Noumegni Steve R, Kaze Arnaud D, Fonarow Gregg C, Echouffo-Tcheugui Justin B
Department of Medicine, University of Maryland Midtown Campus, Baltimore, MD, USA.
Division of Cardiology, Banner - University Medical Center Phoenix, The University of Arizona College of Medicine, Phoenix, AZ, USA.
BMC Cardiovasc Disord. 2025 Jul 18;25(1):524. doi: 10.1186/s12872-025-04998-w.
This short communication aims to assess the associations of body mass index (BMI) with key functional parameters, including exercise tolerance and functional status, among individuals with chronic heart failure.
From four chronic heart failure studies ( HF-ACTION [Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training], NEAT-HFpEF [Nitrate's Effect on Activity Tolerance in Heart Failure With Preserved Ejection Fraction (HFpEF)], INDIE-HFpEF [Inorganic Nitrite Delivery to Improve Exercise Capacity in HFpEF], and RELAX-HFpEF [Phosphodiesterase-5 Inhibition to Improve Clinical Status and Exercise Capacity in Heart Failure with Preserved Ejection Fraction]), we studied 2,546 participants (mean age: 60.2 ± 12.8 years, 67.8% men, 43.7% non-Whites individuals, 83% with heart failure with reduced ejection fraction (HFrEF), 17% with heart failure with preserved ejection fraction [HFpEF]). Among them, 52.8% had obesity [n = 1344], 29.8% were overweight [n = 758], and 17.4% had a normal body mass index [n = 444]). One-unit increment in BMI (kg/m) was associated with a lower 6MWT-D (β: -2.78, 95% CI: -3.54, -2.02), a lower VO2max (β: -0.18, 95% CI: -0.21, -0.15), a lower VO2AT (β: -0.10, 95% CI: -0.12, -0.08), a lower RERpeak (β: -0.003, 95% CI: -0.004, -0.002), a lower QoL (β for ln [KCCQ score]: -0.005, 95% CI: -0.008, -0.002), but not with HRpeak (β: β: -0.04, 95% CI: -0.20, 0.11). After adjustment for confounders, individuals with obesity (BMI ≥ 30 kg/m) compared to those with a normal BMI had lower 6MWT-D (beta coefficient [β]: -21.02, 95% CI: -34.27, -7.77), VO2max (β: -1.90, 95% CI: -2.42, -1.38), VO2AT (β: -1.16, 95% CI: -1.53, -0.80), RERpeak (β: -0.03, 95% CI: -0.05, -0.02), and QoL (β for ln [KCCQ score]: -0.05, 95% CI: -0.10, -0.0006) levels. However, the obesity and normal BMI groups were not significantly different in terms of HRpeak (β: 1.07, 95% CI: -1.71, 3.85).
Our study found that in patients with chronic heart failure, increasing body mass index is associated with poor exercise capacity and functional status. Our findings underscore the potential importance of optimizing weight management among individuals with chronic heart failure to improve functional status.
本简短通讯旨在评估慢性心力衰竭患者体重指数（BMI）与关键功能参数之间的关联，这些参数包括运动耐量和功能状态。
我们从四项慢性心力衰竭研究（心力衰竭：运动训练结局对照试验[HF-ACTION]、射血分数保留的心力衰竭（HFpEF）中硝酸盐对活动耐量的影响[NEAT-HFpEF]、射血分数保留的心力衰竭（HFpEF）中无机亚硝酸盐给药改善运动能力[INDIE-HFpEF]以及射血分数保留的心力衰竭（HFpEF）中磷酸二酯酶-5抑制改善临床状态和运动能力[RELAX-HFpEF]）中选取了2546名参与者（平均年龄：60.2±12.8岁，男性占67.8%，非白人占43.7%，射血分数降低的心力衰竭（HFrEF）患者占83%，射血分数保留的心力衰竭（HFpEF）患者占17%）。其中，52.8%患有肥胖症[n = 1344]，29.8%超重[n = 758]，17.4%体重指数正常[n = 444]。BMI（kg/m）每增加一个单位，与6分钟步行距离降低（β：-2.78，95%置信区间：-3.54，-2.02）、最大摄氧量降低（β：-0.18，95%置信区间：-0.21，-0.15）、无氧阈摄氧量降低（β：-0.10，95%置信区间：-0.12，-0.08）、呼吸交换率峰值降低（β：-0.003，95%置信区间：-0.004，-0.002）、生活质量降低（ln[堪萨斯城心肌病问卷（KCCQ）评分]的β：-0.005，95%置信区间：-0.008，-0.002）相关，但与心率峰值无关（β：β：-0.04，95%置信区间：-0.20，0.11）。在对混杂因素进行调整后，肥胖患者（BMI≥30 kg/m）与体重指数正常的患者相比，6分钟步行距离更低（β系数[β]：-21.02，95%置信区间：-34.27，-7.77）、最大摄氧量更低（β：-1.90，95%置信区间：-2.42，-1.38）、无氧阈摄氧量更低（β：-1.16，95%置信区间：-1.53，-0.80）、呼吸交换率峰值更低（β：-0.03，95%置信区间：-0.05，-0.02）以及生活质量更低（ln[KCCQ评分]的β：-0.05，95%置信区间：-0.10，-0.0006）。然而，肥胖组和体重指数正常组在心率峰值方面无显著差异（β：1.07，95%置信区间：-1.71，3.85）。
我们的研究发现，在慢性心力衰竭患者中，体重指数升高与运动能力和功能状态不佳相关。我们的研究结果强调了在慢性心力衰竭患者中优化体重管理以改善功能状态的潜在重要性。
