Arterial stiffness in patients with chronic heart failure: the role of visceral obesity
Authors: Derevyanchenko M , Statsenko M , Fabritskaya S , Rindina Y 
Published: October 2021

Abstract

Background
Chronic heart failure (CHF) and obesity have a negative impact on the target organs, including the condition of blood vessels. This is manifested in a progressive decrease of the elasticity of the main arteries.

Objective
To evaluate the effect of visceral obesity on the condition of the main arteries in patients with CHF.

Methods
The study included 116 patients with CHF of functional class I-III of ischemic genesis aged from 40 to 65 years, who were divided into 3 comparable groups: group 1 included patients with CHF with normal body weight (n=34), group 2 - overweight CHF (n=40), group 3 – CHF and grade 1–2 obesity (n=42). There were no differences in the severity of CHF between the study groups. The examination included an assessment of the general condition, anthropometry with measurement of the waist circumference (WC), hip circumference (HC), the ratio of WC/HC, as well as bioimpedansmetry with an assessment of the content of subcutaneous and visceral fat in the body. The visceral fat index (VAI) was calculated. Arterial stiffness was assessed by measuring the pulse wave velocity (PWV). The results were processed using the built - in functions of the MC Excel program and the STATISTICA 12.0 program.

Results
A significant increase in the ratio of WC/HC in patients of the 2nd and 3rd groups compared to patients of the 1st group was determined. Abdominal obesity was significantly more common among overweight and obese patients compared to those with normal body weight (78.6, 70, and 0%). A high percentage of visceral obesity was found among people with concomitant obesity/overweight: in 70% among overweight individuals and in 100% among obese individuals. The VAI was higher among patients with CHF and obese/CHF and overweight compared to those with “isolated” CHF. Differences were found in the average thickness of epicardial adipose tissue (EAT), which is a marker of visceral obesity. There was a statistically significant increase in PWV in elastic vessels (PWVe) in patients with CHF and obesity compared to patients with CHF and normal body weight (10.5 [8.9; 11.6] m/s vs 8.5 [7.5; 8.4] m/s. PWVe&gt;10 m/s was significantly more common among over weight or obese patients compared to patients with normal body weight (62.4 and 83.2% vs 37.5%, respectively). Significant correlations were found between PWVe and the severity of visceral obesity (r=0.53, p&lt;0.05), PWVe and WC (r=0.56, p&lt;0.05), PWVe and WC/HC (r=0.48, p&lt;0.05). PWVe was positively correlated witht EAT (r=0.36, p&lt;0.05) and VAI (r=0.34, p&lt;0.05).

Conclusion
The combination of CHF with obesity negatively affects the condition of the main arteries. The relationship between the parameters characterizing the elasticity of the vascular wall and the severity of visceral obesity reflects the important pathogenetic contribution of visceral adipose tissue to the development and progression of arterial stiffness in patients with CHF and obesity.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Grant of Federal State Budgetary Educational Institution of Higher Education “The Volgograd State Medical University” of the Ministry of Health of the Russian Federation