Table 1
Baseline characteristics for patients categorized as ‘Non-obese’ and ‘Obese’ according to HF status. Data are presented as median (25-, 75-percentile), and n (%).
| Variable | Non-obese (n = 273) | Obese (n = 119) | ||
|---|---|---|---|---|
| Without HF (n = 234) | With HF (n = 39) | Without HF (n = 93) | With HF (n = 26) | |
| Age, years | 72 (68, 78) | 80 (71, 85) | 69 (65, 74)* | 71 (68, 74)† |
| Female, female | 107 (45.7%) | 25 (64.1%) | 44 (47.3%) | 14 (53.6%) |
| Systolic blood pressure, mmHg | 138 (127, 149) | 138 (125, 153) | 133 (125, 145) | 135 (125, 145) |
| Diastolic blood pressure, mmHg | 79 (73, 86) | 75 (66, 85) | 80 (74, 85) | 78 (72, 86) |
| Heart rate, beats/min | 68 (60, 76) | 68 (60, 80) | 74 (61, 83)* | 72 (68, 79) |
| BMI | 25.8 (23.5, 27.6) | 26.1 (23.4, 28.4) | 32.3 (31.3, 34.6)* | 35.6 (32.6, 38.7)† |
| Smoking current or past, % | 140 (59.8%) | 8 (34,8%) | 62 (66.7%) | 18 (42.9%) |
| NYHA class I, n (%) | 170 (72.7%) | 7 (18.0%) | 52 (55.9%)* | 3 (11.5%) |
| NYHA class II, n (%) | 55 (23.5%) | 25 (64.1%) | 39 (41.9%)* | 22 (84.6%)† |
| NYHA class III, n (%) | 9 (3.9%) | 7 (18.0%) | 2 (2.2%) | 1 (3.9) |
| Framingham 5-year HF risk, score | 10 (8, 14) | 12 (10, 16) | 11 (8,15) | 14 (10,16) |
| Minnesota LWHFQ, score | 9 (2,22) | 24 (14, 41) | 13 (2,36) | 32 (14, 54) |
| Inclusion site and indication for hospitalization | ||||
| Department of Cardiology, n, (%) | 155 (66.2%) | 29 (74.4%) | 41 (44.1%)* | 16 (61.5%) |
| Chest pain, n (%) | 78 (33.3%) | 9 (23.1%) | 19 (20.4%) | 9 (30.8%) |
| Palpitations/arrhythmia, n (%) | 46 (19.7%) | 13 (33.3%) | 15 (16.1%) | 3 (11.5%) |
| Syncope, n (%) | 20 (8.6%) | 5 (12.8%) | 4 (4.3%) | 0 |
| Dyspnea, n (%) | 4 (1.7%) | 2 (5.1%) | 1 (1.1%) | 5 (19.2%) |
| Other, n (%) | 7 (3.0%) | 0 | 2 (2.2%) | 0 |
| Outpatient Clinic of Diabetes, n (%) | 40 (17.1%) | 4 (10.3%) | 24 25.8%) | 8 (30.8%)† |
| Outpatient Clinic of Nephrology, n (%) | 39 (16.7%) | 6 (15.4%) | 28 (30.1%)* | 2 (7.7%) |
| Medical history | ||||
| Hypertension, % | 189 (80.8%) | 33 (84.6%) | 81 (87.1%) | 22 (84.6%) |
| Ischemic heart disease, % | 62 (26.5%) | 13 (33.3%) | 17 (18.3%) | 6 (23.1%) |
| Atrial fibrillation, % | 68 (29.1%) | 23 (59.0%) | 19 (20.4%) | 5 (19.2%)† |
| Diabetes, % | 71 (30.3%) | 7 (18.0%) | 48 (51.6%)* | 15 (57.7%)† |
| Chronic kidney disease, % | 34 (14.5%) | 3 (7.7%) | 21 (22.6%) | 5 (19.2) |
| Stroke, % | 25 (10.7%) | 7 (18.0%) | 13 (14.0%) | 2 (7.7%) |
| Medication | ||||
| ACE inhibitor, n (%) | 67 (28.6%) | 7 (18.0%) | 27 (29.0%) | 4 (15.4%) |
| Angiotensin II-receptor-antagonist, n (%) | 74 (31.6%) | 12 (30.8%) | 37 (39.8%) | 15 (57.7%)† |
| Aldosterone antagonist, n (%) | 2 (0.9%) | 2 (5.1%) | 1 (1.1%) | 0 |
| Calcium antagonist, n (%) | 72 (30.8%) | 12 (30.8%) | 31 (33.3%) | 8 (30.1%) |
| Beta blocker, n (%) | 102 (43.6%) | 25 (64.1%) | 44 (47.3%) | 12 (46.2%) |
| Loop diuretics, n (%) | 18 (7.7%) | 15 (38.5%) | 19 (20.4%)* | 7 (26.9%) |
| Thiazide, n (%) | 74 (31.6%) | 5 (12.8%) | 36 (38.7%) | 9 (34.6%)† |
| Statin, n (%) | 143 (61.1%) | 23 (59.0%) | 64 (68.8%) | 15 (57.7%) |
| Per oral antidiabetics, n (%) | 56 (23.9%) | 7 (18.0%) | 38 (40.9%)* | 10 (38.5%) |
| Insulin, n (%) | 30 (12.8%) | 3 (7.7%) | 23 (24.7%)* | 7 (26.9%)† |
| Biochemistry | ||||
| Haemoglobin, mmol/L | 8.6 (8.0, 9.1) | 8.2 (7.9, 8.8) | 8.6 (8.2, 9.2) | 8.4 (7.6, 8.8) |
| CRP ≥3 mg/L, % | 66 (28.2%) | 12 (30.8%) | 33 (35.5%) | 14 (53.9%) |
| HbA1c, mmol/mol | 39 (37, 44) | 39 (35, 45) | 45 (38, 58)* | 43 (39, 57)† |
| Creatinine, µmol/L | 81 (70, 100) | 88 (68, 118) | 87 (70, 121) | 84 (74, 109) |
| eGFR, mL/min/1.73m 2 | 72 (55,87) | 59 (43, 81) | 71 (45, 87) | 75 (51, 86) |
| Alkali phosphatase, U/l | 66 (56, 79) | 72 (65, 92) | 72 (60, 84)* | 81 (64, 90) |
| Total cholesterol, mmol/L | 4.4 (3.8, 5.3) | 4.5 (3.5, 5.2) | 4.3 (3.7, 5.2) | 4.3 (3.5, 4.9) |
| HDL, mmol/L | 1.30 (1.05, 1.62) | 1.35 (1.07, 1.74) | 1.15 (0.97, 1.36)* | 1.09 (0.95, 1.46)† |
| LDL, mmol/L | 2.2 (1.7, 3.0) | 2.20 (1.70, 2.70) | 2.1 (1.5, 2.7)* | 1.85 (1.50, 2.70) |
| Troponin I ≥10ng/L | 48 (20.6%) | 17 (43.6%) | 8 (8.7%)* | 5 (19.2%)† |
| NT-proBNP, pg/mL | 202 (99, 523) | 1050 (221, 3040) | 120 (73, 339)* | 196 (113, 740)† |
| NT-proBNP > 125 | 158 (67.5%) | 35 (89.7%) | 45 (48.4%)* | 19 (73.1%) |
| MR-proANP, pmol/L | 130.4 (89.9, 192.9) | 246.3 (143.5, 341.5) | 100.1 (70.9, 147.7)* | 117.2 (71.3, 201.4)† |
| MR-proADM, nmol/L | 0.77 (0.61, 0.99) | 1.04 (0.86, 1.22) | 0.88 (0.70, 1.18)* | 0.94 (0.80, 1.12) |
| Copeptin, pmol/L | 6.1 (3.8, 12.2) | 7.4 (5.4, 20.6) | 8.8 (5.3, 16.8)* | 10.2 (5.4, 17.2) |
[i] * Indicates significant difference (p < 0.05) among patients without HF ‘Non-obese’ vs ‘Obese’.
† Indicates significant difference (p < 0.05) among patients with HF ‘Non-obese’ vs ‘Obese’.
Abbreviations: HF, heart failure; BMI, body mass index; NYHA, New York heart association; LWHFQ, living with heart failure questionnaire; ACE, angiotensin-converting-enzyme; CRP, c-reactive protein; HbA1c, haemoglobin 1Ac; eGFR, estimated glomerular filtration rate; HDL, high-density lipoprotein; LDL, low-density lipoprotein; NT-proBNP, amino-terminal pro-B-type-natriuretic-peptide, MR-proANP, midregional pro-atrial-natriuretic-peptide; MR-proADM, midregional-pro-adrenomedullin.
Table 2
Echocardiographic parameters for patients categorized as ‘Non-obese’ and ‘Obese’ according to HF status. Data are presented as median (25-, 75-percentile), and n (%).
| Variable | Non-obese (n = 273) | Obese (n = 119) | ||
|---|---|---|---|---|
| Without HF (n = 234) | With HF (n = 39) | Without HF (n = 93) | With HF (n = 26) | |
| Systolic function | ||||
| LVEF, % | 62.9 (56.8, 68.0) | 61.2 (43.8, 70.4) | 60.7 (54.9, 66.8) | 55.7 (50.1, 67.3) |
| LVEF ≥50% | 224 (95.7%) | 26 (66.7%) | 82 (88.2%)* | 20 (76.9%) |
| LVEF 40–49% | 10 (4.3%) | 5 (12.8%) | 11 (11.8%)* | 2 (7.7%) |
| LVEF <40% | – | 8 (20.5%) | – | 4 (15.4%) |
| Wall motion score | 16 (16, 16) | 16 (16, 20) | 16 (16, 16) | 16 (16, 17) |
| S’ septal, cm/sec | 7.0 (6.0, 8.1) | 6.0 (5.2, 7.0) | 7.2 (6.3, 8.3) | 7.0 (6.1, 7.7)† |
| S’ lateral, cm/sec | 8.1 (7.0, 9.3) | 6.3 (5.0, 8.5) | 8.3 (7.0 (9.2) | 7.4 (6.8, 8.7)† |
| GLS, % | –21.4 (–23.3, –18.7) | –20.7 (–24.2, –16.9) | –20.1 (–22.2, –17.8)* | –18.6 (–22.3, –14.8) |
| CS, % | –29.1 (–33.6, –25.2) | –26.8 (–32.5, –23.6) | –28.7 (–33.9, –23.9) | –26.8 (–31.0, –21.7) |
| Diastolic function | ||||
| E’ septal, cm/sec | 6.14 (5.28, 7.75) | 5.72 (4.65, 6.57) | 6.90 (5.59, 7.91) | 6.21 (5.13, 7.58) |
| E/e’ septal, cm/sec | 11.2 (9.1, 13.7) | 14.5 (11.7, 17.2) | 11.2 (9.5, 13.5) | 12.0 (10.2, 16.1) |
| E/A | 0.87 (0.72, 1.02) | 0.88 (0.74, 1.26) | 0.85 (0.71, 1.03) | 0.81 (0.73, 0.99) |
| MV deceleration time, ms | 265 (222, 312) | 252 (205, 333) | 263 (223, 307) | 266 (252, 300) |
| LAESV, mL | 52.9 (40.5, 64.7) | 68.8 (56.0, 83.2) | 55.1 (46.5, 65.7) | 64.3 (52.6, 89.3) |
| LAESV indexed to BSA, mL/m 2 | 29.1 (24.2, 35.5) | 41.0 (34.6, 49.3) | 28.1 (23.9, 32.6) | 32.8 (27.4, 45.2)† |
| LAESV indexed to height, mL/m | 30.4 (23.7, 36.7) | 40.7 (35.4, 48.9) | 31.7 (27.4, 37.6)* | 39.7 (29.7, 49.9) |
| Structural Changes | ||||
| IVSd, cm | 0.93 (0.82, 1.02) | 1.00 (0.80, 1.12) | 0.97 (0.86, 1.08)* | 1.00 (0.89, 1.11) |
| LVIDd, cm | 4.69 (4.27, 5.11) | 4.85 (4.20, 5.60) | 4.88 (4.42, 5.36) | 5.03 (4.64, 5.41) |
| LV mass, g | 147,16 (118.05, 173.21) | 163.34 (121.72, 224.14) | 150 (125.45, 183.86) | 185.74 (133.40, 212.76) |
| LVmass indexed to BSA, g/m 2 | 76.03 (65.68, 87.76) | 91.59 (70.60, 119.58) | 72.68 (63.40, 86.96) | 82.26 (68.63, 99.30) |
| LVmass indexed to height, g/m | 83.74 (69.75, 98.50) | 99.92 (69.95, 130.30) | 87.74 (74.87, 104.56)* | 108.80 (82.05, 120.89) |
| LVEDV, mL | 72.29 (60.30, 94.89) | 64.31 (57.93, 80.43) | 82.03 (66.90, 97.41)* | 88.21 (74.74, 110.69)† |
| LVEDV indexed BSA, ml/m 2 | 39.69 (33.56, 48.88) | 35.68 (31.28, 43.99) | 39.32 (32.79, 47.45) | 41.90 (35.42, 50.46) |
| LVEDV indexed to height, ml/m | 42.73 (35.19, 53.72) | 39.19 (34.31, 48.19) | 47.94 (39.41, 56.72)* | 52.43(43.35, 66.21)† |
| Right ventricular function | ||||
| TAPSE, mm | 22.5 (19.6, 25.5) | 20.1 (16.7, 23.3) | 22.2 (20.4, 25.2) | 21.1 (18.7, 23.1) |
[i] * Indicates significant difference (p < 0.05) among patients without HF ‘Non-obese’ vs ‘Obese’.
† Indicates significant difference (p < 0.05) among patients with HF ‘Non-obese’ vs ‘Obese’.
Abbreviations: LV = left ventricle; EF = ejection fraction; GLS = global longitudinal strain; CS = circumferential strain; LAESV = left atrial end systolic volume; BSA =body surface area; LVIDd = left ventricle inter dimensional diastole; LVEDV = left ventricle end diastolic volume; TAPSE = tricuspid annular plane systolic excursion.
Table 3
Association between obesity and HF in logistic regression models.
| Odds Ratio 95% Confidence Interval | Estimate 95% Confidence Interval | p-value | |
|---|---|---|---|
| Model 1 | |||
| Obesity | 2.47 (1.34–4.55) | 0.453 (0.148–0.758) | 0.004 |
| Model 2 | |||
| Obesity | 2.62 (1.38–4.98) | 0.482 (0.161–0.803) | 0.003 |
| Model 3 | |||
| Obesity | 2.56 (1.35–4.89) | 0.471 (0.148–0.793) | 0.004 |
[i] Model 1: Age and gender (reference female).
Model 2: variables in model 1, Diabetes, Atrial fibrillation, Hypertension, Ischemic heart disease, eGFR <60 ml/min/1.73m2, Stroke.
Model 3: variables in model 2, HDL-cholesterol (>1.2 mmol/L women and >1.0 mmol/L men), LDL cholesterol (<2.6 mmol/L), Lipoprotein A (>50 mg/dL).
Figure 1
Diagnostic findings in the non-obese and obese patients. (A) Patient reported symptoms of heart failure (test for trend P = 0.004); (B) Clinical signs of heart failure, (test for trend P = 0.002); (C) Abnormal echocardiography (test for trend P = 0.336).
Figure 2A–D
Plasma concentrations of cardiac biomarkers for obese and non-obese patients, with and without HF. Median values are presented in each box, and p-values represent comparison between categories adjusted for age, sex, eGFR.
Figure 3
Receiver operating characteristics curves for the diagnosis of HF with NT-proBNP, MR-proANP, MR-proADM and copeptin among non-obese patients (A) and obese patients (B).
Figure 4A–D
Correlations between echocardiographic parameters (dependent variables), and the plasma NT-proBNP concentrations, and obesity.
Figure 5A–D
Correlations between echocardiographic parameters (dependent variables), and the plasma MR-proADM concentrations, and obesity.