Парадокс ожиріння при хронічній серцевій недостатності з помірно зниженою та збереженою фракцією лівого шлуночка: вплив на прогноз хворих за даними п’ятирічного спостереження

P. P.  Bidzilya; V. H. Kadzharian; M. V. Bychko

doi:10.14739/2310-1210.2023.4.280957

Authors

P. P. Bidzilya Zaporizhzhia State Medical and Pharmaceutical University, Ukraine, Ukraine https://orcid.org/0000-0003-2451-317X
V. H. Kadzharian Zaporizhzhia State Medical and Pharmaceutical University, Ukraine, Ukraine https://orcid.org/0000-0003-2542-7142
M. V. Bychko Uzhhorod National University, Ukraine, Ukraine https://orcid.org/0009-0003-7880-6581

DOI:

https://doi.org/10.14739/2310-1210.2023.4.280957

Keywords:

chronic heart failure, moderately reduced ejection fraction, preserved ejection fraction, overweight, obesity, prognosis

Abstract

Aim. To investigate the obesity paradox by studying the impact of overweight and abdominal obesity on the prognosis in chronic heart failure (CHF) patients with moderately reduced or preserved left ventricular ejection fraction (LVEF) by five-year follow-up results.

Materials and methods. A prospective, open, parallel-group study included 314 CHF patients with moderately reduced or preserved LVEF, average age was 65.3 ± 11.2 years. Group 1 – 66 patients with normal weight; Group 2 – 67 overweight patients; Group 3 – 90 patients with I degree abdominal obesity; Group 4 – 91 subjects with II–III degrees of obesity.

Adverse cardiovascular events (CVEs) were studied as a cumulative endpoint, cardiovascular death, and rehospitalization due to decompensated CHF.

Results. It has been found that excess body weight (overweight and I–III degrees of abdominal obesity) did not affect the prevalence and spectrum of adverse CVEs in CHF patients with moderately reduced and preserved LVEF. In overweight patients, compared to I degree obesity group, the incidence of cumulative end point (by 15.4 %; χ²= 3.95, p < 0.05) and cases of re-hospitalization (by 19.0 %; χ² = 5.6, p < 0.05) were more often observed.

Concomitant overweight was associated with an increased risk for faster onset of the cumulative end point (HR 1.46, 95 % CI 1.1–2.2, p < 0.05) and re-hospitalization (HR 1.53, 95 % CI 1.1–2.4, p < 0.05).

Conclusions. The presence of excess body weight (overweight and I–III degrees of abdominal obesity) did not affect the prevalence and spectrum of adverse CVEs in CHF patients with moderately reduced and preserved LVEF during the five-year follow-up. In the presence of overweight, in comparison with I degree abdominal obesity, the incidence of cumulative end point and re-hospitalization due to the disease decompensation were more often observed, which could be evidence for the existence of the obesity paradox.

The most adverse effect on the prognosis in CHF patients with moderately reduced and preserved LVEF caused by concomitant overweight, in the presence of which, there was a significant increase in the risk for more faster onset of cumulative end point and re-hospitalization due to decompensation of the disease.

Author Biographies

P. P. Bidzilya, Zaporizhzhia State Medical and Pharmaceutical University, Ukraine

MD, PhD, DSc, Associate Professor of the Department of Internal Diseases 1 and Simulation Medicine

V. H. Kadzharian, Zaporizhzhia State Medical and Pharmaceutical University, Ukraine

MD, PhD, Associate Professor of the Department of Internal Medicine 1 and Simulation Medicine

M. V. Bychko, Uzhhorod National University, Ukraine

MD, PhD, DSc, Professor of the Department of Hospital Therapy

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