Obesity and heart failure with preserved ejection fraction.

OBJECTIVE: Aim: To perform an overall assessment of heart failure with preserved ejection fraction (HFpEF) adults with central obesity. PATIENTS AND METHODS: Materials and Methods: We enrolled HFpEF patients with central obesity (n =73, mean age 52.4 ± 6.3 years) and without obesity (n =70, mean age 51.9 ± 7.1 years) and compared with an age-matched healthy subjects who had not suffered from HF (n = 69, mean age 52.3 ± 7.5 years). Physical examination, routine laboratory tests such as fasting blood glucose, fasting insulin, insulin resistance (HOMA) index, serum lipids, haemoglobin, creatinine, ALT, AST, uric acide, hs CRP, TSH, N-terminal proB-type natriuretic peptide (NT-proBNP) and standard transthoracic echocardiogram (2D and Doppler) examinations were performed and assessed. RESULTS: Results: The average values of diastolic blood pressure (DBP), glucose and lipid profiles, uric acide, hs CRP were found to be significantly higher among obese patients with HFpEF than non-obese. Despite more severe symptoms and signs of HF, obese patients with HFpEF had lower NT-proBNP values than non-obese patients with HFpEF (129±36.8 pg/ml, 134±32.5 pg/ml vs 131±30.4 pg/ml, 139±33.8 pg/ml respectively; p < 0.05). However, it was found that patients with high central (visceral) adiposity have more pronounced obesity-related LV diastolic dysfunction, lower E/e' ratio, lower mitral annular lateral e' velocity, an increased LV diastolic dimension and LV mass index. Compared with non-obese HFpEF and control subjects, obese patients displayed greater right ventricular dilatation (base, 35±3.13 mm, 36±4.7 mm vs 33±2.8 mm, 34±3.2 mm and 29±5.3 mm, 30±3.9 mm; length, 74±5 mm, 76±8 mm vs 67±4 mm, 69±6 mm and 60±3 mm, 61±5 mm respectively; p < 0.05), more right ventricular dysfunction (TAPSE 16±2 mm, 15±3 mm vs 17±2 mm, 17±1 mm and 19±2 mm, 20±3 mm respectively; p < 0.05). CONCLUSION: Conclusions: Obese patients with HFpEF have higher diastolic BP, atherogenic dyslipidemia, insulin resistance index values and greater systemic inflammatory biomarkers, despite lower NT-proBNP values, which increase the risk of cardiovascular events in future. Echocardiography examination revealed not only significant LV diastolic dysfunction, but also displayed greater RV dilatation and dysfunction.

IMPROVEMENT OF CARDIAC FUNCTION AFTER WEIGHT LOSS PROGRAM AMONG YOUNG WOMEN.

OBJECTIVE: The aim: To determine the difference between body composition and hemodynamics indices at baseline and after the weight loss program. PATIENTS AND METHODS: Materials and methods: The subject of this study was 13 young women. The weight and body composition were measured by the bio-impedance method. Hemodynamics indices were measured by the method of the thoracic rheography. The measurement of body composition and indices of hemodynamics were performed at the beginning of the weight loss program and 2 months later. The participants underwent 45 minutes per day of moderate-intensity physical activity 3 times a week. RESULTS: Results: The percentage of body fat decreased in 3.9±0.37% from baseline (p=0.01) and the level of visceral fat - 1.54±0.14 units (p=0.001) respectively. Indices of hemodynamics were improved after the weight loss program. Firstly, the index of cardiac output was reduced in 1.43±1.09 l/min (p=0.019) after 2 months of the weight loss program. Secondly, the indices of peripheral resistance also have been improved. Moreover, the index of workload of left ventricle has decreased from 3.56 to 2.7 kg/m/m2 (p=0.035). CONCLUSION: Conclusions: Our results demonstrated the improvement of indices of hemodynamics due to the normalization of body composition among young women after weight loss program.