(423) Decoupling of Hemodynamics and Congestive Symptoms in Obese Heart Failure Patients

Purpose:BackgroundPrior studies indicate significant physiologic differences between obese and non-obese heart failure (HF) patients, but none have evaluated differences in hemodynamic patterns in these patient populations during treatment for acute decompensated HF (ADHF). ObjectivesIn this study, we assessed differences in hemodynamic trends between obese and non-obese patients during treatment for ADHF.MethodsObese (BMI >30, n=63) and non-obese (BMI <25, n=69) patients with ADHF in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) study who had pulmonary artery catheterization data available through the duration of treatment were evaluated. Hemodynamics were analyzed at baseline and optimal day. Changes in BNP, weight, creatinine, BUN, 6MWT, orthopnea and dyspnea scores were assessed.ResultsDespite similar baseline hemodynamics, obese patients had significantly less absolute and relative pulmonary arterial wedge pressure (PAWP) reduction (-16 ± 28 versus -32 ± 29%, p = 0.04) during treatment. Obese patients also had higher PAWP (22.1 + 8 versus 14.9 + 7.4 mmHg, p=0.001) and PA pressures at optimization compared with non-obese patients. Obese and non-obese patients had similar relative improvements in weight, BNP, six minute walk test distance, dyspnea and orthopnea scores, and similar changes in creatinine and BUN.ConclusionObese patients treated for ADHF display less reduction in invasively measured left heart filling pressures, despite similar improvements in symptoms, weight loss, and noninvasive surrogates of congestion (Figure). Our findings suggest a degree of decoupling between left heart filling pressures and congestive symptoms in obese :BackgroundPrior studies indicate significant physiologic differences between obese and non-obese heart failure (HF) patients, but none have evaluated differences in hemodynamic patterns in these patient populations during treatment for acute decompensated HF (ADHF). ObjectivesIn this study, we assessed differences in hemodynamic trends between obese and non-obese patients during treatment for ADHF. Obese (BMI >30, n=63) and non-obese (BMI <25, n=69) patients with ADHF in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) study who had pulmonary artery catheterization data available through the duration of treatment were evaluated. Hemodynamics were analyzed at baseline and optimal day. Changes in BNP, weight, creatinine, BUN, 6MWT, orthopnea and dyspnea scores were assessed. Despite similar baseline hemodynamics, obese patients had significantly less absolute and relative pulmonary arterial wedge pressure (PAWP) reduction (-16 ± 28 versus -32 ± 29%, p = 0.04) during treatment. Obese patients also had higher PAWP (22.1 + 8 versus 14.9 + 7.4 mmHg, p=0.001) and PA pressures at optimization compared with non-obese patients. Obese and non-obese patients had similar relative improvements in weight, BNP, six minute walk test distance, dyspnea and orthopnea scores, and similar changes in creatinine and BUN. Obese patients treated for ADHF display less reduction in invasively measured left heart filling pressures, despite similar improvements in symptoms, weight loss, and noninvasive surrogates of congestion (Figure). Our findings suggest a degree of decoupling between left heart filling pressures and congestive symptoms in obese