Ibe Tatsuro, Demmer Ryan T, Harada Tomonari, Doi Shunichi, Tada Atsushi, Naser Jwan A, Reddy Yogesh N V, Borlaug Barry A
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
Eur J Heart Fail. 2025 Jun 26. doi: 10.1002/ejhf.3745.
While intentional weight loss achieved through cardiometabolic medications has been associated with robust salutary effects in heart failure (HF) with preserved ejection fraction (HFpEF), the clinical significance of unintentional weight loss in this setting remains unclear.
This retrospective cohort study included 434 overweight or obese patients with invasively proven HFpEF (67 ± 11 years, 236 female), without weight-reducing therapies or known malignancy, who underwent invasive hemodynamic cardiopulmonary testing and long-term clinical follow-up. The annualized weight change from index to final evaluation for the tertiles was: -21.1 to -1.8 kg/year (tertile 1); -1.8 to 0 kg/year (tertile 2); and 0 to +17.0 kg/year (tertile 3). Patients in tertile 1 had subtle abnormalities in ventilatory control at baseline, but there were no other significant differences between groups across a vast array of haemodynamic and metabolic parameters, both at rest and during exercise. Baseline weight was directly correlated with right and left heart filling pressures (r = 0.23-0.34, p < 0.001), but annualized weight change showed no correlation with any baseline haemodynamic measurements (all p > 0.05). Over a median follow-up of 4.7 years (interquartile range 2.3-6.5), patients in tertile 1 had higher risk of all-cause death (hazard ratio [HR] 3.36, 95% confidence interval [CI] 1.77-6.39, p < 0.001), all-cause death or HF hospitalization (HR 2.49, 95% CI 1.53-4.04, p < 0.001) and cardiac death or HF hospitalization (HR 2.28, 95% CI 1.28-4.07, p = 0.005) compared with those in tertile 2 or 3. These findings were consistent after multivariable adjustment.
Unintentional weight loss is associated with worse prognosis in patients with HFpEF and overweight or obesity, even as haemodynamics, exercise capacity, and gas exchange are not different from patients with stable or increasing weight. These data underline important and fundamental differences between therapeutic and unintended weight loss in HFpEF.
虽然通过心脏代谢药物实现的有意体重减轻已被证明对射血分数保留的心力衰竭（HFpEF）具有显著的有益作用，但在这种情况下无意体重减轻的临床意义仍不明确。
这项回顾性队列研究纳入了434例超重或肥胖且经侵入性检查证实为HFpEF的患者（67±11岁，女性236例），这些患者未接受减肥治疗且无已知恶性肿瘤，接受了侵入性血流动力学心肺测试和长期临床随访。从指数到最终评估，三分位数的年化体重变化分别为：-21.1至-1.8千克/年（第一三分位数）；-1.8至0千克/年（第二三分位数）；0至+17.0千克/年（第三三分位数）。第一三分位数的患者在基线时通气控制存在细微异常，但在静息和运动时，两组在大量血流动力学和代谢参数方面没有其他显著差异。基线体重与左右心充盈压直接相关（r = 0.23 - 0.34，p < 0.001），但年化体重变化与任何基线血流动力学测量均无相关性（所有p > 0.05）。在中位随访4.7年（四分位间距2.3 - 6.5年）期间，与第二或第三三分位数的患者相比，第一三分位数的患者全因死亡风险更高（风险比[HR] 3.36，95%置信区间[CI] 1.77 - 6.39，p < 0.001），全因死亡或HF住院风险更高（HR 2.49，95% CI 1.53 - 4.04，p < 0.001），心源性死亡或HF住院风险更高（HR 2.28，95% CI 1.28 - 4.07，p = 0.005）。多变量调整后这些结果仍然一致。
在超重或肥胖的HFpEF患者中，无意体重减轻与更差的预后相关，即使血流动力学、运动能力和气体交换与体重稳定或增加的患者没有差异。这些数据强调了HFpEF中治疗性体重减轻和无意体重减轻之间重要且根本的差异。
