Cocianni Daniele, Rizzi Jacopo Giulio, Barbisan Davide, Contessi Stefano, Perotto Maria, Savonitto Giulio, Zocca Eugenio, Brollo Enrico, Soranzo Elisa, Merlo Marco, Sinagra Gianfranco, Stolfo Davide
Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University Hospital of Trieste, Trieste, Italy.
Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
J Cardiovasc Med (Hagerstown). 2025 Jul 1;26(7):369-380. doi: 10.2459/JCM.0000000000001742. Epub 2025 May 30.
The implications of obesity on phenotype presentation and outcomes in acute decompensated heart failure (ADHF) are relatively unexplored. The aim of this study was to investigate the characteristics and prognostic implications related to obesity in ADHF, according to left ventricular and right ventricular function.
Consecutive patients hospitalized for ADHF were retrospectively enrolled. Obesity was defined as BMI at least 30 kg/m2. Patients were classified according to the range of left ventricular ejection fraction (LVEF) and to the presence of right ventricular dysfunction (RVD). The primary outcome was 1-year all-cause mortality or rehospitalization for ADHF (HFH).
Two thousand and ninety-eight patients were enrolled; 27% had BMI at least 30 kg/m2. Obese patients were younger, more frequently men and diabetic, with higher blood pressure and lower natriuretic peptides; they had smaller left ventricular volumes, lower pulmonary arterial systolic pressure, and lower prevalence of mitral or tricuspid regurgitation. In heart failure with reduced LVEF, obese patients were treated with higher dosages of antineurohormonal drugs and diuretics. At multivariable logistic regression analysis, obesity was an independent predictor of heart failure with preserved ejection fraction (HFpEF) phenotype [odds ratio (OR) = 2.046, P = 0.012] and of RVD (OR = 1.711, P = 0.034). At adjusted analysis, obesity was independently associated with a lower risk of 1-year mortality/HFH (hazard ratio = 0.608, P = 0.003), consistently across LVEF subgroups and presence/absence of RVD. RVD was associated with a higher risk of 1-year mortality/HFH in nonobese but not in obese patients.
Obesity was highly prevalent (27%) in ADHF and associated with a lower risk of 1-year mortality or HFH. Obesity was an independent predictor of HFpEF phenotype and of RVD, but RVD was associated with higher mortality/morbidity risk only in nonobese patients.
肥胖对急性失代偿性心力衰竭（ADHF）的表型表现和预后的影响相对未被充分研究。本研究的目的是根据左心室和右心室功能，调查ADHF中与肥胖相关的特征及其对预后的影响。
对因ADHF住院的连续患者进行回顾性纳入。肥胖定义为体重指数（BMI）至少30kg/m²。根据左心室射血分数（LVEF）范围和右心室功能障碍（RVD）的存在情况对患者进行分类。主要结局是1年全因死亡率或因ADHF再次住院（HFH）。
共纳入2098例患者；27%的患者BMI至少30kg/m²。肥胖患者更年轻，男性和糖尿病患者更常见，血压更高，利钠肽水平更低；他们的左心室容积更小，肺动脉收缩压更低，二尖瓣或三尖瓣反流的患病率更低。在LVEF降低的心力衰竭患者中，肥胖患者接受更高剂量的抗神经激素药物和利尿剂治疗。在多变量逻辑回归分析中，肥胖是射血分数保留的心力衰竭（HFpEF）表型的独立预测因素[比值比（OR）=2.046，P=0.012]和RVD的独立预测因素（OR=1.711，P=0.034）。在校正分析中，肥胖与1年死亡率/HFH的较低风险独立相关（风险比=0.608，P=0.003），在LVEF亚组和有无RVD的情况下均一致。RVD与非肥胖患者1年死亡率/HFH的较高风险相关，但与肥胖患者无关。
肥胖在ADHF中非常普遍（27%），并与1年死亡率或HFH的较低风险相关。肥胖是HFpEF表型和RVD的独立预测因素，但RVD仅在非肥胖患者中与更高的死亡率/发病率风险相关。
