Neurohormonal and metabolic profile of heart failure in obese versus non-obese patients

BACKGROUND：Obesity is a predisposing factor for heart failure (HF). However, the factors contributing to the development of HF in obesity have not been fully elucidated. We analyzed potential blood biomarkers related to metabolism and neurohormonal factors in obese and non-obese patients with HF. METHOD：Various biomarkers in the blood, including amino acid profile, free fatty acid (FFA), and neurohormonal markers, were measured in patients with HF. Patients were divided into the obese and non-obese groups (body mass index ≥23 vs. <23 kg/m2, respectively) and marker levels were compared between the groups. RESULT：FFA (0.7 vs. 0.4 mEq/L, p=.02), alanine (445 vs. 376 μmol/L, p=.03), valine (257 vs. 229 μmol/L, p=.03), branched-chain amino acids (BCAAs) (466 vs. 419 μmol/L, p=.03) noradrenaline (NA) (779 vs. 408 pg/mL, p=.01), and plasma aldosterone concentration (PAC) (133 vs. 80 pg/mL, p=.05) levels were significantly higher in the obese group than in the non-obese group. Plasma valine and BCAA levels were significantly positively correlated with HbA1c level as well as albumin and hemoglobin levels which are known markers of metabolic reserve against cachexia. CONCLUSION：Obesity-related HF was associated with further neurohormonal activation indicated by elevated NA and PAC levels. It was also associated with higher valine and BCAA levels, which could be markers of insulin resistance as well as metabolic reserve against cardiac cachexia.