Author + information
- Received February 16, 2019
- Revision received April 25, 2019
- Accepted April 25, 2019
- Published online July 10, 2019.
- Yogesh N.V. Reddy, MBBS, MSca,
- Mahesh Anantha-Narayanan, MBBSb,
- Masaru Obokata, MD, PhDa,
- Katlyn E. Koepp, BSca,
- Patricia Erwin, MLSc,
- Rickey E. Carter, PhDd and
- Barry A. Borlaug, MDa,∗ (, )@bborlaugmd
- aDepartment of Cardiovascular Medicine, University of Minnesota, Minneapolis, Minnesota
- bDivision of Cardiovascular Diseases, University of Minnesota, Minneapolis, Minnesota
- cDepartment of Medical Education, Mayo Clinic, Rochester, Minnesota
- dHealth Sciences Research, Mayo Clinic, Rochester, Minnesota
- ↵∗Address for correspondence:
Barry A. Borlaug, Mayo Clinic and Foundation, 200 First Street SW, Rochester, Minnesota 55905.
Objectives The authors aimed to explore whether weight loss may improve central hemodynamics in obesity.
Background Hemodynamic abnormalities in obese heart failure with preserved ejection fraction patients are correlated with the amount of excess body mass, suggesting a possible causal relationship.
Methods Relevant databases were systematically searched from inception to May 2018, without language restriction. Studies reporting invasive hemodynamic measures before and following therapeutic weight loss interventions in patients with obesity but no clinically overt heart failure were extracted.
Results A total of 9 studies were identified, providing data for 110 patients. Six studies tested dietary intervention and 3 studies tested bariatric surgery. Over a median duration of 9.7 months (range 0.75 to 23), a median weight loss of 43 kg (range 10 to 58) was associated with significant reductions in heart rate (–9 beats/min, 95% confidence interval [CI]: –12 to –6; p < 0.001), mean arterial pressure (–7 mm Hg, 95% CI: –11 to –3; p < 0.001), and resting oxygen consumption (–85 mL/min, 95% CI: –111 to –60; p < 0.001). Central cardiac hemodynamics improved, manifest by reductions in pulmonary capillary wedge pressure (–3 mm Hg, 95% CI: –5 to –1; p < 0.001) and mean pulmonary artery pressure (–5 mm Hg, 95% CI: –8 to –2; p = 0.001). Exercise hemodynamics were assessed in a subset of patients (n = 49) in which there was significant reduction in exercise pulmonary artery pressure (p = 0.02).
Conclusions Therapeutic weight loss in obese patients without HF is associated with favorable hemodynamic effects. Randomized controlled trials evaluating strategies for weight loss in obese patients with heart failure such as the obese phenotype of heart failure with preserved ejection fraction are needed.
Dr. Borlaug is supported by National Institutes of Health grants R01 HL128526, R01 HL 126638, U01 HL125205, and U10 HL110262.
All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 16, 2019.
- Revision received April 25, 2019.
- Accepted April 25, 2019.
- 2019 American College of Cardiology Foundation
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