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Obesity paradox in pulmonary hypertension due to left ventricular systolic dysfunction

Adipositasparadox bei pulmonaler Hypertonie aufgrund linksventrikulärer systolischer Dysfunktion

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Abstract

Objective

Pulmonary hypertension (PH) due to left ventricular systolic dysfunction (PH-HFrEF) is a common heart disease with poor prognosis. In this study, we explored the risk factors for PH-HFrEF and investigated the related factors affecting the prognosis of PH-HFrEF patients.

Methods

The study recruited consecutive patients with PH-HFrEF and systolic pulmonary artery pressure (sPAP) of more than 40 mm Hg with left ventricular ejection fraction (LVEF) of less than 45% on echocardiography. Patients with left ventricular systolic dysfunction (HFrEF) but without PH (sPAP < 30 mmHg and LVEF < 45%) were chosen as the control group. Patients were followed up for 18 months, and major adverse cardiac events (MACE) were recorded.

Results

In total, 93 patients with PH-HFrEF formed the study group and 93 LVEF-matched patients with HFrEF were enrolled as controls. Body mass index (BMI) in PH-HFrEF patients was significantly lower compared with the control group (p < 0.05). Multivariate logistic regression analysis revealed that low BMI was an independent predictor of the presence of PH in patients with HFrEF (p < 0.05). There were 23 (24.7%) MACE in the PH-HFrEF group and 18 (19.4%) MACE in the control group. Cox regression analysis showed that low BMI was an independent predictor of MACE occurrence in the PH-HFrEF group (p < 0.05).

Conclusion

Low BMI appear to be significantly associated with PH occurrence in patients with HFrEF, and is an independent predictor of MACE in patients with PH-HFrEF.

Zusammenfassung

Ziel

Die pulmonale Hypertonie (PH) aufgrund linksventrikulärer systolischer Dysfunktion (PH-HFrEF) stellt eine häufige Herzerkrankung mit ungünstiger Prognose dar. In der vorliegenden Studie wurden die Risikofaktoren für eine PH-HFrEF und die entsprechenden Faktoren mit Einfluss auf die Prognose von PH-HFrEF-Patienten untersucht.

Methoden

Für die Studie wurden konsekutiv Patienten mit PH-HFrEF und systolischem pulmonalarteriellem Druck (sPAP) von mehr als 40 mm Hg mit linksventrikulärer Ejektionsfraktion (LVEF) von weniger als 45% in der Echokardiographie rekrutiert. Patienten mit linksventrikulärer systolischer Dysfunktion (HFrEF), aber ohne PH (sPAP < 30 mm Hg und LVEF < 45%) wurden als Kontrollgruppe ausgewählt. Die Patienten wurden 18 Monate lang nachbeobachtet, dabei wurden schwere ungünstige kardiale Ereignisse („major adverse cardiac events“, MACE) dokumentiert.

Ergebnisse

Insgesamt bildeten 93 Patienten mit PH-HFrEF die Studiengruppe und 93 LVEF-gematchte Patienten mit HFrEF die Kontrollgruppe. Der Body-Mass-Index (BMI) bei den PH-HFrEF-Patienten war signifikant niedriger als in der Kontrollgruppe (p < 0,05). Die multivariate logistische Regressionsanalyse ergab, dass ein niedriger BMI ein unabhängiger Prädiktor für das Vorliegen einer PH bei Patienten mit HFrEF (p < 0,05) war. Es gab 23 (24,7%) MACE in der PH-HFrEF-Gruppe und 18 (19,4%) MACE in der Kontrollgruppe. In der Cox-Regressionsanalyse zeigte sich, dass ein niedriger BMI ein unabhängiger Prädiktor für das Auftreten von MACE in der PH-HFrEF-Gruppe war (p < 0,05).

Schlussfolgerung

Ein niedriger BMI scheint signifikant mit dem Vorliegen einer PH bei Patienten mit HFrEF assoziiert zu sein und stellt einen unabhängigen Prädiktor für das Auftreten von MACE bei Patienten mit PH-HFrEF dar.

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Acknowledgements

This study was supported by the Suzhou Science and Technology Development Program Guidance Project Fund (grant number SYSD2013093), the Youth Natural Science Fund of Soochow University (grant number SDY2013A32), the Research Fund of the Second Affiliated Hospital of Soochow University (grant number SDFEYGJ1405), and the Xinxin Heart (SIP) Foundation (2019-CCA-ACCESS-058). The authors gratefully acknowledge the assistance of Dr. Xinyi Zhu, Miss Yan-Ni Wu, and Miss Jing Zhu with patient recruitment. The authors would like to thank the participants and their families for participating in this study.

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Authors and Affiliations

  1. Department of Cardiology, The Second Affiliated Hospital of Soochow University, No 1055, Sanxiang Road, 215004, Suzhou City, China

    Li Wang,  Liang-Ping Zhao, Yuqi Chen, Xiansong Chang, Fulu Jin & Xiang Liu

  2. Emergency Department, The Seventh People’s Hospital of Suzhou, Suzhou City, China

    Li Wang & Xiansong Chang

Authors
  1. Li Wang
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  2. Liang-Ping Zhao
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Contributions

LPZ and LW participated in the study design. YC participated data analysis. XC, FJ and XL participated in acquisition of data and interpretation of the results. LPZ and LW contributed to writing and revising the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Liang-Ping Zhao.

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Conflict of interest

L. Wang, L.-P. Zhao, Y. Chen, X. Chang, F. Jin, and X. Liu declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

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Wang, L., Zhao, LP., Chen, Y. et al. Obesity paradox in pulmonary hypertension due to left ventricular systolic dysfunction. Herz 46, 575–580 (2021). https://doi.org/10.1007/s00059-021-05023-4

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