Heart failure with preserved ejection fraction in patients with obesity: cardiopulmonary evaluation

Background: Obesity is a major worldwide healthcare problem, frequently associated to a specific phenotype of heart failure with preserved ejection fraction (HFpEF). However, HFpEF diagnosis in this population remains challenging, due to sign/symptoms overlapping and some limitations in diagnostic scoring systems. Aim: To investigate whether a specific cardiopulmonary exercise testing (CPET) pattern can be identified in patients with obesity and HFpEF when compare to obese patients without this complication. Materials and methods: Patients with obesity and sign or symptoms of HFpEF will undergo all clinical examinations indicated to make diagnosis of HFpEF applying the current diagnostic algorithms, and a maximal CPET. At the end, patients have been divided into groups according to HFpEF probability, and differences in CPET parameter between groups have been evaluated. Results: 46 patients have been included in the study. Maximal and submaximal cardiorespiratory fitness results lower in patients with HFpEF when compared to obese patients without this complication. Moreover, oxygen pulse response is significantly lower in patients with obesity and HFpEF. No exercise-induced pulmonary hypertension have been described in individuals with obesity-related HFpEF. Conclusions: Patients with obesity-related HFpEF exhibit significantly reduced maximal and submaximal functional capacity. This limitation in exercise capacity appears to be primarily attributable to cardiac-related dysfunction, as well as substantial peripheral limitations, without significant pulmonary or ventilatory limitations.