Heart Failure With Preserved Ejection Fraction Across the Spectrum of Body Mass Index

Abstract

Background Limited data are available on the relationship between body mass index (BMI) and heart failure (HF) physiology or clinical outcomes in patients with heart failure with preserved ejection fraction (HFpEF). Objectives This study aims to assess the relationship between BMI and echocardiographic and hemodynamic measures as well as the risk of HF hospitalization and death. Methods This analysis was performed using a large multicenter registry of patients with diagnosed HFpEF in PCORnet (National Patient-Centered Clinical Research Network) from 2012 to 2018 who had undergone either echocardiography or invasive right heart catheterization. Results Of the 149,027 patients with HFpEF, 1.8% were underweight, 20.5% had a normal BMI, 27.9% were overweight, 22.1% had class 1 obesity, 13.3% had class 2, and 14.4% had class 3 obesity. The median follow-up time was 3.5 years. Higher BMI was associated with significant increases in multiple echocardiographic and hemodynamic markers of HF severity, including larger left atrial diameter, left ventricular end-diastolic diameter, and higher mean pulmonary artery pressure and pulmonary capillary wedge pressure ( P < 0.001 for all). Higher BMI was associated with a significant and linear increase in the risk of HF hospitalization. In contrast, a sharp L-shaped relationship was observed between BMI and death, such that patients who were underweight had the highest risk of death and increasing BMI >30 kg/m2 was associated with a stable risk of death compared with patients who were overweight. Conclusions In these large, real-world, multicenter analyses, higher BMI was associated with adverse hemodynamic and structural cardiac changes, a linear increase in the risk of HF hospitalization, and a stable risk of death.