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Background <p>Obesity is linked to adverse health effects, but paradoxically improves survival in heart failure (HF). Peak oxygen consumption (VO<sub>2</sub>), a measure of exercise capacity, is a key prognostic indicator in HF. We examined the interaction between obesity and peak VO<sub>2</sub> in predicting survival in patients with HF with reduced ejection fraction (HFrEF).</p> Methods <p>We retrospectively reviewed 18,879 patients who underwent maximal cardiopulmonary exercise testing using the modified Bruce ramp protocol between 2012 and 2020. The inclusion criteria were left ventricular ejection fraction &lt;40% and body mass index (BMI) &gt; 18.5 kg/m<sup>2</sup>. Patients were classified as those with normal weight (BMI: 18.5–22.9 kg/m<sup>2</sup>), overweight (23.0–24.9 kg/m<sup>2</sup>), or obesity (≥25.0 kg/m<sup>2</sup>) per 2020 Korean Society for the Study of Obesity guidelines.</p> Results <p>For the 819 included patients (292 with normal weight, 197 with overweight, 330 with obesity), median age was 59 (interquartile range [IQR]: 49–67) years, 75.2% were male, and the median BMI was 24.1 (IQR: 22.1–26.5) kg/m<sup>2</sup>. Patients with obesity achieved the highest workload, peak VO<sub>2</sub>, and exercise time (all <i>P</i> &lt; 0.001). They also had lower all-cause mortality versus patients with normal weight (hazard ratio 0.46, 95% confidence interval 0.25–0.82, <i>P</i> = 0.009). In patients with obesity, elevated peak VO<sub>2</sub> was associated with a U-shaped mortality curve, unlike the linear relationship in other groups (<i>P</i> for interaction = 0.001).</p> Conclusions <p>Patients with obesity and HFrEF showed better survival, consistent with the obesity paradox. However, the U-shaped relationship between peak VO<sub>2</sub> and mortality in this group suggests the survival advantage may diminish at higher levels of exercise capacity, warranting further investigation.</p> <p></p>

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Peak oxygen consumption as a modifier of the obesity paradox in patients with obesity with heart failure with reduced ejection fraction

  • 期刊论文

  • 发表日期：

    2026年2月2日

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  • Moojun Kim,
  • Jooyeon Lee,
  • Taeil Yang,
  • Jaewon Oh,
  • Seok-Min Kang,
  • Chan Joo Lee

摘要

Background

Obesity is linked to adverse health effects, but paradoxically improves survival in heart failure (HF). Peak oxygen consumption (VO2), a measure of exercise capacity, is a key prognostic indicator in HF. We examined the interaction between obesity and peak VO2 in predicting survival in patients with HF with reduced ejection fraction (HFrEF).

Methods

We retrospectively reviewed 18,879 patients who underwent maximal cardiopulmonary exercise testing using the modified Bruce ramp protocol between 2012 and 2020. The inclusion criteria were left ventricular ejection fraction <40% and body mass index (BMI) > 18.5 kg/m2. Patients were classified as those with normal weight (BMI: 18.5–22.9 kg/m2), overweight (23.0–24.9 kg/m2), or obesity (≥25.0 kg/m2) per 2020 Korean Society for the Study of Obesity guidelines.

Results

For the 819 included patients (292 with normal weight, 197 with overweight, 330 with obesity), median age was 59 (interquartile range [IQR]: 49–67) years, 75.2% were male, and the median BMI was 24.1 (IQR: 22.1–26.5) kg/m2. Patients with obesity achieved the highest workload, peak VO2, and exercise time (all P < 0.001). They also had lower all-cause mortality versus patients with normal weight (hazard ratio 0.46, 95% confidence interval 0.25–0.82, P = 0.009). In patients with obesity, elevated peak VO2 was associated with a U-shaped mortality curve, unlike the linear relationship in other groups (P for interaction = 0.001).

Conclusions

Patients with obesity and HFrEF showed better survival, consistent with the obesity paradox. However, the U-shaped relationship between peak VO2 and mortality in this group suggests the survival advantage may diminish at higher levels of exercise capacity, warranting further investigation.