Obesity in heart failure with preserved ejection fraction: Insights from the REDUCE LAP-HF II trial.
Atrial shunts
Exercise capacity
Exercise haemodynamics
Heart failure with preserved ejection fraction
Obesity
Pulmonary capillary wedge pressure
Journal
European journal of heart failure
ISSN: 1879-0844
Titre abrégé: Eur J Heart Fail
Pays: England
ID NLM: 100887595
Informations de publication
Date de publication:
21 Nov 2023
21 Nov 2023
Historique:
revised:
23
10
2023
received:
13
08
2023
accepted:
12
11
2023
pubmed:
22
11
2023
medline:
22
11
2023
entrez:
21
11
2023
Statut:
aheadofprint
Résumé
Obesity is causally related to the development of heart failure with preserved ejection fraction (HFpEF) but complicates the diagnosis and treatment of this disorder. We aimed to determine the relationship between severity of obesity and clinical, echocardiographic and haemodynamic parameters in a large cohort of patients with documented HFpEF. The REDUCE LAP-HF II trial randomized 626 patients with ejection fraction ≥40% and exercise pulmonary capillary wedge pressure (PCWP) ≥25 mmHg to atrial shunt or sham procedure. We tested for associations between body mass index (BMI), clinical characteristics, cardiac structural and functional abnormalities, physical limitations, quality of life and outcomes with atrial shunt therapy. Overall, 60.9% of patients had BMI ≥30 kg/m Increasing severity of obesity was associated with greater cardiac remodelling, higher right and left ventricular filling pressures, higher cardiac output and increased subsequent heart failure events. Despite significant obesity, many HFpEF patients have preserved right heart and pulmonary vascular function and thus, may be appropriate candidates for atrial shunt therapy.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Corvia Medical Inc
Informations de copyright
© 2023 European Society of Cardiology.
Références
Ebong IA, Goff DC Jr, Rodriguez CJ, Chen H, Bluemke DA, Szklo M, et al. The relationship between measures of obesity and incident heart failure: The Multi-Ethnic Study of Atherosclerosis. Obesity (Silver Spring) 2013;21:1915-1922. https://doi.org/10.1002/oby.20298
Krishnamoorthy A, Greiner MA, Bertoni AG, Eapen ZJ, O'Brien EC, Curtis LH, et al. The obesity and heart failure epidemics among African Americans: Insights from the Jackson Heart Study. J Card Fail 2016;22:589-597. https://doi.org/10.1016/j.cardfail.2016.03.004
Loehr LR, Rosamond WD, Poole C, Marie McNeill A, Chang PP, Folsom AR, et al. Association of multiple anthropometrics of overweight and obesity with incident heart failure: The Atherosclerosis Risk in Communities study. Circ Heart Fail 2009;2:18-24. https://doi.org/10.1161/CIRCHEARTFAILURE.108.813782
Rao VN, Zhao D, Allison MA, Guallar E, Sharma K, Criqui MH, et al. Adiposity and incident heart failure and its subtypes: MESA (Multi-Ethnic Study of Atherosclerosis). JACC Heart Fail 2018;6:999-1007. https://doi.org/10.1016/j.jchf.2018.07.009
Avelar E, Cloward TV, Walker JM, Farney RJ, Strong M, Pendleton RC, et al. Left ventricular hypertrophy in severe obesity: Interactions among blood pressure, nocturnal hypoxemia, and body mass. Hypertension 2007;49:34-39. https://doi.org/10.1161/01.HYP.0000251711.92482.14
Boorsma EM, Ter Maaten JM, Voors AA, van Veldhuisen DJ. Renal compression in heart failure: The renal tamponade hypothesis. JACC Heart Fail 2022;10:175-183. https://doi.org/10.1016/j.jchf.2021.12.005
Jin X, Hung CL, Tay WT, Soon D, Sim D, Sung KT, et al. Epicardial adipose tissue related to left atrial and ventricular function in heart failure with preserved versus reduced and mildly reduced ejection fraction. Eur J Heart Fail 2022;24:1346-1356. https://doi.org/10.1002/ejhf.2513
Obokata M, Reddy YN, Pislaru SV, Melenovsky V, Borlaug BA. Evidence supporting the existence of a distinct obese phenotype of heart failure with preserved ejection fraction. Circulation 2017;136:6-19. https://doi.org/10.1161/CIRCULATIONAHA.116.026807
Pandey A, Cornwell WK 3rd, Willis B, et al. Body mass index and cardiorespiratory fitness in mid-life and risk of heart failure hospitalization in older age: Findings from the Cooper Center Longitudinal Study. JACC Heart Fail 2017;5:367-374. https://doi.org/10.1016/j.jchf.2016.12.021
Borlaug BA, Jensen MD, Kitzman DW, Lam CSP, Obokata M, Rider OJ. Obesity and heart failure with preserved ejection fraction: New insights and pathophysiological targets. Cardiovasc Res 2023;118:3434-3450. https://doi.org/10.1093/cvr/cvac120
van Woerden G, van Veldhuisen DJ, Westenbrink BD, de Boer RA, Rienstra M, Gorter TM. Connecting epicardial adipose tissue and heart failure with preserved ejection fraction: Mechanisms, management and modern perspectives. Eur J Heart Fail 2022;24:2238-2250. https://doi.org/10.1002/ejhf.2741
Berry N, Mauri L, Feldman T, Komtebedde J, van Veldhuisen DJ, Solomon SD, et al. Transcatheter interatrial shunt device for the treatment of heart failure: Rationale and design of the pivotal randomized trial to REDUCE Elevated Left Atrial Pressure in Patients with Heart Failure II (REDUCE LAP-HF II). Am Heart J 2020;226:222-231. https://doi.org/10.1016/j.ahj.2019.10.015
Borlaug BA, Blair J, Bergmann MW, Bugger H, Burkhoff D, Bruch L, et al.; REDUCE LAP-HF-II Investigators. Latent pulmonary vascular disease may alter the response to therapeutic atrial shunt device in heart failure. Circulation 2022;145:1592-1604. https://doi.org/10.1161/CIRCULATIONAHA.122.059486
Shah SJ, Borlaug BA, Chung ES, Cutlip DE, Debonnaire P, Fail PS, et al. Atrial shunt device for heart failure with preserved and mildly reduced ejection fraction (REDUCE LAP-HF II): A randomised, multicentre, blinded, sham-controlled trial. Lancet 2022;399:1130-1140. https://doi.org/10.1016/S0140-6736(22)00016-2
Feldman T, Mauri L, Kahwash R, Litwin S, Ricciardi MJ, van der Harst P, et al.; REDUCE LAP-HF I Investigators and Study Coordinators. Transcatheter interatrial shunt device for the treatment of heart failure with preserved ejection fraction (REDUCE LAP-HF I [Reduce Elevated Left Atrial Pressure in Patients with Heart Failure]): A phase 2, randomized, sham-controlled trial. Circulation 2018;137:364-375. https://doi.org/10.1161/CIRCULATIONAHA.117.032094
Kaye DM, Hasenfuss G, Neuzil P, Post MC, Doughty R, Trochu JN, et al. One-year outcomes after transcatheter insertion of an interatrial shunt device for the management of heart failure with preserved ejection fraction. Circ Heart Fail 2016;9:e003662. https://doi.org/10.1161/CIRCHEARTFAILURE.116.003662
Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015;28:1-39.e14. https://doi.org/10.1016/j.echo.2014.10.003
Hoit BD, Litwin SE. The new normal: How should we assess cardiac chamber sizes and proportionality across the full spectrum of body sizes with varying degrees of adiposity? J Am Soc Echocardiogr 2022;35:151-153. https://doi.org/10.1016/j.echo.2021.11.013
Borlaug BA. Evaluation and management of heart failure with preserved ejection fraction. Nat Rev Cardiol 2020;17:559-573. https://doi.org/10.1038/s41569-020-0363-2
Solomon SD, McMurray JJV, Anand IS, Ge J, Lam CSP, Maggioni AP, et al.; PARAGON-HF Investigators and Committees. Angiotensin-neprilysin inhibition in heart failure with preserved ejection fraction. N Engl J Med 2019;381:1609-1620. https://doi.org/10.1056/NEJMoa1908655
Yusuf S, Pfeffer MA, Swedberg K, Granger CB, Held P, McMurray J, et al.; CHARM Investigators and Committees. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: The CHARM-Preserved trial. Lancet 2003;362:777-781. https://doi.org/10.1016/S0140-6736(03)14285-7
Massie BM, Carson PE, McMurray JJ, Komajda M, McKelvie R, Zile MR, et al.; I-PRESERVE Investigators. Irbesartan in patients with heart failure and preserved ejection fraction. N Engl J Med 2008;359:2456-2467. https://doi.org/10.1056/NEJMoa0805450
Pitt B, Pfeffer MA, Assmann SF, Boineau R, Anand IS, Claggett B, et al.; TOPCAT Investigators. Spironolactone for heart failure with preserved ejection fraction. N Engl J Med 2014;370:1383-1392. https://doi.org/10.1056/NEJMoa1313731
Anker SD, Butler J, Filippatos G, Ferreira JP, Bocchi E, Böhm M, et al.; EMPEROR-Preserved Trial Investigators. Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med 2021;385:1451-1461. https://doi.org/10.1056/NEJMoa2107038
Butler J, Filippatos G, Siddiqi TJ, Brueckmann M, Böhm M, Chopra VK, et al. Empagliflozin, health status, and quality of life in patients with heart failure and preserved ejection fraction: The EMPEROR-Preserved trial. Circulation 2022;145:184-193. https://doi.org/10.1161/CIRCULATIONAHA.121.057812
Nassif ME, Windsor SL, Borlaug BA, Kitzman DW, Shah SJ, Tang F, et al. The SGLT2 inhibitor dapagliflozin in heart failure with preserved ejection fraction: A multicenter randomized trial. Nat Med 2021;27:1954-1960. https://doi.org/10.1038/s41591-021-01536-x
Adamson C, Kondo T, Jhund PS, de Boer RA, Cabrera Honorio JW, Claggett B, et al. Dapagliflozin for heart failure according to body mass index: The DELIVER trial. Eur Heart J 2022;43:4406-4417. https://doi.org/10.1093/eurheartj/ehac481
Reddy YNV, Lewis GD, Shah SJ, Obokata M, Abou-Ezzedine OF, Fudim M, et al. Characterization of the obese phenotype of heart failure with preserved ejection fraction: A RELAX trial ancillary study. Mayo Clin Proc 2019;94:1199-1209. https://doi.org/10.1016/j.mayocp.2018.11.037
Obokata M, Reddy YNV, Melenovsky V, Sorimachi H, Jarolim P, Borlaug BA. Uncoupling between intravascular and distending pressures leads to underestimation of circulatory congestion in obesity. Eur J Heart Fail 2022;24:353-361. https://doi.org/10.1002/ejhf.2377
Litwin SE. Which measures of obesity best predict cardiovascular risk? J Am Coll Cardiol 2008;52:616-619. https://doi.org/10.1016/j.jacc.2008.05.017