What is the clinical evidence from this study?

Study design: Cohort. Population: Postpartum infections (n=21968). Intervention: Observational. Primary outcome: Prevalence of postpartum infection (95% CI 27.8-28.4).

What does this research mean for the field?

The prevalence of postpartum infection among women in Ukraine is 28.1%, with 83.1% of cases detected after hospital discharge. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

January 1, 2024

Obesity and heart failure with preserved ejection fraction

Key Result

The prevalence of postpartum infection among women in Ukraine was 28.1%, with 83.1% of cases detected after hospital discharge.

Study Design

Type

Cohort (n=21,968)

Multicenter

Yes

Structured PICO

Does central obesity worsen clinical, laboratory, and echocardiographic parameters in patients with HFpEF?

Population

212 adults, including heart failure with preserved ejection fraction (HFpEF) patients with central obesity (n=73, mean age 52.4 ± 6.3 years), HFpEF patients without obesity (n=70, mean age 51.9 ± 7.1 years), and age-matched healthy subjects without HF (n=69, mean age 52.3 ± 7.5 years).

Intervention

Central obesity (observational exposure)

Comparator

Non-obese HFpEF patients and healthy subjects

Outcome

Clinical, laboratory (including NT-proBNP, glucose, lipids, hs CRP), and echocardiographic parameters (LV diastolic dysfunction, RV dilatation and dysfunction)surrogate

In patients with HFpEF, central obesity is associated with worse LV diastolic and RV dysfunction and higher inflammatory and metabolic markers, despite paradoxically lower NT-proBNP levels.

Limitations

Unable to perform clinical or microbiological testing of participants with chorioamnionitis in labour, puerperal sepsis, and thrombotic phlebitis
Did not measure duration of membrane rupture directly
Unable to confirm whether prescribed antibiotics were given or determine the timing of the prescription relative to the procedure

Abstract

OBJECTIVE: Aim: To perform an overall assessment of heart failure with preserved ejection fraction (HFpEF) adults with central obesity. PATIENTS AND METHODS: Materials and Methods: We enrolled HFpEF patients with central obesity (n =73, mean age 52.4 ± 6.3 years) and without obesity (n =70, mean age 51.9 ± 7.1 years) and compared with an age-matched healthy subjects who had not suffered from HF (n = 69, mean age 52.3 ± 7.5 years). Physical examination, routine laboratory tests such as fasting blood glucose, fasting insulin, insulin resistance (HOMA) index, serum lipids, haemoglobin, creatinine, ALT, AST, uric acide, hs CRP, TSH, N-terminal proB-type natriuretic peptide (NT-proBNP) and standard transthoracic echocardiogram (2D and Doppler) examinations were performed and assessed. RESULTS: Results: The average values of diastolic blood pressure (DBP), glucose and lipid profiles, uric acide, hs CRP were found to be significantly higher among obese patients with HFpEF than non-obese. Despite more severe symptoms and signs of HF, obese patients with HFpEF had lower NT-proBNP values than non-obese patients with HFpEF (129±36.8 pg/ml, 134±32.5 pg/ml vs 131±30.4 pg/ml, 139±33.8 pg/ml respectively; p < 0.05). However, it was found that patients with high central (visceral) adiposity have more pronounced obesity-related LV diastolic dysfunction, lower E/e' ratio, lower mitral annular lateral e' velocity, an increased LV diastolic dimension and LV mass index. Compared with non-obese HFpEF and control subjects, obese patients displayed greater right ventricular dilatation (base, 35±3.13 mm, 36±4.7 mm vs 33±2.8 mm, 34±3.2 mm and 29±5.3 mm, 30±3.9 mm; length, 74±5 mm, 76±8 mm vs 67±4 mm, 69±6 mm and 60±3 mm, 61±5 mm respectively; p < 0.05), more right ventricular dysfunction (TAPSE 16±2 mm, 15±3 mm vs 17±2 mm, 17±1 mm and 19±2 mm, 20±3 mm respectively; p < 0.05). CONCLUSION: Conclusions: Obese patients with HFpEF have higher diastolic BP, atherogenic dyslipidemia, insulin resistance index values and greater systemic inflammatory biomarkers, despite lower NT-proBNP values, which increase the risk of cardiovascular events in future. Echocardiography examination revealed not only significant LV diastolic dysfunction, but also displayed greater RV dilatation and dysfunction.

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