Obesity-related heart failure with preserved ejection fraction: diagnostic and therapeutic challenges

Jung, Mi‐Hyang; Shin, Mi-Seung

doi:10.3904/kjim.2022.271

Cited by 3 publications

(5 citation statements)

References 64 publications

(72 reference statements)

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“…A phase angle value lower than 4.9° is associated with a condition known as sarcopenia [ 17 , 31 , 32 , 33 ], characterized by a quantitative and qualitative deficiency in muscle tissue. This phenomenon has also been observed in the pre-transplant period, for example, in liver cirrhosis [ 34 ], kidney transplantation, and in heart failure [ 35 ]. In the two populations studied, the BMI and body composition data were substantially similar, except for cellular water compartmentalization, which was slightly less favorable in the kidney transplant group.…”

Section: Discussionmentioning

confidence: 82%

Cardiorespiratory Performance in Kidney and Liver Transplant Recipients: The Dilemma to Combine Lifestyle and Fitness

Polara,

Montagnoli,

Palazzo

et al. 2024

JFMK

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It is widely demonstrated that moderate-intensity exercise is associated with improved fitness in non-communicable chronic diseases. However, there are no specific guidelines available for transplant recipients. Body composition is closely linked to exercise capacity, typically estimated by cardiopulmonary testing, but its potential correlation with cardiovascular health outcomes has not been investigated yet. This study aims to evaluate and compare cardiorespiratory performance and body composition in two groups of liver and kidney transplant recipients. A mixed group of transplant recipients (10 kidney and 15 liver) participating in a lifestyle reconditioning program through unsupervised physical exercise prescription was examined. Both groups were assessed using bioimpedance analysis (BIA), lifestyle, and physical activity levels by IPAQ questionnaire and cardiopulmonary testing (CPET). The two groups differed by IPAQ examination: liver transplant patients practiced more physical activity. Statistically significant differences were found in peak VO2/HR (oxygen pulse), which was higher in the kidney group compared to the liver group (15.63 vs. 12.49 with p < 0.05). Body composition did not show significant differences in BMI and the percentage of FM/FFM (FFM: 78.04 ± 7.7 in Kidney T vs. 77.78 ± 7.2 in Liver T). Systolic pressure measured at the peak was significantly higher in the liver group (162.6 vs. 134 with p < 0.01). The correlation between the CPET and BIA parameters showed a positive VO2 max and FFM mass trend. The results suggest differences in cardiorespiratory fitness between the two populations of solid organ transplant recipients despite not being related to the physical activity level. The data support the importance of body composition analysis in sports medicine and the prescription of physical exercise, especially considering the potential correlation with VO2 max, even though home-based exercise does not seem to alter it substantially. BMI does not appear to be a determinant of cardiovascular performance. Other determinants should be investigated to understand the differences observed.

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Section: Discussionmentioning

confidence: 82%

Cardiorespiratory Performance in Kidney and Liver Transplant Recipients: The Dilemma to Combine Lifestyle and Fitness

Polara,

Montagnoli,

Palazzo

et al. 2024

JFMK

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“…Adipocytes can directly produce angiotensinogen, angiotensin II, and aldosterone or indirectly enhance aldosterone secretion from the adrenal gland by releasing leptin and catecholamine [58][59][60]. The level of natriuretic peptide is reduced in obesity [11,61]. Increased levels of neprilysin in obesity lead to the degradation of the natriuretic peptide, which consequently stimulates the RAAS [62].…”

Section: Hemodynamic Factors: Sodium Retention Via the Neurohormonal ...mentioning

confidence: 99%

“…Renal sodium retention is a key factor in the pathogenesis of obesity-related hypertension and organ dysfunction [ 8 , 11 , 43 ]. Neurohormonal derangements, such as activation of the sympathetic nervous system (SNS) and renin-angiotensin-aldosterone system (RAAS) and deficiency of the natriuretic peptide system, are antedated by renal sodium retention.…”

Section: Postulated Mechanisms Behind Obese-related Hypertension and ...mentioning

confidence: 99%

“…Table 2 presents additional information regarding the effects of each of the four drugs on weight loss, blood pressure, and contraindications for each of the four drugs. Other promising drugs, such as the sodium-glucose cotransporter 2 inhibitor, setmelanotide, and other GLP-1 agonists, are under development [ 11 , 90 , 95 ]. Semaglutide, which is another GLP-1 receptor agonist, at a 2.4-mg subcutaneous injection (higher dose formulation of semaglutide, once-weekly dose; Wegovy, Novo Nordisk), was approved by the U.S. Food and Drug Administration for weight loss.…”

Section: How To Manage Obesity-related Hypertensionmentioning

confidence: 99%

“…It accounts for 65% to 75% of essential hypertension [8][9][10], is characterized by increased salt sensitivity, and is frequently the cause of resistant hypertension [8][9][10]. Furthermore, obesity-related hypertension frequently precedes the onset of coronary artery disease, heart failure, and chronic kidney disease (CKD) [10][11][12][13][14][15][16]. Meanwhile, obesity is observed in approximately 20% to 25% of patients with CKD worldwide and is also a significant risk factor for CKD development [17].…”

Section: Introductionmentioning

confidence: 99%

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Obesity-related hypertension and chronic kidney disease: from evaluation to management

Jung

Ihm

2023

Kidney Res Clin Pract

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With the recent obesity pandemic, obesity-related hypertension and its complications (e.g., heart failure, coronary disease, and chronic kidney disease [CKD]) are gaining attention in clinical and research fields. Obesity-related hypertension frequently precedes the onset of CKD and aggravates its progression. In this review, we discuss the role of visceral fat in the pathophysiology of obesity-related hypertension and the potential therapeutic strategies for its prevention and management. Various factors, including the sympathetic nervous system, renin-angiotensin-aldosterone system, and inflammatory pathways, are intricately involved in the pathogenesis of obesity-related hypertension. These factors individually and jointly contribute to the development of hypertension (usually sodium-sensitive or resistant hypertension) and, ultimately, to the progression of CKD. From a clinical standpoint, a decline in renal function in advanced CKD further makes blood pressure control challenging since only a few options are available for blood pressure-lowering medications. Proactive lifestyle modification, pharmacological treatment for obesity, and bariatric surgery can be considered for obesity control and management. Furthermore, intensive blood pressure control is required to prevent and halt the development and progression of CKD.

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Beyond weight loss: the potential of glucagon-like peptide-1 receptor agonists for treating heart failure with preserved ejection fraction

Wang,

Yang,

Cheng

et al. 2024

Heart Fail Rev

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Obesity-related heart failure with preserved ejection fraction: diagnostic and therapeutic challenges

Cited by 3 publications

References 64 publications

Cardiorespiratory Performance in Kidney and Liver Transplant Recipients: The Dilemma to Combine Lifestyle and Fitness

Cardiorespiratory Performance in Kidney and Liver Transplant Recipients: The Dilemma to Combine Lifestyle and Fitness

Obesity-related hypertension and chronic kidney disease: from evaluation to management

Beyond weight loss: the potential of glucagon-like peptide-1 receptor agonists for treating heart failure with preserved ejection fraction

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