Therapeutic weight loss is significantly associated with favorable hemodynamic effects in patients with obesity without a history of heart failure, according to study results published in JACC: Heart Failure.
Modest weight loss induced by caloric restriction has been shown to improve aerobic capacity in patients with obesity and heart failure with preserved ejection fraction. Researchers conducted this systematic review and meta-analysis of 9 prospective observational studies to examine the relationship between weight loss interventions and cardiac hemodynamic changes, measured invasively, in patients with obesity. They assessed 6 studies of dietary intervention and 3 of bariatric surgery, with a total of 110 included patients who had no history of heart failure (median study level mean age, 37 years; baseline weight, 124 kg).
In each study, hemodynamic evaluation was conducted prior to intervention and at a median follow-up of 9.7 months. Across all studies, patients lost a median of 43 kg, or 25% of baseline weight. This weight loss was significantly associated with reductions in cardiac output (-0.64 L/min [9%]; P <.001), heart rate (-9 bpm [11%]; P <.001), mean arterial pressure (-7 mm Hg [7%]; P <.001) and resting oxygen consumption (-85 mL/min [24%]; P <.001).
The researchers also discovered improvements in central cardiac hemodynamics, as evidenced by reductions in pulmonary capillary wedge pressure (-3 mm Hg [26%]; P <.001), mean right atrial pressure (-2 mm Hg [46%]; P =.042), and mean pulmonary artery pressure (-5 mm Hg [22%]; P =.001) after weight loss. Furthermore, a subset of 49 patients from 5 studies was assessed for exercise hemodynamics before and after intervention, which revealed a significant reduction in peak exercise pulmonary artery pressure after weight loss (P =.02).
Limitations to this study included high heterogeneity and broad variability among the included studies, attributable to a lack of standardization.
“In obese patients without heart failure, weight loss is associated with improved biventricular filling pressures, lower systemic and pulmonary artery pressures, reduction in ventricular work, and more favorable cardiac perfusion relative to metabolism,” the researchers said, adding that future studies are needed “to define the potential role and optimal methods to achieve weight loss in this large and growing cohort of patients for whom few treatment options exist.”
Reddy YNV, Anantha-Narayanan M, Obokata M, et al. Hemodynamic effects of weight loss in obesity: a systematic review and meta-analysis [published online July 10, 2019]. JACC: Heart Fail. doi:10.1016/j.jchf.2019.04.019