Examining treatments and outcomes in patients with obesity and heart failure

Dr Sarah Gutman, Baker Heart and Diabetes Institute

2023 Postdoctoral Fellowship

Years funded: 2024 - 2025

Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome in which patients have clinical features of heart failure (HF) in the presence of normal or near-normal left ventricular ejection fraction. HFpEF is the most common cause of HF and obesity is one of the key risk factors for HFpEF, but key knowledge gaps are limiting effective and targeted HFpEF treatments. Better understanding is needed about the effects of weight loss on HFpEF. Weight loss in HF patients has been associated with a lower incidence of HF and an improvement in symptoms. However, the mechanism for this has not been proven and it is not known whether haemodynamic abnormalities in patients with established HF are reversible.

My studies will characterise the link between HFpEF and obesity, using invasive haemodynamics, cardiopulmonary exercise testing (CPET) and CMR.

I will answer:

1. Does significant weight loss reverse the haemodynamic abnormalities that characterise the obese HfpEF phenotype and, if so, how? In particular, is the left ventricular fibrosis seen in HfpEF patients with obesity reversible after significant weight loss?
2. Is there a difference in the haemodynamic/exercise response to weight loss with surgery or medication, or a difference between patients with different characteristics?
3. What clinical, haemodynamic and metabolic features increase the risk of HF hospitalisations and cardiac death in people with obesity? In particular, can myocardial fibrosis and total epicardial adipose tissue identified through CMR be used to identify patients with obesity at risk of HFpEF?

HFpEF and obesity are two of the fastest growing chronic diseases worldwide, and addressing key knowledge gaps will provide strategies to address these related epidemics.