Low NT-proBNP levels in overweight and obese patients do not rule out a diagnosis of heart failure with preserved ejection fraction

Abstract Background Weight loss (WL) has been considered as a prognostic factor in heart failure with reduced ejection fraction (HFrEF). However, the prognosis and associated factors of WL in heart failure with preserved ejection fraction (HFpEF) have remained unclear. Purpose This study aimed to examine the prevalence, prognosis, and clinical characteristics of worse prognosis based on the identified WL after discharge in HFpEF. Methods The study was conducted as a part of a multicenter cohort study (Flagship). The cohort study enrolled ambulatory HF who hospitalized due to acute HF or exacerbation of chronic HF. Patients with severe cognitive, psychological disorders or readmitted within 6-month after discharge were excluded in the study. WL was defined as ≥5% weight loss in 6-month after discharge and HFpEF was defined as left ventricular ejection fraction (LVEF) ≥50% at discharge. Age, gender, etiology, prior HF hospitalization, New York Heart Association (NYHA) class, brain natriuretic peptide (BNP) or N-terminal-proBNP (NT-proBNP), anemia (hemoglobin; male <13g/dL, female <12g/dL), serum albumin, Geriatric Depression Scale, hand grip strength and comorbidities were collected at discharge. Patients were stratified according to their body mass index (BMI) at discharge as non-obese (BMI <25) or obese (BMI ≥25). We analyzed the association between WL and HF rehospitalization from 6 month to 2 years after discharge using Kaplan-Meier curve analysis and Cox regression analysis adjusted for age and gender, and clinical characteristics associated to worse prognosis in WL using logistic regression analysis adjusted for potential confounders in HFpEF. Results A total of 619 patients with HFpEF were included in the analysis. The prevalence of WL was 12.9% in 482 non-obese and 15.3% in 137 obese patients. During 2 years, 72 patients were readmitted for HF (non-obese: 48, obese: 24). WL in non-obese independently associated with poor prognosis (hazard ratio: 2.2: 95% confidence interval: 1.13–4.25) after adjustment for age and sex, while WL in obese patients did not. Logistic regression analysis chose age (odds ratio 1.02 per 1 year; 1.00–1.05), anemia (2.14; 1.32–3.48), and BNP ≥200pg/mL or NT-proBNP ≥900pg/mL (1.83; 1.18–2.86) as independent associated factors for worse prognosis of WL in non-obese patients. Conclusion In HFpEF, WL in early after discharge in non-obese elderly patients may be a prognostic indicator for HF rehospitalization. HF management including WL prevention along with controlling anemia is likely to improve prognosis in this population. Kaplan Meier survival curves Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): A Grant-in-Aid for Scientific Research (A) from the Japan Society for the Promotion of Science

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Heart Failure with Preserved Ejection Fraction in Morbidly Obese Patients is Associated with Increased Readmission Rate: Study from Large, Multicentric National Database

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2019.07.420 ◽

2019 ◽

Vol 25 (8) ◽

pp. S146

Author(s):

Moghniuddin Mohammed ◽

Ioannis Mastoris ◽

Juwairiya Arshi ◽

Habeeb A. Mohammed ◽

Andrew Sauer ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Readmission Rate ◽

National Database ◽

Morbidly Obese ◽

Obese Patients ◽

Preserved Ejection Fraction ◽

Rate Study

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Obesity accelerates cardiac senescence in heart failure with preserved ejection fraction

European Heart Journal ◽

10.1093/ehjci/ehaa946.0871 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

F.H Verbrugge ◽

Y.N.V Reddy ◽

S Kapa ◽

B.A Borlaug

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Diastolic Dysfunction ◽

Left Ventricular ◽

P Value ◽

Funding Source ◽

Obese Patients ◽

Preserved Ejection Fraction ◽

Ecg Analysis ◽

The Impact

Abstract Background Diastolic reserve decreases with aging. A recently developed artificial intelligence (AI) algorithm can predict age based on 12-lead electrocardiogram (ECG) analysis. Purpose This study aims to use a validated AI algorithm to assess cardiac senescence and investigate the impact of obesity on cardiac aging in heart failure with preserved ejection fraction (HFpEF). Methods This retrospective cohort study includes 403 patients with HFpEF, admitted for treatment with intravenous diuretics. ECG age was assessed by a convolutional neural network as previously validated. Patients were stratified according to the presence of obesity (body mass index >30 kg/m2) and ECG age was compared between groups. The relationship between ECG versus calendar age and structural/functional alterations on echocardiography, as well as the risk of atrial fibrillation (AF) development, was evaluated. Results In 253 (63%) obese patients with HFpEF, calendar age was 8 years younger compared with their non-obese counterparts, but ECG age was only 3 years younger. ECG minus calendar age was higher in obese patients (P-value <0.001; figure) and correlated moderately strong with weight, fat free, and fat mass (r=0.35–0.41; P-value <0.001). Older ECG age was correlated with worse diastolic function, but not with left ventricular afterload (table). Calendar age correlated less strongly with diastolic dysfunction (table). ECG age did predict AF development, independently of calendar age, gender, and presence of obesity [HR (95% CI) = 1.31 (1.06–1.63) per 5-year; P-value=0.015]. Conclusions Obesity accelerates cardiac senescence in HFpEF as reflected by more pronounced diastolic dysfunction and a higher AF risk, which was identified from ECG analysis by a validated AI algorithm. Figure 1 Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Belgian American Educational Foundation (B.A.E.F.); Special Research Fund (BOF) of Hasselt University (Hasselt, Belgium).

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Natriuretic peptides for the detection of diastolic dysfunction and heart failure with preserved ejection fraction—a systematic review and meta-analysis

BMC Medicine ◽

10.1186/s12916-020-01764-x ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Sharon Remmelzwaal ◽

Adriana J. van Ballegooijen ◽

Linda J. Schoonmade ◽

Elisa Dal Canto ◽

M. Louis Handoko ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Diastolic Dysfunction ◽

Natriuretic Peptides ◽

Predictive Value ◽

Diagnostic Performance ◽

Meta Analysis ◽

Preserved Ejection Fraction ◽

Acute Setting ◽

Rule Out

Abstract Background An overview of the diagnostic performance of natriuretic peptides (NPs) for the detection of diastolic dysfunction (DD) and heart failure with preserved ejection fraction (HFpEF), in a non-acute setting, is currently lacking. Methods We performed a systematic literature search in PubMed and Embase.com (May 13, 2019). Studies were included when they (1) reported diagnostic performance measures, (2) are for the detection of DD or HFpEF in a non-acute setting, (3) are compared with a control group without DD or HFpEF or with patients with heart failure with reduced ejection fraction, (4) are in a cross-sectional design. Two investigators independently assessed risk of bias of the included studies according to the QUADAS-2 checklist. Results were meta-analysed when three or more studies reported a similar diagnostic measure. Results From 11,728 titles/abstracts, we included 51 studies. The meta-analysis indicated a reasonable diagnostic performance for both NPs for the detection of DD and HFpEF based on AUC values of approximately 0.80 (0.73–0.87; I2 = 86%). For both NPs, sensitivity was lower than specificity for the detection of DD and HFpEF: approximately 65% (51–85%; I2 = 95%) versus 80% (70–90%; I2 = 97%), respectively. Both NPs have adequate ability to rule out DD: negative predictive value of approximately 85% (78–93%; I2 = 95%). The ability of both NPs to prove DD is lower: positive predictive value of approximately 60% (30–90%; I2 = 99%). Conclusion The diagnostic performance of NPs for the detection of DD and HFpEF is reasonable. However, they may be used to rule out DD or HFpEF, and not for the diagnosis of DD or HFpEF.

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Proteomics to Improve Phenotyping in Obese Patients with Heart Failure with Preserved Ejection Fraction

European Journal of Heart Failure ◽

10.1002/ejhf.2291 ◽

2021 ◽

Author(s):

Karl‐Patrik Kresoja ◽

Karl‐Philipp Rommel ◽

Rolf Wachter ◽

Sylvia Henger ◽

Christian Besler ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Obese Patients ◽

Preserved Ejection Fraction ◽

Patients With Heart Failure

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Regional Adipose Distribution and its Relationship to Exercise Intolerance in Older Obese Patients Who Have Heart Failure With Preserved Ejection Fraction

JACC Heart Failure ◽

10.1016/j.jchf.2018.06.002 ◽

2018 ◽

Vol 6 (8) ◽

pp. 640-649 ◽

Cited By ~ 30

Author(s):

Mark J. Haykowsky ◽

Barbara J. Nicklas ◽

Peter H. Brubaker ◽

W. Gregory Hundley ◽

Tina E. Brinkley ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Exercise Intolerance ◽

Obese Patients ◽

Preserved Ejection Fraction

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Association of Heart Failure with Preserved Ejection Fraction and Components of Metabolic Syndrome

Acta Medica Marisiensis ◽

10.1515/amma-2015-0078 ◽

2015 ◽

Vol 61 (4) ◽

pp. 261-264

Author(s):

Cerghizan Anda-Mihaela ◽

Băţagă Simona ◽

L Cozlea ◽

ID Tarţa ◽

B Chibelean ◽

...

Keyword(s):

Heart Failure ◽

Metabolic Syndrome ◽

Ejection Fraction ◽

Diastolic Dysfunction ◽

Hdl Cholesterol ◽

Normal Weight ◽

Obese Patients ◽

Preserved Ejection Fraction ◽

The Metabolic Syndrome ◽

Low Hdl

AbstractThe aim of the current study was to find any possible associations between elements of metabolic syndrome and echocardiographic characteristics (grade of diastolic dysfunction) in normoponderal and overweight patients with heart failure with preserved ejection fraction.A retrospective observational analytical study was performed on 130 patients presenting heart failure with documented ejection fraction over 50%. They were divided into two groups based on their body mass index. The first group included 56 normal weight patients and the second group included 74 overweight patients. Elements of the metabolic syndrome analysed in the current study were arterial hypertension, high triglyceride levels, low HDL-cholesterol and diabetes.None of the components of metabolic syndrome alone had a role in the evolution of diastolic dysfunction in either group. Three or four elements present in obese patients were negatively associated with grade 2 diastolic dysfunction, high values of blood pressure (over 180/110 mmHg) were more often encountered in obese patients with first and second grade of diastolic dysfunction.

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