Body mass, cardiac remodeling, and relationships between N-terminal pro-B-type natriuretic peptide (NT-proBNP) and left ventricular (LV) filling pressures.A and B, Increased body mass was associated with larger right ventricular (RV) size and total heart volume. C, Pulmonary capillary wedge pressure (PCWP) was directly correlated with NT-proBNP in all patients with heart failure with preserved ejection fraction (HFpEF), but the relationship was shifted upward in obese HFpEF, indicating a higher PCWP for any value of NT-proBNP compared with nonobese HFpEF. (D) In contrast, the correlations between LV transmural pressure (LVTMP) and NT-proBNP did not differ in obese and nonobese HFpEF.
Correlations between left ventricular filling pressures, adiposity, and plasma volume. Elevations in left heart filling pressures were related to greater body mass (A) and plasma volume (B) in obese heart failure with preserved ejection fraction (HFpEF) but not in nonobese HFpEF. PCWP indicates pulmonary capillary wedge pressure.
Exercise capacity and hemodynamic reserve is reduced in obese heart failure with preserved ejection fraction (HFpEF).A, Compared with control subjects, the increase in cardiac index was lower in both nonobese and obese HFpEF but similar between the groups. B, The efficiency of translating metabolic work (Vo2) to external ergometric work (cycling Watts) was lower in subjects with obese HFpEF compared with nonobese HFpEF and control subjects. C, Peak Vo2 was inversely correlated with body mass. D, Peak exercise pulmonary artery mean pressure (mPAP) was higher in subjects with obese than in both subjects with nonobese HFpEF and control subjects. This was explained by impaired pulmonary vasodilation with exercise in subjects with obese HFpEF compared with both subjects with nonobese HFpEF and control subjects, evidenced by greater decreases in pulmonary artery compliance index (PACI) and less reduction in pulmonary vascular resistance index (PVRI; E and F). Error bars indicate SEM. *P<0.05 vs control subjects. †P<0.05 vs nonobese HFpEF.
Pericardial restraint and ventricular interdependence are enhanced in obese heart failure with preserved ejection fraction (HFpEF).A, Compared with patients with nonobese HFpEF and control subjects, patients with obese HFpEF displayed greater total epicardial heart volume. B, Representative short-axis echocardiographic images of the mitral valve and midcavity levels at end diastole in obese HFpEF. The septum becomes flattened and less convex to the right ventricle (RV) at end diastole, indicative of enhanced ventricular interaction. C and D, This was further supported by higher left ventricular (LV) eccentricity index and right atrial pressure (RAP)/PCWP ratio in subjects with obese HFpEF compared with nonobese HFpEF and control subjects. *P<0.05 vs control subjects. †P<0.05 vs nonobese HFpEF.
Interactions between pericardial restraint, pulmonary artery pressures, and filling pressures in subjects with heart failure with preserved ejection fraction (HFpEF).A and B, Compared with nonobese HFpEF, left ventricular (LV) eccentricity index was greater in obese HFpEF for any given value of pulmonary artery (PA) systolic pressure both at end diastole and end systole, suggesting that septal distortion in obese HFpEF was not simply related to more right ventricular (RV) afterload mismatch. C, The increase in right atrial pressure (RAP; which approximates pericardial pressure) relative to oxygen consumption (Vo2) was greater in subjects with obese HFpEF than in both subjects with nonobese HFpEF and control subjects with exercise. D, The pulmonary capillary wedge pressure (PCWP) required to achieve any given distending LV pressure (transmural pressure [LVTMP]) was shifted upward in obese HFpEF. See text for details. *P<0.05 vs control subjects. †P<0.05 vs nonobese HFpEF.
Barry A. Borlaug, Rickey E. Carter, Vojtech Melenovsky, Christopher V. DeSimone, Prakriti Gaba, Ammar Killu, Niyada Naksuk, Lilach Lerman and Samuel J. Asirvatham
Circulation: Heart Failure. 2017;10:e003612, originally published April 10, 2017
