Effects Of Overweight And Obesity On Cardiac Structure And Function In Heart Failure With Preserved Ejection Fraction

Objective: To investigate the effects of overweight and obesity on cardiac structure and function in patients with ejection fraction retention heart failure（HFpEF）.Methods: A total of 252 newly diagnosed HFpEF patients admitted to Department of Geriatrics,First Hospital of Lanzhou University from January 2015 to January 2019 were selected.According to BMI,122 cases were divided into normal weight group（18.5≤BMI < 24 kg/m2）and 130 cases were overweight and obese group（BMI≥24 kg/m2）.Detailed patient’s medical history was recorded.Comprehensive physical examination was conducted including bod weight and height.Blood routine est,biochemical analysis including N-terminal B-type natriuretic peptide（NT-prob NP）and other indexes obtained.Echocardiography was used to evaluated cardiac structure and function.Two independent sample T test and Mann-Whitney U test were used to compare the differences of general clinical data and echocardiographic parameters between the two groups.Correlation analysis and multiple linear regression analysis were used to explore the correlation between BMI and cardiac structure and function of HFpEF patients,as well as the influence of various risk factors on them.Results:Overweight and obese HFpEF patients were younger,had higher prevalence of hypertension and sleep apnea hypopnea syndrome（OSAHS）,and used more angiotensin converting enzyme inhibitors（ACEI）.The levels of RBC,HBG,ALB,UA,TG,GLU and T3 in overweight and obese HFpEF patients were higher than those in normal weight HFpEF patients.In overweight and obese HFpEF group,LVIDs,LVIDd,IVSTs,PWTs and PWTd,left ventricular mass index（（linear method）LVMI-L）,left ventricular mass index（（linear method）LVM-L）,left ventricular end-systolic volume（LVESV）,left ventricular end-diastolic volume（LVE-DV）,left atrial volume（LAV）,left atrial diameter（LAD）,mitral valve orifice early diastolic maximum filling velocity（E peak）（E）were larger than those in HFpEF patients with normal body weight and were significantly positively correlated with BMI;Left ventricular ejection fraction（LVEF）and isovolumic diastolic time（IVRT）were smaller than those in HFpEF patients with normal weight group and were significantly negatively correlated with BMI;Right ventricular end-diastolic free wall thickness（RV-FWD）,right ventricular end-systolic free wall thickness（RV-FWS）,right ventricular base diameter（RV-D1）,middle right ventricular diameter（RV-D2）,right atrium long axis diameter（RA-D2）,right ventricular outflow tract diameter（pulmonary valve ring level）RV of HFpEF patients in overweight and obesity group OT2)and pulmonary artery diameter（PA）were significantly higher than those in HFpEF patients with normal body weight,and were significantly positively correlated with BMI.Stepwise linear regression analysis showed LVIDd,IVSTd,PWTd,LVMi-L,LVE-DV,LVEF,LAV,IVRT,RV-FWd,RVOT2,PA and RA-D2 was independently correlated with BMI;IVSTd,PWTd,LVMi-L and E were independently correlated with hypertension.LVE-DV,LVEF,LAV,E,E’L,RV-D1,RA-D2 and RAA were independently correlated with atrial fibrillation.LVIDd,LVEF,S’L,RV-D1,RVOT2,RV-D3,PASP and PA were independently correlated with chronic obstructive pulmonary disease（COPD）.E’L was independently correlated with ARB.LVMi-L,RV-D3,RA-D2and RAA were independently correlated withβ-blockers.E’L,LAV,RV-D1,RV-D3,RA-D2 and RAA were independently correlated with TC.LVIDd and IVRT were independently correlated with TG.LVEDV,PASP and RV-D3 were independently correlated with high density lipoprotein cholesterol（HDL-C）.RVOT2 and PA were independently correlated with low density lipoprotein cholesterol（LDL-C）.IVSTd,PWTd and LVMi-L were independently correlated with ferritin.Conclusion: Overweight and obesity could affect the heart structure and function of HFpEF patients,and with the increase of BMI,the heart structure and function of HFpEF patients could change more obviously.