Distinct blood volume and left ventricular adaptation to severe obesity in middle-aged adults at risk for heart failure

Q: What is the study aiming to determine about obesity and heart failure risk?

The study investigates whether obesity severity in middle-aged individuals at increased risk is associated with blood volume expansion and subsequent left ventricular remodeling before heart failure onset.

Q: How were participants grouped in the analysis?

Participants included non-obese controls and at-risk adults, stratified by BMI into IRNon-Obese, IRClass-I, and IRClass-II/III categories.

Q: What did the study find regarding blood volume and left ventricular changes across BMI classes?

Fat mass was independently associated with blood volume, which in turn was associated with higher left ventricular end-diastolic volume. Blood volume was lower in controls than in all at-risk groups, and only the IRClass-II/III group showed enlarged left ventricular end-diastolic volume when normalized to body surface area compared with both controls and IRNon-Obese.

Sep 29, 2026

Uploaded by Danger Angel

Obesity is hypothesized to contribute to heart failure through increases in blood volume and left ventricular remodeling, yet the links between adiposity severity and blood-volume expansion with subsequent left ventricular changes in middle-aged at-risk individuals before heart failure remain unclear. Using carbon monoxide rebreathing, body composition measures, and echocardiography, investigators compared blood volume and left ventricular structure and function across non-obese controls and at-risk strata by BMI class.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Aims

Methods

Participants and stratification

Measurements

Conclusions

Keywords

Introduction

European Journal of Heart Failure (2025) 27, 2480–2489 RESEARCH ARTICLE doi:10.1002/ejhf.70037 Distinct blood volume and left ventricular adaptation to severe obesity in middle-aged adults at risk for heart failure Joseph Campain 1†, Denis J. Wakeham 1,2†, Katrin Dias 1,2, James P. MacNamara 1,2, Mitchel Samels 1, Erin J Howden 1,3, Graeme Carrick-Ranson 1,2,4, Michinari Hieda 1,2, Benjamin D. Levine 1,2, Satyam Sarma 1,2, and Christopher M. Hearon Jr 1,2,5 * 1 Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX, USA; 2 Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA; 3 Cardiometabolic Health and Exercise Physiology Lab, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; 4 Department of Surgery, the University of Auckland, Auckland, New Zealand; and 5 Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX, USA Received 5 December 2024; revised 5 August 2025; accepted 26 August 2025 ; online publish-ahead-of-print 9 September 2025 Aims Obesity is commonly hypothesized to lead to the development of heart failure (HF) in part due to increases in blood volume (BV) and left ventricular (LV) remodelling. Whether adiposity and obesity severity are associated with BV expansion and subsequent LV remodelling in middle-aged individuals at increased risk (IR) prior to the onset of HF is unknown. ..................................................................................................................................................................... Methods and We analysed data from 96 middle-aged (40–64 years) non-obese (25.8 [23.6–28.6] kg/m2) controls (CON) and 126 results IR middle-aged adults (elevated cardiac biomarkers plus established risk factors). IR adults were stratified based upon body mass index class: (1) <30 kg/m2 , IRNon-Obese (n = 28, 28.2 [24.6–29.9] kg/m2); (2) Class I >30–35 kg/m2 , IRClass-I (n = 39, 33 [31.9–33.6] kg/m2); and, (3) Class II/III >35 kg/m2 , IRClass-II/IIII (n = 59, 41.2 [37.1–43.8] kg/m2). BV (carbon monoxide rebreathing), body composition (hydrodensitometry or dual-energy X-ray absorptiometry), and LV structure and function (echocardiography) were assessed. Fat mass was independently associated with BV (β= 0.17, p < 0.001) which was independently associated with LV end-diastolic volume (LVEDV) index (β= 0.54, p < 0.001). BV was lower in CON (5046 ± 1123 ml) than all IR groups (IRNon-Obese: 5622 ± 1137; IRClass-I: 6033 ± 1237; IRClass-II/III: 6548 ± 1153 mL; all p < 0.05). IRClass-II/III had greater erythrocyte volume compared to CON (p < 0.005), even after normalization to fat-free mass (CON: 36.2 ± 4.6; IRClass-II/III: 39.9 ± 5.1 ml/kg fat-free mass; p < 0.001). Only IRClass-II/III had an enlarged LV end-diastolic volume when normalized to body surface area compared to both CON and IRNon-Obese (both, p < 0.05). ............................................................... ................................................................ ...................................... Conclusions While lean mass is the primary determinant of BV, fat mass is independently associated with BV expansion and larger LVEDV. IR adults with class II/III obesity display distinct LV enlargement that is disproportionate to body size (i.e. LVEDV index) and may represent a physiologically distinct subgroup of obesity as opposed to a simple continuum of disease severity. .......................................................................................................... *Corresponding author. Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 7232 Greenville Ave., Dallas, TX 75231, USA. Email: [christopher.hearon@utsouthwestern.edu](christopher.hearon@utsouthwestern.edu) †Contributed equally. © 2025 The Author(s). European Journal of Heart Failure published by John Wiley

FAQs

What is the study aiming to determine about obesity and heart failure risk?

The study investigates whether obesity severity in middle-aged individuals at increased risk is associated with blood volume expansion and subsequent left ventricular remodeling before heart failure onset.

How were participants grouped in the analysis?

Participants included non-obese controls and at-risk adults, stratified by BMI into IRNon-Obese, IRClass-I, and IRClass-II/III categories.

What did the study find regarding blood volume and left ventricular changes across BMI classes?

Fat mass was independently associated with blood volume, which in turn was associated with higher left ventricular end-diastolic volume. Blood volume was lower in controls than in all at-risk groups, and only the IRClass-II/III group showed enlarged left ventricular end-diastolic volume when normalized to body surface area compared with both controls and IRNon-Obese.

Sep 29, 2026

Uploaded by Danger Angel