OBJECTIVES: The aim of this study was to assess the effects of central and general obesity measures on long-term longitudinal changes in ventricular-arterial mechanics. BACKGROUND: Obesity, female sex, and ventricular-arterial stiffening are associated with the development of heart failure with preserved ejection fraction. Fat distribution and chronic changes in body composition may affect longitudinal changes in LV properties, independent of arterial load. METHODS: In 1,402 subjects from a randomly selected, community-based population, comprehensive echo-Doppler echocardiography was performed at two examinations separated by 4 years. From this population, 788 subjects had paired data adequate for determining left ventricular end-systolic elastance (Ees), end-diastolic elastance (Eed), and effective arterial elastance (Ea). RESULTS: Over 4 years, Ea was decreased by 3% in tandem with improved blood pressure control, whereas Ees and Eed were increased by 14% and 8% (all, p < 0.001). Greater weight loss over 4 years was associated with progressively greater decreases in Ea in men and women. After adjustment for Ea change, weight gain was correlated with increases in Eed in both women and men. Central obesity was associated with greater age-related increases in Ees in women but not in men, independent of arterial load, but central obesity did not predict changes in Eed or Ea. CONCLUSIONS: In these subjects, weight gain was associated with increases in LV diastolic stiffness, even after adjustment for changes in arterial afterload, whereas weight loss was associated with reductions in arterial stiffness. Age-related LV systolic stiffening was increased in women, but not in men, with central obesity. Strategies for promoting weight loss and reducing central adiposity may be effective in preventing heart failure with preserved ejection fraction, particularly in women.

Division of Cardiovascular Diseases Department of Medicine Mayo Clinic Rochester Rochester Minnesota

Division of Cardiovascular Diseases Department of Medicine Mayo Clinic Rochester Rochester Minnesota; Department of Cardiology Institute for Clinical and Experimental Medicine Prague Czech Republic

Division of Cardiovascular Diseases Department of Medicine Mayo Clinic Rochester Rochester Minnesota; International Clinical Research Center St Anne's University Hospital Brno Czech Republic; Center for Cardiovascular Prevention of the 1st Faculty of Medicine Charles University and Thomayer Hospital Prague Czech Republic; Department of Preventive Cardiology Institute for Clinical and Experimental Medicine Prague Czech Republic

JACC Heart Fail. 2014 Oct;2(5):509-11. doi: 10.1016/j.jchf.2014.04.007. PubMed

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Kenchaiah S, Evans JC, Levy D, et al. Obesity and the risk of heart failure. N Engl J Med. 2002;347:305–13. PubMed

Murphy NF, MacIntyre K, Stewart S, Hart CL, Hole D, McMurray JJ. Long-term cardiovascular consequences of obesity: 20-year follow-up of more than 15 000 middle-aged men and women (the Renfrew-Paisley study) Eur Heart J. 2006;27:96–106. PubMed

Lavie CJ, Alpert MA, Arena R, Mehra MR, Milani RV, Ventura HO. Impact of Obesity and the Obesity Paradox on Prevalence and Prognosis in Heart Failure. JACC: Heart Failure. 2013;1:93–102. PubMed

Clark AL, Fonarow GC, Horwich TB. Obesity and the obesity paradox in heart failure. Progress in cardiovascular diseases. 2014;56:409–14. PubMed

Norton GR, Majane OH, Libhaber E, et al. The relationship between blood pressure and left ventricular mass index depends on an excess adiposity. J Hypertens. 2009;27:1873–83. PubMed

Ammar KA, Redfield MM, Mahoney DW, Johnson M, Jacobsen SJ, Rodeheffer RJ. Central obesity: association with left ventricular dysfunction and mortality in the community. Am Heart J. 2008;156:975–81. PubMed PMC

Paulus WJ, Tschope C. A novel paradigm for heart failure with preserved ejection fraction: comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation. J Am Coll Cardiol. 2013;62:263–71. PubMed

Borlaug BA, Redfield MM, Melenovsky V, et al. Longitudinal changes in left ventricular stiffness: a community-based study. Circ Heart Fail. 2013;6:944–52. PubMed PMC

Garza CA, Pellikka PA, Somers VK, et al. Major weight loss prevents long-term left atrial enlargement in patients with morbid and extreme obesity. European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology. 2008;9:587–93. PubMed PMC

Koshino Y, Villarraga HR, Somers VK, et al. Changes in myocardial mechanics in patients with obesity following major weight loss after bariatric surgery. Obesity. 2013;21:1111–8. PubMed

Folsom AR, Kushi LH, Anderson KE, et al. Associations of general and abdominal obesity with multiple health outcomes in older women: the Iowa Women's Health Study. Arch Intern Med. 2000;160:2117–28. PubMed

Fox CS, Massaro JM, Hoffmann U, et al. Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study. Circulation. 2007;116:39–48. PubMed

Ferreira I, Snijder MB, Twisk JW, et al. Central fat mass versus peripheral fat and lean mass: opposite (adverse versus favorable) associations with arterial stiffness? The Amsterdam Growth and Health Longitudinal Study. J Clin Endocrinol Metab. 2004;89:2632–9. PubMed

Jacobsen SJ, Mahoney DW, Redfield MM, Bailey KR, Burnett JC, Jr, Rodeheffer RJ. Participation bias in a population-based echocardiography study. Ann Epidemiol. 2004;14:579–84. PubMed

Kane GC, Karon BL, Mahoney DW, et al. Progression of left ventricular diastolic dysfunction and risk of heart failure. Jama. 2011;306:856–63. PubMed PMC

Redfield MM, Jacobsen SJ, Borlaug BA, Rodeheffer RJ, Kass DA. Age- and gender-related ventricular-vascular stiffening: a community-based study. Circ Heart Fail. 2005;112:2254–62. PubMed

Borlaug BA, Kass DA. Ventricular-vascular interaction in heart failure. Cardiol Clin. 2011;29:447–59. PubMed

Borlaug BA, Lam CS, Roger VL, Rodeheffer RJ, Redfield MM. Contractility and ventricular systolic stiffening in hypertensive heart disease insights into the pathogenesis of heart failure with preserved ejection fraction. J Am Coll Cardiol. 2009;54:410–8. PubMed PMC

Ommen SR, Nishimura RA, Appleton CP, et al. Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: A comparative simultaneous Doppler-catheterization study. Circ Heart Fail. 2000;102:1788–94. PubMed

Kass DA. Assessment of diastolic dysfunction: Invasive modalities. Cardiol Clin. 2000;18:571–586. PubMed

Chen CH, Fetics B, Nevo E, et al. Noninvasive single-beat determination of left ventricular end-systolic elastance in humans. J Am Coll Cardiol. 2001;38:2028–34. PubMed

Cornier MA, Despres JP, Davis N, et al. Assessing adiposity: a scientific statement from the American Heart Association. Circulation. 2011;124:1996–2019. PubMed

Yang L, Samarasinghe YP, Kane P, Amiel SA, Aylwin SJ. Visceral adiposity is closely correlated with neck circumference and represents a significant indicator of insulin resistance in WHO grade III obesity. Clin Endocrinol (Oxf) 2010;73:197–200. PubMed

Liang J, Teng F, Li Y, et al. Neck Circumference and Insulin Resistance in Chinese Adults: The Cardiometabolic Risk in Chinese (CRC) Study. Diabetes Care. 2013;36:e145–6. PubMed PMC

Alpert MA, Omran J, Mehra A, Ardhanari S. Impact of Obesity and Weight Loss on Cardiac Performance and Morphology in Adults. Progress in cardiovascular diseases. 2014;56:391–400. PubMed

Kenchaiah S, Evans JC, Levy D, et al. Obesity and the Risk of Heart Failure. New England Journal of Medicine. 2002;347:305–313. PubMed

Recio-Rodriguez JI, Gomez-Marcos MA, Patino-Alonso MC, Agudo-Conde C, Rodriguez-Sanchez E, Garcia-Ortiz L. Abdominal obesity vs general obesity for identifying arterial stiffness, subclinical atherosclerosis and wave reflection in healthy, diabetics and hypertensive. BMC Cardiovasc Disord. 2012;12:3. PubMed PMC

Russo C, Jin Z, Homma S, et al. Effect of obesity and overweight on left ventricular diastolic function: a community-based study in an elderly cohort. J Am Coll Cardiol. 2011;57:1368–74. PubMed PMC

Canepa M, Strait JB, Abramov D, et al. Contribution of central adiposity to left ventricular diastolic function (from the Baltimore Longitudinal Study of Aging) Am J Cardiol. 2012;109:1171–8. PubMed PMC

Rider OJ, Francis JM, Tyler D, Byrne J, Clarke K, Neubauer S. Effects of weight loss on myocardial energetics and diastolic function in obesity. Int J Cardiovasc Imaging. 2013;29:1043–50. PubMed

Ashrafian H, le Roux CW, Darzi A, Athanasiou T. Effects of bariatric surgery on cardiovascular function. Circulation. 2008;118:2091–102. PubMed

Utz W, Engeli S, Haufe S, et al. Moderate dietary weight loss reduces myocardial steatosis in obese and overweight women. Int J Cardiol. 2013;167:905–9. PubMed

Sarma S, Carrick-Ranson G, Fujimoto N, et al. The Effects of Age and Aerobic Fitness on Myocardial Lipid Content. Circ Cardiovasc Imaging. 2013 PubMed PMC

Rosito GA, Massaro JM, Hoffmann U, et al. Pericardial fat, visceral abdominal fat, cardiovascular disease risk factors, and vascular calcification in a community-based sample: the Framingham Heart Study. Circulation. 2008;117:605–13. PubMed

Allison DB, Zannolli R, Faith MS, et al. Weight loss increases and fat loss decreases all-cause mortality rate: results from two independent cohort studies. International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity. 1999;23:603–11. PubMed

Look ARG, Wing RR, Bolin P, et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;369:145–54. PubMed PMC

Kawaguchi M, Hay I, Fetics B, Kass DA. Combined ventricular systolic and arterial stiffening in patients with heart failure and preserved ejection fraction: implications for systolic and diastolic reserve limitations. Circulation. 2003;107:714–20. PubMed

Chantler PD, Lakatta EG, Najjar SS. Arterial-ventricular coupling: mechanistic insights into cardiovascular performance at rest and during exercise. J Appl Physiol (1985) 2008;105:1342–51. PubMed PMC

Kuznetsova T, D'Hooge J, Kloch-Badelek M, Sakiewicz W, Thijs L, Staessen JA. Impact of hypertension on ventricular-arterial coupling and regional myocardial work at rest and during isometric exercise. J Am Soc Echocardiogr. 2012;25:882–90. PubMed PMC

Canepa M, Strait JB, Milaneschi Y, et al. The relationship between visceral adiposity and left ventricular diastolic function: Results from the Baltimore Longitudinal Study of Aging. Nutr Metab Cardiovasc Dis. 2013 PubMed PMC

Manrique C, Demarco VG, Aroor AR, et al. Obesity and insulin resistance induce early development of diastolic dysfunction in young female mice fed a Western diet. Endocrinology. 2013;154:3632–42. PubMed PMC

Borlaug BA, Redfield MM. Diastolic and systolic heart failure are distinct phenotypes within the heart failure spectrum. Circulation. 2011;123:2006–13. discussion 2014. PubMed PMC

Steiropoulos P, Papanas N, Bouros D, Maltezos E. Obstructive sleep apnea aggravates glycemic control across the continuum of glucose homeostasis. Am J Respir Crit Care Med. 2010;182:286. PubMed

Arias MA, Garcia-Rio F, Alonso-Fernandez A, Mediano O, Martinez I, Villamor J. Obstructive sleep apnea syndrome affects left ventricular diastolic function: effects of nasal continuous positive airway pressure in men. Circulation. 2005;112:375–83. PubMed

Lim S, Meigs JB. Ectopic fat and cardiometabolic and vascular risk. Int J Cardiol. 2013 PubMed

Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62:e147–239. PubMed

Ledwidge M, Gallagher J, Conlon C, et al. Natriuretic peptide-based screening and collaborative care for heart failure: the STOP-HF randomized trial. Jama. 2013;310:66–74. PubMed

Okorodudu DO, Jumean MF, Montori VM, et al. Diagnostic performance of body mass index to identify obesity as defined by body adiposity: a systematic review and meta-analysis. International journal of obesity. 2010;34:791–9. PubMed

Cruz P, Johnson BD, Karpinski SC, et al. Validity of weight loss to estimate improvement in body composition in individuals attending a wellness center. Obesity. 2011;19:2274–9. PubMed PMC

Arterial Stiffening With Exercise in Patients With Heart Failure and Preserved Ejection Fraction

Evidence Supporting the Existence of a Distinct Obese Phenotype of Heart Failure With Preserved Ejection Fraction