Wayne L Miller1, Barry A Borlaug2. 1. Division of Circulatory Failure, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota. Electronic address: miller.wayne@mayo.edu. 2. Division of Circulatory Failure, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
Abstract
BACKGROUND: Fluid overload is common in heart failure (HF) and obesity; however, the relationship between the extent of intravascular volume expansion and indices such as body mass index (BMI) in obese and non-obese patients with HF has not been defined to address the issue of a HF obesity phenotype. METHODS: Total blood volume (TBV) was measured clinically using a radiolabeled albumin indicator-dilution technique in patients with predominately class III ambulatory chronic HF (N=66). Obesity was defined by BMI ≥30 kg/m2. RESULTS: Markedly increased intravascular volume expansion (defined by TBV expansion >+25% above normal) was highly prevalent in the obese (53%) compared to non-obese patients with HF (29%, P = .04) driven by plasma volume expansion. TBV was correlated with excess body weight and BMI (both P < .01). Also, cardiac index was higher, systemic vascular resistance lower, and left ventricular filling pressures comparable in obese compared with non-obese patients. CONCLUSIONS: Quantitative assessment of intravascular volume demonstrates for the first time that severe (not mild or moderate) volume expansion is highly common in obese patients with ambulatory chronic HF. This supports an evolving concept of an obesity-specific HF phenotype. Further study is needed to understand the mechanisms controlling volume regulation and the potential compensatory or detrimental impact on outcomes in obesity and HF.
BACKGROUND: Fluid overload is common in heart failure (HF) and obesity; however, the relationship between the extent of intravascular volume expansion and indices such as body mass index (BMI) in obese and non-obesepatients with HF has not been defined to address the issue of a HFobesity phenotype. METHODS: Total blood volume (TBV) was measured clinically using a radiolabeled albumin indicator-dilution technique in patients with predominately class III ambulatory chronic HF (N=66). Obesity was defined by BMI ≥30 kg/m2. RESULTS: Markedly increased intravascular volume expansion (defined by TBV expansion >+25% above normal) was highly prevalent in the obese (53%) compared to non-obesepatients with HF (29%, P = .04) driven by plasma volume expansion. TBV was correlated with excess body weight and BMI (both P < .01). Also, cardiac index was higher, systemic vascular resistance lower, and left ventricular filling pressures comparable in obese compared with non-obesepatients. CONCLUSIONS: Quantitative assessment of intravascular volume demonstrates for the first time that severe (not mild or moderate) volume expansion is highly common in obesepatients with ambulatory chronic HF. This supports an evolving concept of an obesity-specific HF phenotype. Further study is needed to understand the mechanisms controlling volume regulation and the potential compensatory or detrimental impact on outcomes in obesity and HF.
Authors: Hidemi Sorimachi; Masaru Obokata; Naoki Takahashi; Yogesh N V Reddy; Christopher C Jain; Frederik H Verbrugge; Katlyn E Koepp; Sundeep Khosla; Michael D Jensen; Barry A Borlaug Journal: Eur Heart J Date: 2021-04-21 Impact factor: 35.855
Authors: C Charles Jain; Dawn Pedrotty; Philip A Araoz; Alan Sugrue; Vaibhav R Vaidya; Deepak Padmanabhan; Shivaram P Arunachalam; Lilach O Lerman; Samuel J Asirvatham; Barry A Borlaug Journal: Circ Heart Fail Date: 2021-01-22 Impact factor: 8.790
Authors: Marat Fudim; Nicolas Ashur; Aaron D Jones; Andrew P Ambrosy; Bradley A Bart; Javed Butler; Horng H Chen; Stephen J Greene; Yogesh Reddy; Margaret M Redfield; Abhinav Sharma; Adrian F Hernandez; Gary Michael Felker; Barry A Borlaug; Robert J Mentz Journal: ESC Heart Fail Date: 2020-12-09