Hemodynamic Effects of Weight Loss in Obesity: A Systematic Review and Meta-Analysis

Yogesh N.V. Reddy, Mahesh Anantha-Narayanan, Masaru Obokata, Katlyn E. Koepp, Patricia Erwin, Rickey E. Carter, Barry A Borlaug

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives: The authors aimed to explore whether weight loss may improve central hemodynamics in obesity. Background: Hemodynamic abnormalities in obese heart failure with preserved ejection fraction patients are correlated with the amount of excess body mass, suggesting a possible causal relationship. Methods: Relevant databases were systematically searched from inception to May 2018, without language restriction. Studies reporting invasive hemodynamic measures before and following therapeutic weight loss interventions in patients with obesity but no clinically overt heart failure were extracted. Results: A total of 9 studies were identified, providing data for 110 patients. Six studies tested dietary intervention and 3 studies tested bariatric surgery. Over a median duration of 9.7 months (range 0.75 to 23.0 months), a median weight loss of 43 kg (range 10 to 58 kg) was associated with significant reductions in heart rate (−9 beats/min, 95% confidence interval [CI]: −12 to −6; p < 0.001), mean arterial pressure (−7 mm Hg, 95% CI: −11 to −3; p < 0.001), and resting oxygen consumption (−85 ml/min, 95% CI: −111 to −60; p < 0.001). Central cardiac hemodynamics improved, manifested by reductions in pulmonary capillary wedge pressure (−3 mm Hg, 95% CI: −5 to −1; p < 0.001) and mean pulmonary artery pressure (−5 mm Hg, 95% CI: −8 to −2; p = 0.001). Exercise hemodynamics were assessed in a subset of patients (n = 49) in which there was significant reduction in exercise pulmonary artery pressure (p = 0.02). Conclusions: Therapeutic weight loss in obese patients without HF is associated with favorable hemodynamic effects. Randomized controlled trials evaluating strategies for weight loss in obese patients with heart failure such as the obese phenotype of heart failure with preserved ejection fraction are needed.

Original languageEnglish (US)
Pages (from-to)678-687
Number of pages10
JournalJACC: Heart Failure
Volume7
Issue number8
DOIs
StatePublished - Aug 1 2019

Fingerprint

Meta-Analysis
Weight Loss
Obesity
Hemodynamics
Confidence Intervals
Heart Failure
Pulmonary Artery
Exercise
Pressure
Pulmonary Wedge Pressure
Bariatric Surgery
Oxygen Consumption
Arterial Pressure
Language
Randomized Controlled Trials
Heart Rate
Databases
Phenotype
Therapeutics

Keywords

  • heart failure
  • invasive hemodynamics
  • meta-analysis
  • obesity
  • weight loss

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Hemodynamic Effects of Weight Loss in Obesity : A Systematic Review and Meta-Analysis. / Reddy, Yogesh N.V.; Anantha-Narayanan, Mahesh; Obokata, Masaru; Koepp, Katlyn E.; Erwin, Patricia; Carter, Rickey E.; Borlaug, Barry A.

In: JACC: Heart Failure, Vol. 7, No. 8, 01.08.2019, p. 678-687.

Research output: Contribution to journalArticle

Reddy, Yogesh N.V. ; Anantha-Narayanan, Mahesh ; Obokata, Masaru ; Koepp, Katlyn E. ; Erwin, Patricia ; Carter, Rickey E. ; Borlaug, Barry A. / Hemodynamic Effects of Weight Loss in Obesity : A Systematic Review and Meta-Analysis. In: JACC: Heart Failure. 2019 ; Vol. 7, No. 8. pp. 678-687.
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AU - Reddy, Yogesh N.V.

AU - Anantha-Narayanan, Mahesh

AU - Obokata, Masaru

AU - Koepp, Katlyn E.

AU - Erwin, Patricia

AU - Carter, Rickey E.

AU - Borlaug, Barry A

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AB - Objectives: The authors aimed to explore whether weight loss may improve central hemodynamics in obesity. Background: Hemodynamic abnormalities in obese heart failure with preserved ejection fraction patients are correlated with the amount of excess body mass, suggesting a possible causal relationship. Methods: Relevant databases were systematically searched from inception to May 2018, without language restriction. Studies reporting invasive hemodynamic measures before and following therapeutic weight loss interventions in patients with obesity but no clinically overt heart failure were extracted. Results: A total of 9 studies were identified, providing data for 110 patients. Six studies tested dietary intervention and 3 studies tested bariatric surgery. Over a median duration of 9.7 months (range 0.75 to 23.0 months), a median weight loss of 43 kg (range 10 to 58 kg) was associated with significant reductions in heart rate (−9 beats/min, 95% confidence interval [CI]: −12 to −6; p < 0.001), mean arterial pressure (−7 mm Hg, 95% CI: −11 to −3; p < 0.001), and resting oxygen consumption (−85 ml/min, 95% CI: −111 to −60; p < 0.001). Central cardiac hemodynamics improved, manifested by reductions in pulmonary capillary wedge pressure (−3 mm Hg, 95% CI: −5 to −1; p < 0.001) and mean pulmonary artery pressure (−5 mm Hg, 95% CI: −8 to −2; p = 0.001). Exercise hemodynamics were assessed in a subset of patients (n = 49) in which there was significant reduction in exercise pulmonary artery pressure (p = 0.02). Conclusions: Therapeutic weight loss in obese patients without HF is associated with favorable hemodynamic effects. Randomized controlled trials evaluating strategies for weight loss in obese patients with heart failure such as the obese phenotype of heart failure with preserved ejection fraction are needed.

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