Obesity: the perfect storm for heart failure

Abstract

Obesity condition causes morphological and functional alterations involving the cardiovascular system. These can represent the substrates for different cardiovascular diseases, such as atrial fibrillation, coronary artery disease, sudden cardiac death, and heart failure (HF) with both preserved ejection fraction (EF) and reduced EF. Different pathogenetic mechanisms may help to explain the association between obesity and HF including left ventricular remodelling and epicardial fat accumulation, endothelial dysfunction, and coronary microvascular dysfunction. Multi‐imaging modalities are required for appropriate recognition of subclinical systolic dysfunction typically associated with obesity, with echocardiography being the most cost‐effective technique. Therapeutic approach in patients with obesity and HF is challenging, particularly regarding patients with preserved EF in which few strategies with high level of evidence are available. Weight loss is of extreme importance in patients with obesity and HF, being a primary therapeutic intervention. Sodium–glucose co‐transporter‐2 inhibitors have been recently introduced as a novel tool in the management of HF patients. The present review aims at analysing the most recent studies supporting pathogenesis, diagnosis, and management in patients with obesity and HF.

Association between Obesity and Atrial Function in Patients with Non-Valvular Atrial Fibrillation: An Echocardiographic Study

“…Obesity increases the thromboembolic risk, probably due to the chronic inflammatory state which in itself activates the thrombotic process and plays a role in the pathogenesis of "atrial myopathy" responsible for both HFpEF and AF. Unfortunately, the thromboembolic risk in obese patients is often undertreated, which makes the evaluation of this type of patient highly relevant to allow for more accurate risk stratification and consequently adequate treatment [23].…”

Commentary on: ‘Cuspidi C., et al. Left ventricular systolic dysfunction in obesity: a meta-analysis of speckle tracking echocardiographic studies’

“…Notably, Cuspidi et al [1] affirm that their data suggest that calculation of GLS should be incorporated into routine work-up aimed to identify obesity-mediated subclinical cardiac damage [1]. Although multiimaging modalities are required for appropriate recognition of subclinical systolic dysfunction typically associated with obesity, standard echocardiography remains, at least in my opinion, the most cost-effective technique [7].…”

“…Although some doubts were raised about the clinical role of obesity as an independent cardiovascular risk factor, thus leading to hypothesize an 'obesity paradox', because of the observation of paradoxically better outcomes in older obese patients [5], even in those with chronic heart failure [6], there is general agreement about the fact that obesity condition causes morphological and functional alterations involving the cardiovascular system, including left ventricular remodeling and epicardial fat accumulation, endothelial dysfunction and coronary microvascular dysfunction [7]. These can represent the substrates for different cardiovascular diseases, such as atrial fibrillation, coronary artery disease, sudden cardiac death, and heart failure with both preserved ejection fraction and reduced ejection fraction [7].…”