Features of The Formation of An Unfavorable Functional Phenotype in Patients with Chronic Heart Failure and Obesity

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.