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Omega-3 Red Blood Cell Content Is Associated with Fat Mass Index and Leptin in Subjects with Obesity and Heart Failure with Preserved Ejection Fraction (P21-001-19).

ABSTRACT: AbstractObjectivesOverweight and obesity affect 80% of patients with heart failure and preserved ejection fraction (HFpEF). Exercise intolerance is a cardinal manifestation of HFpEF and is associated with excess fat mass (FM). Dietary polyunsaturated fatty acids (PUFA) have been associated with lower FM. However, the relationship between Omega-3 (N-3) PUFA and FM in HFpEF remains unclear. Red blood cell membrane (RBC) N-3 and omega-6 (N-6) PUFA content may serve as better objective measures of intake than subject-reported data. We hypothesized that increased RBC omega-3 (N-3) content is associated with lower FM and leptin in subjects with obesity and HFpEF.MethodsTwenty-four consecutive subjects with HFpEF underwent body composition measurement with bioelectrical impedance analysis to obtain FM Index (FMI; kg/m) and venipuncture to obtain RBC total percentage of N-3 PUFA content (RBC N-3%) as well as the ratio of N-6 to N-3 PUFA (N-6/N-3 ratio).ResultsFourteen subjects were female (58%) with a median age of 53 (interquartile range [IQR] 48–63). Median BMI was 42.4 kg/m (38.1–47.4) and FMI was 18.7 kg/m (14.2–22.7). Median leptin was 82.5 ng/mL (63.5–116.5), RBC N-3% was 7.4% (6.6–8.9), and N-6/N-3 ratio was 5.00 (4.03–5.70). RBC N-3% was inversely associated with FMI ( = ?0.406, = 0.049), while N-6/N-3 ratio was positively associated with FMI ( = +0.472, = 0.020) (). N-6/N-3 ratio was also associated with leptin ( = +0.462, = 0.023), while RBC N-3% presented an inverse trend with leptin ( = ?0.388, = 0.061) ().ConclusionsHigher percentage of N-3 PUFA in RBC membranes is associated with lower FMI and leptin in subjects with obesity and HFpEF. These findings suggest that increasing dietary N-3 intake and reducing N-6/N-3 ratio may protect against adiposity in HFpEF.Funding SourcesThis cross-sectional analysis was performed from baseline data of the DHART2 clinical trial (NCT02173548) and was funded by the NIH (1R34HL11348-01A1).Supporting Tables, Images and/or Graphs

SUBMITTER: Billingsley H

PROVIDER: S-EPMC6578465 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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Project description:BACKGROUND:The role of coronary microvascular disease and its impact on functional and energetic reserve in heart failure with preserved ejection fraction (HFpEF) remains unclear. We hypothesized that in response to submaximal pharmacologic stress (dobutamine), patients with HFpEF have impairment in left ventricular (LV) myocardial mechanical (external work [EW]), energetic (myocardial O2 consumption [MVO2]), and myocardial blood flow (MBF) reserve. We further assessed whether coupling of MBF to EW is impaired in HFpEF and associated with compensatory increases or pathological decreases in myocardial O2 extraction. Lastly, we assessed whether coupling of MVO2 to EW (mechanical efficiency) was impaired in HFpEF. METHODS AND RESULTS:In prospectively enrolled patients with HFpEF (n=19) and age/sex-matched healthy controls (n=19), we performed 11C-acetate positron emission tomography assessing MVO2 and MBF at rest and during dobutamine infusion. EW was calculated as stroke volume (echo)×end-systolic pressure×heart rate. At rest, compared with controls, patients with HFpEF had higher LV EW, MVO2, and MBF. With dobutamine, LV EW, MVO2, and MBF increased in both HFpEF and controls; however, the magnitude of increases was significantly smaller in HFpEF. In both groups, MBF increased in relation to EW, but in HFpEF, the slope of the relationship was significantly smaller than in controls. Myocardial O2 extraction was increased in HFpEF. Mechanical efficiency was similar in HFpEF and controls. In a post hoc analysis, HFpEF patients with LV hypertrophy (n=10) had significant reductions in LV mechanical efficiency relative to controls. CONCLUSIONS:In HFpEF during submaximal dobutamine stress, there is myocardial mechanical-, energetic- and flow-reserve dysfunction with impaired coupling of blood flow to demand and slight increases in myocardial O2 extraction. These findings provide evidence that coronary microvascular dysfunction is present in HFpEF, limits O2 supply relative to demand, and is associated with reserve dysfunction.

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Omega-3 Red Blood Cell Content Is Associated with Fat Mass Index and Leptin in Subjects with Obesity and Heart Failure with Preserved Ejection Fraction (P21-001-19).

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