Estimates of myocardial perfusion are associated with obesity in patients with heart failure with preserved ejection fraction: the role of biological sex

Background: The subendocardial viability ratio (SEVR), derived from pulse wave analysis (PWA), provides a non-invasive estimate of myocardial perfusion. Lower SEVR predicts all-cause mortality in various patient populations including those with hypertension, type 2 diabetes mellitus and chronic kidney disease. Recent evidence indicates that SEVR is lower in patients with heart failure with preserved ejection fraction (HFpEF) and is influenced by several factors such as obesity, biological sex, and wave reflection parameters. Obesity is a prevalent comorbid condition associated with HFpEF-related pathophysiology, but its influence on SEVR in patients with HFpEF is unknown. Thus, the current study sought to examine the role of obesity on SEVR in patients with HFpEF, and to explore the impact of biological sex on this relationship. Methods: Twenty-seven (14M/13F, age 70±7 y, body mass index [BMI] 33±5 kg/m 2 ) patients with HFpEF underwent assessments of cardiovascular hemodynamics (PWA) and myocardial perfusion (SEVR). Results: Compared to males, females had higher supine brachial systolic blood pressure (SBP, 131±14 vs 120±8 mmHg), brachial pulse pressure (PP, 59±12 vs 48±8 mmHg), aortic (central) SBP (117±9 vs 109±7 mmHg), aortic PP (45±8 vs 37±7 mmHg), augmentation pressure (AP, 14±7 vs 9±5 mmHg), augmentation index normalized to heart rate of 75 bpm (AIxHR75, 26±10 vs 18±12 %), systolic pressure time integral (SPTI, 2,389±242 vs 2,113±206 mmHg.s.min), ejection duration (ED, 38±3 vs 35±3 %), forward (Pf, 31±7 vs 25±3 mmHg), and reflected (Pb, 19±3 vs 15±3 mmHg) pulse height and lower SEVR (126±16 vs 147±19 %) (all, p<0.05). Importantly, BMI was associated with SEVR (r = -0.48), SPTI (r = 0.42), ED (r = 0.39) and Pf (r = 0.34) (all, p<0.05) in the whole cohort. When data were examined by biological sex, BMI was associated with SEVR (r = -0.64) and SPTI (r = 0.52) (both, p<0.05) in females but not males (SEVR, r = -0.37; SPTI, r = 0.32, both, p>0.05) with HFpEF. Conclusion: These preliminary data provide novel insight into the influence of obesity on myocardial perfusion in adults with HFpEF in a sex-dependent manner. VA Advanced Fellowship in Geriatrics (N.A.C.) NIH (HL170007 & HL162856, D.W.W.) U.S Department of Veterans Affairs (CX002152, D.W.W; IK2RX003670, K.B). This abstract was presented at the American Physiology Summit 2025 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.