Obesity Accelerates Cardiac Senescence in Heart Failure with Preserved Ejection Fraction

Abstract

Introduction Obesity and aging are prominent risk factors for HFpEF. Obese versus non-obese patients are typically younger, but the effects of obesity on premature cardiac senescence remain insufficiently explained. Recent data suggest that cardiac senescence might be estimated from a 12-lead ECG by artificial intelligence (AI). Hypothesis Obese versus non-obese patients with HFpEF have true premature adverse cardiac remodeling, associated with diastolic dysfunction and a higher risk of atrial fibrillation (AF), which is reflected by faster ECG aging. Methods This retrospective cohort study of 408 patients with HFpEF, hospitalized for decompensation and treatment with intravenous loop diuretics, assessed ECG age upon admission with a previously validated AI algorithm. Differences in the relationship between chronological versus ECG age and underlying cardiac remodeling and function on echocardiography, as well AF risk, were evaluated and compared between obese versus non-obese patients. Age- and gender normalized echocardiography parameters were calculated according to regression equations determined from the PAVD study in Olmsted County (MN, US) Results Obese (n = 255) versus non-obese (n = 153) HFpEF patients were on average 9 years younger. ECG minus chronological age as surrogate for premature cardiac senescence was higher in the obese (P-value Conclusions Obesity is associated with older ECG compared to chronological age in HFpEF, which probably reflects premature cardiac senescence given its association with structural remodeling, more pronounced diastolic dysfunction, and a higher AF risk.