Exercise limitations in heart failure with preserved ejection fraction and obesity: is the issue the engine or chassis?
Notice bibliographique
Résumé
Abstract Background Heart failure with preserved ejection fraction (HFpEF) is a complex clinical syndrome characterized by reduced peak oxygen uptake (VO2peak) secondary to central and peripheral limitations. Obesity is a well-established risk factor for HFpEF and has garnered considerable interest as a therapeutic target, particularly in the context of the obese-HFpEF phenotype. However, the impact of obesity on VO2peak and its Fick determinants in HFpEF remains unclear. Purpose To understand the impact of obesity on VO2peak and it’s central and peripheral determinants in individuals with HFpEF. Methods Patients referred to a multi-disciplinary unexplained dyspnea clinic with an established HFpEF diagnosis were included (n=448), and sub-grouped based on body mass index (BMI, ≥30 kg/m2 or <30) into HFpEF with- (HFpEFObese, n=138; BMI=34.3±3.7 kg/m2; 68% female; 71±9 yrs) or without obesity (HFpEFNon-Obese, n=310; BMI=24.9±3.0 kg/m2; 60% female; 74±9 yrs.). Patients underwent maximal cardiopulmonary exercise testing with simultaneous echocardiography (CPETecho) to assess VO2peak, exercise hemodynamics (cardiac output, CO; stroke volume, SV; heart rate, HR, mean pulmonary artery pressure, mPAP) and the arterio-venous oxygen difference (a-vO2diff). HFpEF sub-groups were compared using ANCOVA with adjustment for age and sex. Comparison was made using absolute values and values adjusted for bodyweight (peak VO2) or body surface area (BSA; CO, SV) . Pooled HFpEF sub-groups were also compared using ANCOVA (adjusted for age and sex) to controls (CON, n=153; BMI: 23.1±2.7 kg/m2, 41% female; 62±5 yrs) without HFpEF to elucidate the impact of HFpEF, versus HFpEF plus obesity on VO2peak and its determinants. Results HFpEFObese and HFpEFNon-Obese had comparable absolute VO2peak, peak exercise HR and a-vO2diff, while HFpEFObese had higher CO at peak exercise secondary to a larger SV. Resting and exercise mPAP and mPAP-CO slopes were higher in HFpEF vs CON (P<0.001 for all; Fig. 2), with no differences seen between HFpEF obesity phenotypes (P>0.50 for all). In contrast, bodyweight-adjusted peak VO2 was markedly lower in HFpEFObese (Fig. 1B), despite comparable peak exercise cardiac index and stroke volume index. Regardless of HFpEF sub-group, peak VO2, central (CO, HR, mPAP) and peripheral factors (a-vO2diff) were markedly impaired in HFpEF versus CON (Fig. 1). Conclusions Obese HFpEF patients demonstrate a higher stroke volume reserve while maintaining oxygen extraction. However, these adaptations are insufficient to sustain weight-adjusted peak VO2 at the levels of their non-obese counterparts. This suggests that obesity induces adaptive cardiac and peripheral muscle remodeling. Accordingly, HFpEF patients achieving weight reduction should be supported with adjuvant exercise training programs to preserve cardiac and peripheral muscle performance as the load of excess body mass is alleviated, thereby enhancing exercise tolerance.Fig 1.Differences in VO2 determinantsFig 2.Differences in mPAP and CO
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».