Characterizing obesity-HFpEF in younger acute respiratory failure patients
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Background
Hypoxic hypercapnic respiratory failure is a major cause of acute hospitalization. Cardiopulmonary insults can lead to respiratory distress and, if untreated, respiratory failure. West Virginia has the highest prevalence of obesity in the nation, accounting for the higher incidence of heart failure with preserved ejection fraction (HFpEF). This diagnosis is elusive in younger patients below age 65 years because echocardiograms are often normal and invasive hemodynamics are not widely measured. H2FPEF score, “obesity age” (BMI + age), and newly described HFpEF-ABA scores may predict obesity-related HFpEF in acute respiratory failure settings. Given the global rise in obesity, early identification of HFpEF is critical to optimizing respiratory failure care.
Purpose
This cohort study investigates the burden of obesity-related HFpEF in patients younger than 65 years old presenting with respiratory failure.
Methods
The study included patients ≤65 years of age admitted to Charleston Area Medical Center from 1/2023-12/2023 with respiratory failure, BMI > 30 kg/m2, and EF > 50%. Patients with specific cardiomyopathies or identifiable triggers for for respiratory failure were excluded. “Premature HFpEF” was defined as ‘obesity years’ >100. Demographic data on BMI, echocardiographic and hemodynamic findings were analyzed. Logistic regression was used to assess the relationship between premature HFpEF and respiratory failure, adjusting for confounders.
Results
Among 44 patients with respiratory failure, 64% exhibited premature obesity-related heart failure with preserved ejection fraction (HFpEF), characterized by a mean age and body mass index (BMI) of 111.5 kg/m2-years. These patients demonstrated elevated left ventricular end-diastolic pressure (LVEDP) exceeding 18 mmHg during cardiac catheterization. H2FPEF score could not be measured due to obesity limiting Doppler echocardiographic studies. The HFpEF -ABA score was > 80% and ‘obesity age’ was > 95 in 85% of the cohort.
Conclusion
Early recognition of obesity-related HFpEF enables healthcare providers to tailor individualized treatment regimens. Preventive strategies focused on obesity reduction can reverse associated comorbidities, improve patient outcomes, and lower healthcare costs in the long run.
