Work

Impact of global work index on obesity paradox in heart failure with advanced left ventricle remodeling

Year: 2026

Type: article

Abstract: Aims This study aimed to examine the role of myocardial work in the obesity paradox among heart patients with heart failure and advanced left ventricular remodeling. Methods In this post hoc analysis, 515 consecutive patients with LVEF ≤ 50% who were hospitalized between May 2016 and December 2020 were included and followed for a median of 37.4 months. Left ventricular mass index (LVMI) was used to define advanced left ventricular remodeling. The primary endpoint was major adverse cardiovascular events (MACE). We assessed the prognostic impact of obesity at different levels of the global work index (GWI) in patients with advanced left ventricular remodeling. Results Of the 515 patients, 330 were classified as having advanced left ventricular remodeling based on LVMI thresholds (men ≥110 g/m 2 , women ≥120 g/m 2 ). In this subgroup, a BMI ≥ 28 kg/m 2 was associated with a lower risk of MACE. These 330 patients were further stratified into higher GWI ( n = 139) and lower GWI ( n = 191) subgroups. In the higher GWI subgroup, both BMI ≥ 28 kg/m 2 and continuous BMI values were associated with a reduced risk of MACE. No such association was observed in the lower GWI subgroup. Conclusion Myocardial work index modifies the relationship between BMI and prognosis in heart failure. GWI should be considered when evaluating the obesity paradox in patients with left ventricular systolic dysfunction, particularly those with advanced left ventricular remodeling.

Source: Frontiers in Cardiovascular Medicine

DOI: 10.3389/fcvm.2026.1693862