Implications of obesity on clinical outcomes in acute decompensated heart failure across the left ventricular ejection fraction spectrum and right ventricular dysfunction

Aims: The implications of obesity on phenotype presentation and outcomes in acute decompensated heart failure (ADHF) are relatively unexplored. The aim of this study was to investigate the characteristics and prognostic implications related to obesity in ADHF, according to left ventricular and right ventricular function. Methods: Consecutive patients hospitalized for ADHF were retrospectively enrolled. Obesity was defined as BMI at least 30kg/m2. Patients were classified according to the range of left ventricular ejection fraction (LVEF) and to the presence of right ventricular dysfunction (RVD). The primary outcome was 1-year all-cause mortality or rehospitalization for ADHF (HFH). Results: Two thousand and ninety-eight patients were enrolled; 27% had BMI at least 30kg/m2. Obese patients were younger, more frequently men and diabetic, with higher blood pressure and lower natriuretic peptides; they had smaller left ventricular volumes, lower pulmonary arterial systolic pressure, and lower prevalence of mitral or tricuspid regurgitation. In heart failure with reduced LVEF, obese patients were treated with higher dosages of antineurohormonal drugs and diuretics. At multivariable logistic regression analysis, obesity was an independent predictor of heart failure with preserved ejection fraction (HFpEF) phenotype [odds ratio (OR)=2.046, P=0.012] and of RVD (OR=1.711, P=0.034). At adjusted analysis, obesity was independently associated with a lower risk of 1-year mortality/HFH (hazard ratio=0.608, P=0.003), consistently across LVEF subgroups and presence/absence of RVD. RVD was associated with a higher risk of 1-year mortality/HFH in nonobese but not in obese patients. Conclusion: Obesity was highly prevalent (27%) in ADHF and associated with a lower risk of 1-year mortality or HFH. Obesity was an independent predictor of HFpEF phenotype and of RVD, but RVD was associated with higher mortality/morbidity risk only in nonobese patients.