Abstract
Objective. To assess the functional manifestations of an unfavorable cardiometabolic phenotype in patients with chronic heart failure and obesity based on an analysis of exercise tolerance and quality-of-life indicators.
Materials and methods. A cross-sectional comparative study included patients with obesity and chronic heart failure, as well as individuals with obesity without clinical signs of heart failure. To assess the severity of cardiometabolic disorders, the examined patients were stratified by the presence of an unfavorable metabolic phenotype. Functional status was studied using a treadmill test with analysis of exercise duration, workload achieved, estimated oxygen consumption (VO₂), chronotropic index, heart rate increment, and features of the hemodynamic response to exercise. Quality of life was assessed with the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the SF-36.
Results. The formation of an unfavorable cardiometabolic phenotype was accompanied by a significant reduction in the functional reserve of the cardiovascular system. The examined patients showed lower treadmill test duration, workload achieved, oxygen consumption, chronotropic index, and heart rate increment, together with an enhanced pressor response to exercise. According to the MLHFQ, more pronounced limitations of physical activity, increased emotional distress, and worse integral quality-of-life scores were found. According to the SF-36, physical functioning, vitality, and general health scores were reduced.
Conclusion. An unfavorable cardiometabolic phenotype in patients with chronic heart failure and obesity is associated with reduced aerobic working capacity, the development of chronotropic incompetence, impaired adaptive mechanisms of the cardiovascular system, and worse quality of life. The results obtained justify the introduction of cardiometabolic rehabilitation programs aimed at increasing functional reserve, optimizing the hemodynamic response to exercise, and improving the clinical status of patients.
References
McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2023;44(37):3627-3639.
Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. Circulation. 2022;145(18):e895-e1032.
Kittleson MM, Nelson AJ, McDonagh TA, Rosano GMC, Lam CSP, et al. 2025 ACC Scientific Statement on the Management of Obesity in Adults With Heart Failure. J Am Coll Cardiol. 2025;86(12):1174-1202.
Koskinas KC, Van Craenenbroeck EM, Antoniades C, Blüher M, Carbone S, Eckel RH, et al. Obesity and cardiovascular disease: an ESC clinical consensus statement. Eur Heart J. 2024;45(38):4063-4098.
Savarese G, Rosano GMC, Lund LH, et al. Heart failure and obesity: translational approaches and therapeutic opportunities. Eur J Heart Fail. 2025;27(2):215-230.
Lembo M, Del Forno D, Severino P, et al. Obesity: the perfect storm for heart failure. ESC Heart Fail. 2024;11(2):1103-1118.
Zheng W, Wang Y, Li X, et al. Heart failure with preserved ejection fraction and obesity. Diabetol Metab Syndr. 2025;17:191.
Borlaug BA. Obesity and heart failure with preserved ejection fraction: mechanisms and management. Nat Rev Cardiol. 2024;21(11):731-748.
Packer M. Do obesity and visceral adiposity promote heart failure with reduced ejection fraction? Eur Heart J. 2026;47(1):12-20.
Pandey A, Omar W, Ayers C, et al. Obesity, inflammation, and incident heart failure: insights from contemporary population studies. JACC Heart Fail. 2023;11(9):820-831.
Arena R, Myers J, Guazzi M. Cardiopulmonary exercise testing is a core assessment for patients with heart failure. Eur J Prev Cardiol. 2021;28(1):e5-e16.
Guazzi M, Adams V, Conraads V, Halle M, Mezzani A, Vanhees L, et al. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Eur Heart J. 2021;42(23):2237-2250.
Ross R, Blair SN, Arena R, Church TS, Després JP, Franklin BA, et al. Importance of assessing cardiorespiratory fitness in clinical practice. Circulation. 2022;145(15):e653-e669.
Keteyian SJ, Brawner CA, Savage PD, Ehrman JK, Schairer J, Divine G, et al. Peak aerobic capacity predicts prognosis in patients with heart failure. J Am Coll Cardiol. 2021;77(9):1144-1154.
Brubaker PH, Kitzman DW. Chronotropic incompetence: causes, consequences, and management. Circulation. 2021;144(7):555-568.
Coats AJS, Forman DE, Haykowsky M, Kitzman DW, McMurray JJV, et al. Physical function and exercise capacity in heart failure. Eur J Heart Fail. 2022;24(6):1013-1027.
Piepoli MF, Corra U, Benzer W, Bjarnason-Wehrens B, Dendale P, et al. Secondary prevention through cardiac rehabilitation. Eur Heart J. 2021;42(15):1451-1467.
Lavie CJ, Arena R, Alpert MA, Milani RV, Ventura HO. Management of cardiovascular diseases in patients with obesity. Prog Cardiovasc Dis. 2022;70:24-34.
Rector TS, Kubo SH, Cohn JN. Patients' self-assessment of their congestive heart failure: Minnesota Living with Heart Failure Questionnaire. Heart Fail. 1987;3:198-209.
Garin O, Ferrer M, Pont A, Rue M, Kotzeva A, Wiklund I, et al. Disease-specific health-related quality of life questionnaires for heart failure. Eur J Heart Fail. 2021;23(2):301-309.
Ware JE Jr, Sherbourne CD. The MOS 36-item Short-Form Health Survey (SF-36): conceptual framework and item selection. Med Care. 1992;30(6):473-483.
Flynn KE, Lin L, Ellis SJ, Russell SD, Spertus JA, Whellan DJ, et al. Outcomes and quality of life in heart failure. Circ Heart Fail. 2021;14(4):e007688.
Dunlay SM, Roger VL, Redfield MM. Epidemiology of heart failure with preserved ejection fraction. Nat Rev Cardiol. 2022;19(1):65-75.
Sarzani R, Bordicchia M, Spannella F, et al. Adipocentric origin of the common cardiometabolic diseases. Front Med (Lausanne). 2024;11:1365183.
Lala A, et al. The continuum of prevention and heart failure in obesity. J Card Fail. 2026;32(1):45-58.
