at different GWI levels in this patient population.

Main Methods:

  • A post hoc analysis of 515 heart failure patients (LVEF ≤50%) hospitalized between May 2016 and December 2020.
  • Advanced left ventricular remodeling defined by left ventricular mass index (LVMI).
  • Primary endpoint: major adverse cardiovascular events (MACE). Prognostic impact of BMI and GWI assessed.

Main Results:

  • Of 515 patients, 330 had advanced left ventricular remodeling (LVMI thresholds met).
  • In this subgroup, BMI ≥28 kg/m² was linked to lower MACE risk.
  • Higher GWI subgroup (n=139) showed reduced MACE with higher BMI; no association in lower GWI subgroup (n=191).

Conclusions:

  • Myocardial work index significantly modifies the relationship between BMI and prognosis in heart failure.
  • GWI is a crucial factor for evaluating the obesity paradox in patients with left ventricular systolic dysfunction and advanced remodeling.
Abstract

Keywords:
body mass indexglobal work indexheart failureleft ventricular mass indexmyocardial work

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