Heart failure and obesity in adults: Pathophysiology, clinical manifestations and management

Current Heart Failure Reports

Volumn 11, Issue 2, 2014, Pages 156-165

  Alpert, Martin A ^a   Agrawal, Harsh ^a   Aggarwal, Kul ^a   Kumar, Senthil A ^a   Kumar, Arun ^a  

^a University of Missouri   (United States)

Author keywords

Central hemodynamics; Clinical manifestations; Concentric and eccentric hypertrophy; Epidemiology; Heart failure; Left ventricular diastolic chamber size; Left ventricular diastolic dysfunction; Left ventricular geometry; Left ventricular hypertrophy; Left ventricular systolic dysfunction; Left ventricularmass; Medical therapy; Neurohormonal and metabolic alterations; Obesity; Obesity cardiomyopathy; Obesity paradox; Pathophysiology; Risk factor; Severe obesity; Systemic hypertension; Tissue doppler imaging; Weight loss

Indexed keywords

ADRENERGIC RECEPTOR BLOCKING AGENT; ANGIOTENSIN RECEPTOR ANTAGONIST; BETA ADRENERGIC RECEPTOR BLOCKING AGENT; BRAIN NATRIURETIC PEPTIDE; CALCIUM CHANNEL BLOCKING AGENT; DIGITALIS; DIPEPTIDYL CARBOXYPEPTIDASE INHIBITOR; DIURETIC AGENT; NATRIURETIC FACTOR; RENIN INHIBITOR; VASODILATOR AGENT; AGENTS INTERACTING WITH TRANSMITTER, HORMONE OR DRUG RECEPTORS;

ADIPOSE TISSUE; BARIATRIC SURGERY; BODY MASS; CARDIOMEGALY; CARDIOMYOPATHY; CARDIOPULMONARY HEMODYNAMICS; CLINICAL FEATURE; DIET RESTRICTION; DISEASE CLASSIFICATION; DISEASE SEVERITY; DYSPNEA; EDEMA; EXERCISE; HEART ATRIUM FIBRILLATION; HEART FAILURE; HEART LEFT ATRIUM; HEART LEFT VENTRICLE EJECTION FRACTION; HEART LEFT VENTRICLE HYPERTROPHY; HEART LEFT VENTRICLE MASS; HEART PERFORMANCE; HEART RIGHT VENTRICLE FUNCTION; HUMAN; HYPERTENSION; HYPOXIA; LEFT VENTRICULAR DIASTOLIC DYSFUNCTION; LEFT VENTRICULAR SYSTOLIC DYSFUNCTION; LUNG CONGESTION; METABOLIC ACIDOSIS; OBESITY; POSITIVE END EXPIRATORY PRESSURE; PULMONARY HYPERTENSION; REVIEW; RISK FACTOR; SLEEP DISORDERED BREATHING; SODIUM RESTRICTION; THORAX RADIOGRAPHY; TISSUE DOPPLER IMAGING; WEIGHT REDUCTION; WORLD HEALTH ORGANIZATION; COMPLICATION; ETIOLOGY; HEART LEFT VENTRICLE FUNCTION; HEMODYNAMICS; PATHOLOGY; PATHOPHYSIOLOGY; PHYSIOLOGY;

HEART FAILURE; HEMODYNAMICS; HUMANS; NEUROTRANSMITTER AGENTS; OBESITY; RISK FACTORS; VENTRICULAR DYSFUNCTION, LEFT; WEIGHT LOSS;

EID: 84903610293     PISSN: 15469530     EISSN: 15469549     Source Type: Journal    
DOI: 10.1007/s11897-014-0197-5     Document Type: Review

References (96)

1. .• Alpert MA, Omran J, Mehra A, Ardhanari S. Impact of obesity and weight loss on cardiac performance and morphology in adults. Prog Cardiovasc Dis. 2013;56:391-400. This is a comprehensive review of cardiac performance and morphology in obesity that includes a discussion of possible neurohormonal and metabolic alterations that may affect cardiac structure and function.
2. .• 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. J Am Coll Cardiol Heart Fail. 2013;1:93-102. This is an intensive review of heart failure as it relates to obesity, including discussions on epidemiology, cardiac structure and function, the obesity paradox, the effects of weight loss and the impact of obesity on left ventricular assist devices and heart transplantation.
3. Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease: risk factors, paradox and impact of weight loss. J Am Coll Cardiol. 2009;53:1925-32.
4. Hunt SA, Abraham WT, Chin MH, et al. 2009 update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults. Circulation. 2009;119:e391.
5. Anh LV, Horwich TB, Fonarow GC. Epidemiology and risk profile in heart failure. Nat Rev Cardiol. 2011;8:30-41.
6. .• Roger VL. Epidemiology of heart failure. Circ Res. 2013;113:646-59. This is a thorough discussion of the epidemiology of heart failure.
7. Owan TE, Hodge DO, Herges, et al. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 2006;355:251-9. (Pubitemid 44079340)
8. Garg N, Senthilkumar A, Nusair MB, et al. Heart failure with a normal left ventricular ejection fraction: Epidemiology, pathophysiology, diagnosis and management. Am J Med Sci. 2013;346:129-36.
9. Kenchaiah S, Evans JC, Levy D, et al. Obesity and the risk of heart failure. N Engl J Med. 2002;347:305-13. (Pubitemid 34815352)
10. Baena-Diez JM, Bynam AO, Grau M, et al. Obesity as an independent risk factor for heart failure: Zona Franco Cohort Study. Clin Cardiol. 2010;33:760-4.
11. Nicklas BJ, Lesari M, Penninx BW, et al. Abdominal obesity is an independent risk factor for heart failure in older people. J Am Geriatr Soc. 2006;54:413-20. (Pubitemid 43327152)
12. Alpert MA, Terry BE, Mulekar M, et al. Cardiac morphology and left ventricular function in morbidly obese patients with and without congestive heart failure. Am J Cardiol. 1997;80:736-40. (Pubitemid 27413582)
13. World Health Organization technical report 894. Obesity: Preventing and managing the global epidemic. Geneva: World Health Organization; 2000.
14. Oreopoulos A, Padwal R, Kalantar-Zadeh K, Fonarow GC, Norris CM, McCallister FA. Body mass index in heart failure: a meta-analysis. Am Heart J. 2008;156:13-22. (Pubitemid 351862293)
15. Clark AL, Chya J, Horwich TB. The obesity paradox in men versus women with systolic heart failure. Am J Cardiol. 2012;110:77-82.
16. Clark AL, Fonarow GC, Horwich TB. Waist circumference, body mass index and survival in systolic heart failure: the obesity paradox. J Card Fail. 2011;17:374-80.
17. Padwal R, McCallister FA, McMurry JJ, et al. The obesity paradox in patients with preserved versus reduced ejection fraction: a meta-analysis of individual patient data. Int J Obes. 2013. doi:10.1038/ijo.2013.203.
18. Fonarow GC, Srikanthan P, Costanzo R, et al. The obesity paradox in acute heart failure: analysis of body mass index and in-hospital mortality for 108,927 patients in the Acute Decompensated Heart Failure National Registry. Am Heart J. 2007;15-3:74-81.
19. Alexander JK, Alpert MA. Hemodynamic alterations with obesity in man. In: Alpert MA, Alexander JK, editors. The Heart and Lung in Obesity. Armonk: Futura Publishing Co; 1998. p. 45-56.
20. Alexander JK, Dennis EW, Smith WG, et al. Blood volume, cardiac output and distribution of systemic blood flow in extreme obesity. Cardiovasc Res Center Bull. 1962;1:39-44.
21. Alexander JK. Obesity and cardiac performance. Am I Cardiol. 1964;14:860-5.
22. DeDivitiis O, Fazio S, Petitto M, et al. Obesity and cardiac function. Circulation. 1981;64:477-82. (Pubitemid 11061615)
23. Alaud-din A, Meteressian S, Lisbona R, et al. Assessment of cardiac function in patients who were morbidly obese. Surgery. 1982;92:226-35.
24. Kasper EK, Hruban RH, Baughman KL. Cardiomyopathy of obesity: A clinical pathological evaluation of 43 obese patients with heart failure. Am J Cardiol. 1992;70:921-4.
25. Kaltman AJ, Goldring RM. Role of circulatory congestion in the cardiorespiratory failure of obesity. Am J Med. 1976;60:645-53.
26. Backman C, Freyschuss U, Hallberg D, et al. Cardiovascular function in extreme obesity. Acta Med Scand. 1973;193:437-46.
27. Alexander JK. Historical notes. In: Alpert MA, Alexander JK, editors. The Heart and Lung in Obesity. Armonk: Futura Publishing Co; 1998. p. 1-10.
28. Bedford E. The study of fatty heart. A disease of Victorian times. Br Heart J. 1972;34:23-8.
29. Smith HL, Willius FA. Adiposity of the heart. Arch Intern Med. 1933;52:911-31.
30. Amad RH, Brennan JC, Alexander JK. The cardiac pathology of obesity. Circulation. 1965;32:740-5.
31. Alexander JK, Pettigrove JK. Obesity and congestive heart failure. Geriatrics. 1967;22:101-8.
32. Warnes CA, Roberts WC. The heart in massive (more than 300 pounds or 136 kilograms) obesity. Analysis of 12 patients studies at necropsy. Am J Cardiol. 1989;54:1087-91. (Pubitemid 15211596)
33. Alpert MA, Alexander JK. Cardiac morphology and obesity in man. In: Alpert MA, Alexander JK, editors. The Heart and Lung in Obesity. Armonk: Futura Publishing Co; 1998. p. 25-49.
34. Abel ED, Litwin SE, Sweeney G. Cardiac remodeling in obesity. Physiol Rev. 2008;88:389-419. (Pubitemid 351520084)
35. Wong C, Marwick TH. Obesity cardiomyopathy: Pathogenesis and pathophysiology. Nat Clin Pract Cardiovasc Med. 2007;4:436-43. (Pubitemid 47189016)
36. Alpert MA. Obesity cardiomyopathy. Pathophysiology and evolution of the clinical syndrome. Am J Med Sci. 2001;321:225-36. (Pubitemid 32275931)
37. Alpert MA, Terry BE, Kelly DL. Effect of weight loss on cardiac chamber size, wall thickness and left ventricular function in morbid obesity. Am J Cardiol. 1985;55:783-6. (Pubitemid 15148260)
38. Zema MJ, Caccavano M. Feasibility of detailed M-mode echocardiographic examination in markedly obese adults. Prospective study of 50 patients. J Clin Ultrasound. 1982;10:31-4. (Pubitemid 12211052)
39. Garcia LC, Laredo C, Arriaga J, et al. Echocardiographic findings in obesity. Rev Invest Clin. 1982;34:235-42.
40. Nakajima T, Fujioka S, Tokunaga K, et al. Non-invasive study of left ventricular performance in obese patients: Influence of duration of obesity. Circulation. 1985;71:481-5.
41. Alpert MA, Lambert CR, Panayiotou H, et al. Relation of duration of morbid obesity to left ventricle rmass, systolic function and diastolic filling, and effect of weight loss. Am J Cardiol. 1996;76:1194-7.
42. Alpert MA, Lambert CR, Terry BE, et al. Effect of weight loss on left ventricular mass in non-hypertensive morbidity obese patients. Am J Cardiol. 1994;73:918-21. (Pubitemid 24158323)
43. Danias RG, Tritos NA, Stuber M, et al. Cardiac structure and function in the obese: a cardiac magnetic resonance imaging study. J Cardiac Res. 2003;5:431-8. (Pubitemid 36859426)
44. Iacobellis G, Ribaudo MC, Leto G, et al. Influence of excess fat on cardiac morphology and function and function in uncomplicated obesity. Obes Res. 2002;10:767-73. (Pubitemid 135687517)
45. Tian ZQ, Zhong J, Zhao ZG, et al. Relationship between abdominal obesity and left ventricular weight/function. Zhonhua Xin Xue Bing Zen Zhi. 2007;35:155-8.
46. Messerli FH, Sundgaard-Riise K, Reisin ED, Dreslinski GR, et al. Dimorphic cardiac adaptation to obesity and arterial hypertension. Ann Intern Med. 1983;94:757-61. (Pubitemid 14248400)
47. Bella JN, Devereutx RB, Roman MJ, et al. Relations of left ventricular mass to fat-free and adipose body mass: the Strong Heart Study. Circulation. 1998;98:2538-44. (Pubitemid 29001192)
48. .• Aurigemma GP, de Simone G, Fitzgibbons TP. Cardiac remodeling in obesity. Circ Cardiovasc Imaging. 2013;6:442-52. This review describes left ventricular morphology as it relates to obesity with special emphasis on left ventricular geometry.
49. Woodwiss AJ, Libhaber CD, Majane OHI, et al. Obesity promotes left ventricular concentric rather than eccentric geometric remodeling and hypertrophy independent of blood pressure. Am J Hypertens. 2008;21:1149-53.
50. Lauer MS, Anderson KM, Kannel WB, et al. The impact of obesity on left ventricular mass and geometry. JAMA. 1991;266:231-6.
51. Lavie CJ, Milani RV, Patel D, et al. Disparate effects of hypertension and obesity on left ventricular geometry and mortality in 8088 elderly patients with preserved systolic function. Postgrad Med. 2009;121:119-25.
52. Smalcelj A, Pulievic D, Buljievic B, et al. Left ventricular hypertrophy in obese hypertensives: is it really eccentric? An echocardiographic study. Coll Antropol. 2000;24:167-83.
53. Peterson LR, Waggoner AD, Schectman KB, et al. Alterations in left ventricular structure and function in young healthy obese women. J Am Coll Cardiol. 2004;43:1388-404.
54. Turkbey EB, McClelland RL, Kronmal RA, et al. The impact of obesity on the left ventricle; the multi-ethnic study of atherosclerosis (MESA). JACC Cardiovasc Imaging. 2010;3:266-74.
55. Iacobellis G, Ribaudo MC, Zappaterreno A, et al. Adapted changes in left ventricular structure and function in severe uncomplicated obesity. Obes Res. 2004;12:1616-21. (Pubitemid 41132470)
56. Okpura IC, Adediran OS, Odia OJ, et al. Left ventricular geometric patterns in obese Nigerian adults: An echocardiographic study. Internet J Intern Med. 2010;9:1-7.
57. Merlino G, Scaglione R, Corrao S, et al. Association between lymphocyte beta-adrenergic receptors and left ventricular dysfunction in young obese subjects. Int J Obes. 1994;18:699-703. (Pubitemid 24307613)
58. Ferraro S, Pessone-Filardo P, Desiderio A, et al. Left ventricular systolic and diastolic function in severe obesity: a radionuclide study. Cardiology. 1996;82:347-53. (Pubitemid 26168133)
59. Stoddard MF, Tseuda K, Thomas M, et al. The influence of obesity on left ventricular filling and systolic function. Am Heart J. 1992;124:894-9.
60. Chakko S, Alpert MA. Obesity and ventricular function: diastolic function. In: Alpert MA, Alexander JK, editors. The Heart and Lung in Obesity. Armonk: Futura Publishing Co; 1998. p. 57-76.
61. Alpert MA, Lambert CR, Terry BE, et al. Effect of weight loss on left ventricular diastolic filling in morbid obesity. Am J Cardiol. 1997;80:736-40.
62. Herszkowicz N, Barbato A, Salvi W, et al. Contribution of Doppler echocardiography to the evaluation of systolic and diastolic function of obese women versus a control group. Arq Bras Cardiol. 2001;76:189-96.
63. Ku CS, Lin S, Wang DJ, et al. Left ventricular filling in young normotensive obese adults. Am J Cardiol. 1994;73:613-5. (Pubitemid 24142601)
64. Talano AC, Bitigen A, Cevik C, et al. The role of tissue Doppler study in the assessment of left ventricular dysfunction in obesity. Acta Cardiol. 2008;63:541-6.
65. .• Kossaify A, Nicolais N. Impact of overweight and obesity on left ventricular diastolic function and value of tissue Doppler echocardiography. Clin Med Insights Cardiol. 2013;7:43-50. This study uses tissue Doppler imaging to assess left ventricular diastolic function in obesity.
66. Alpert MA, Lambert CR, Panayiotou H, et al. Interrelationship of left ventricular mass, systolic function and diastolic filling in normotensive morbidly obese patients. Int J Obes Relat Detab Disard. 1996;19:550-7.
67. Alpert MA, Alexander JK. Obesity and ventricular function in man: Systolic function. In: Alpert MA, Alexander JK, editors. The Heart and Lung in Obesity. Armouk: Futura Publishing Co; 1998. p. 77-94.
68. Alpert MA, Terry BE, Lambert CR, et al. Factors influencing left ventricular systolic function in non-hypertensive morbidly obese patients and effect of weight loss induced by gastroplasty. Am J Cardiol. 1993;75:773-7.
69. Tumuklu MM, Etikan I, Kucasik B, et al. Effect of obesity on left ventricular structure and myocardial systolic function: assessment by tissue Doppler imaging and strain/strain rate imaging. Echocardiology. 2007;24:802-9. (Pubitemid 47346738)
70. Barbosa MM, Beleigoli AM, de Fatima DM, et al. Strain imaging and morbid obesity: insight into subclinical ventricular dysfunction. Clin Cardiol. 2011;34:288-93.
71. Otto ME, Belohlavek M, Khandheria B. Comparison of right and left ventricular function in obese and non-obese men. Am J Cardiol. 2004;93:1569-72. (Pubitemid 38749227)
72. 2. J Cardiovasc Imaging. 2009;25:272-7.
73. Orhan AL, Uslu N, Davi SU, et al. Effects of isolated obesity on left and right ventricular function: a tissue Doppler and strain rate imaging study. Echocardiography. 2010;22:236-43.
74. Thakur V, Richards R, Reisin E. Obesity, hypertension and the heart. Am J Med Sci. 2001;321:242-8.
75. McGavock JM, Victor R, Unger RH, Szczepaniak LS. Adiposity of the heart revisited. Ann Intern Med. 2006;144:515-24.
76. Amador N, de Jesus EJ, Rodriguez L, et al. Relationship between left ventricular mass and heart sympathetic activity in male obese subjects. Arch Med Res. 2004;34:411-5. (Pubitemid 40044669)
77. Alexander JK, Alpert MA. Pathogenesis and clinical manifestations of obesity cardiomyopathy. In: Alpert MA, Alexander JK, editors. The Heart and Lung in Obesity. Armonk: Futura Publishing Co; 1998. p. 133-46.
78. Bayess-Genis A, DeFillipi C, Januzzi Jr JL. Understanding aminoterminal pro-B-type natriuretic peptide in obesity. Am J Cardiol. 2008;101:89-94.
79. Daniels LB, Clapton P, Bhalla V, et al. How obesity effects the cut-points for B-type natriuretic peptides in the diagnosis of acute heart failure. Results from the Breathing Not Properly Multinational Study. Am Heart J. 2006;151:999-1005.
80. Alexander JK, Petersen KL. Cardiovascular effects of weight reduction. Circulation. 1972;45:310-8.
81. Backman L, Freyschuss U, Hallberg D, et al. Reversibility of cardiopulmonary changes in extreme obesity. Act Med Scand. 1979;205:367-73.
82. Reisin E, Frohlich ED, Messerli FH, et al. Cardiovascular changes after weight loss in obesity hypertension. Ann Intern Med. 1983;98:315-9. (Pubitemid 13158499)
83. .• Grapsa J, Tan TL, Paschou SA, et al. The effect of bariatric surgery on echocardiographic indices: a review of the literature. Eur J Clin Invest. 2013;43:1224-30. This is an excellent review of multiple studies using echocardiography to assess the effects of weight loss on cardiac structure and function.
84. Jhaveri RR, Pond KK, Hauser TH, et al. Cardiac remodeling after substantial weight loss: a prospective cardiac magnetic resonance study after bariatric surgery. Surg Obes Relat Dis. 2009;5:648-52.
85. Haufe S, Utz W, Engeli S, et al. Left ventricular mass and function with reduced-fat or reduced-carbohydrate hypocaloric diets in overweight and obese subjects. Hypertension. 2012;59:70-5.
86. .• Luaces M, Cachofeiro V, Garcia-Munoz-Najar A, et al. Anatomical and functional alterations of the heart in morbid obesity. Changes after bariatric surgery. Rev Esp Cardiol. 2012;65:14-21. This study demonstrates that substantial weight loss from bariatric surgery in severely obese patients reduces the incidence of abnormal left ventricular geometry caused by severe obesity.
87. .• de las Fuentes L, Waggoner AD, Mohammed BS, et al. Effect of moderate diet-induced weight loss and weight regain on cardiovascular structure and function. J Am Coll Cardiol. 2009;54:2376-81. This study confirms that weight loss form bariatric surgery in Severely obese patients produces regress of left ventricular hypertrophy and favorable alterations in left ventricular geometry.
88. Rider OJ, Franco JM, Ali MK, et al. Beneficial cardiovascular effects on bariatric surgical and dietary weight loss in obesity. J Am Coll Cardiol. 2009;54:718-26.
89. Ashrafian H, le Roux CW, Darzi A, et al. Effects of bariatric surgery on cardiovascular function. Circulation. 2008;118:2091-102.
90. McCloskey CD, Ramani GV, Mathier MA, et al. Bariatric surgery improves cardiac function in morbidly obese patients with severe cardiomyopathy. Surg Obes Relat Dis. 2007;3:503-7. (Pubitemid 47440679)
91. Karason K, Wallentin I, Largson B, Sjostrom I. Effects of obesity and weight loss on left ventricular mass and relative wall thickness: survey and intervention study. BMJ. 1997;315:912-6. (Pubitemid 27425122)
92. Owan T, Avelar E, Marely K, et al. Favorable changes in cardiac geometry and function following gastric bypass surgery: 2 year fellowship in the Utah obesity study. J Am Coll Cardiol. 2011;57:732-9.
93. Valezi AC, Machodo VH. Morphofunctional evaluation of the heart in obese patients before and after bariatric surgery. Obes Surg. 2011;21:1693-7.
94. Garca CA, Pellika PA, Sommers VK, et al. Structural and functional changes in the left and right ventricules after major weight loss following bariatric surgery for morbid obesity. Am J Cardiol. 2010;105:550-5.
95. Estes EH, Sieker HO, McIntosh HD, et al. Reversible cardiopulmonary syndrome with extreme obesity. Circulation. 1957;41:179-87.
96. .• Miranda WR, Batsis JA, Sarr MG, et al. Impact of bariatric surgery on quality of life, functional capacity and symptoms in patients with heart failure. Obes Surg. 2013;23:1101-5. This study demonstrates that weight loss from bariatric surgery produces improvements in clinical manifestations of heart failure and quality of life in severely obese patients.