Heart failure & cardiomyopathiesCohort study
Congestion and Low Cardiac Output Hemodynamic Phenotype Drives Outcomes in Overweight and Obese Heart Failure with Preserved Ejection Fraction (HFpEF)
- Cohort study
- single-centre
Authors' conclusion
In a predominantly overweight and obese HFpEF cohort meeting standard diagnostic criteria for clinical HFpEF, 34% had a depressed cardiac index on hemodynamic testing. Hemodynamic assessment may identify an under-recognized low-output hemodynamic phenotype in HFpEF, which in combination with congestion, is associated with worse clinical outcomes.
Study context
- Population
- Predominantly overweight and obese HFpEF patients with right heart catheterization, Johns Hopkins HFpEF Clinic
- Participants
- 227 participants
- Exposure
- Hemodynamic phenotypes in HFpEF
- Outcome
- Mortality by hemodynamic phenotype
- Follow-up
- Median 39 months
Main finding
As reported in the abstract
Mortality
- Low cardiac perfusion (thermodilution and Fick) associated with worse mortality, even after accounting for BMI overcorrection
Observational data: associations, not effects.
Further findings
| Outcome | P value |
|---|---|
| Age, cold vs warm | P = 0.002 |
| Male sex, cold vs warm | P = 0.04 |
- Wet-cold vs other 3 hemodynamic groups
- 469 pg/mL [257-1,389 pg/mL] · NT-proBNP (highest), median [Q1-Q3] · AF rate (highest) 54% · On beta-blocker 68%
- Age, cold vs warm: cold mean 68 (SD 11) years
- Age, cold vs warm: warm mean 62 (SD 12) years
- Male sex, cold vs warm: cold 51%
- Male sex, cold vs warm: warm 66%
- Wet-cold vs other 3 hemodynamic groups: NT-proBNP overall P = 0.0001
- Wet-cold vs other 3 hemodynamic groups: AF overall P = 0.001
- Wet-cold vs other 3 hemodynamic groups: beta-blocker P = 0.05
Cold profile (dry-cold + wet-cold) prevalence
- Cold profile share of cohort
- 34%
AF, NT-proBNP and pulmonary vascular resistance indices, cold vs warm
- More AF in cold profile
- P = 0.0007
- Higher NT-proBNP in cold profile
- P = 0.03
- Higher pulmonary vascular resistance indices in cold profile
Original publication
Congestion and Low Cardiac Output Hemodynamic Phenotype Drives Outcomes in Overweight and Obese HFpEF. JACC Heart Fail. Published 30 September 2025. doi:10.1016/j.jchf.2025.102586
Summarised from the published abstract; every number is checked against it