AI Article Synopsis

  • This study examines the relationship between body mass index (BMI) and all-cause mortality in patients eligible for cardiac resynchronization therapy (CRT), focusing on the "obesity paradox," where obesity may sometimes correlate with better health outcomes.
  • A total of 1,585 patients were categorized by BMI into normal weight, overweight, and obese groups, with the findings showing that obese patients had a lower mortality rate compared to normal-weight patients over a mean follow-up of 5.1 years.
  • The research indicates that factors like diabetes and hypertension are more prevalent in those with higher BMI, but despite this, the lower mortality in obese patients suggests an intriguing relationship that warrants further investigation.

Article Abstract

Aims: Patients with obesity have an overall higher cardiovascular risk, at the same time obesity could be associated with a better outcome in a certain subgroup of patients, a phenomenon known as the obesity paradox. Data are scarce in candidates for cardiac resynchronization therapy (CRT). We aimed to investigate the association between body mass index (BMI) and all-cause mortality in patients eligible for CRT.

Methods: Altogether 1,585 patients underwent cardiac resynchronization therapy between 2000-2020 and were categorized based on their BMI, 459 (29%) patients with normal weight (BMI < 25 kg/m2), 641 (40%) patients with overweight (BMI 25- < 30 kg/m2) and 485 (31%) with obesity (BMI ≥ 30 kg/m2). The primary endpoint was all-cause mortality, heart transplantation, and left ventricular assist device implantation. We assessed periprocedural complications and 6-month echocardiographic response.

Results: Normal-weight patients were older compared to patients with overweight or obesity (70 years vs. 69 years vs. 68 years; P ‹0.001), respectively. Sex distribution, ischaemic aetiology, and CRT-D implantation rates were similar in the three patient groups. Diabetes mellitus (BMI < 25 kg/m 26% vs. BMI 25- < 30 kg/m 37% vs. BMI ≥ 30 kg/m 48%; P ‹0.001) and hypertension (BMI < 25 kg/m 71% vs. BMI 25- < 30 kg/m 74% vs. BMI ≥ 30 kg/m 82%; P ‹0.001) were more frequent in patients with overweight and obesity. During the mean follow-up time of 5.1 years, 973 (61%) reached the primary endpoint, 66% in the BMI < 25 kg/m group, 61% in the BMI 25- < 30 kg/m group and 58% in the BMI ≥ 30 kg/m group (log-rank P‹0.05). Patients with obesity showed mortality benefit over normal-weight patients (HR 0.78; 95%CI 0.66-0.92; P = 0.003). The obesity paradox was present in patients free from diabetes, atrial fibrillation, and ischemic events. Periprocedural complication rates did not differ in the three groups (BMI < 25 kg/m 25% vs. BMI 25- < 30 kg/m 28% vs. BMI ≥ 30 kg/m 26%; P = 0.48). Left ventricular ejection fraction improved significantly in all patient groups (BMI < 25 kg/m median -LVEF 7% vs. BMI 25- < 30 kg/m median -LVEF 7.5% vs. BMI ≥ 30 kg/m median -LVEF 6%; P < 0.0001) with a similar proportion of developing reverse remodeling (BMI < 25 kg/m 58% vs. BMI 25- < 30 kg/m 61% vs. BMI ≥ 30 kg/m 57%; P = 0.48); P = 0.75).

Conclusions: The obesity paradox was present in our HF cohort at long-term, patients underwent CRT implantation with obesity and free of comorbidities showed mortality benefit compared to normal weight patients. Patients with obesity showed similar echocardiographic response and safety outcomes compared to normal weight patients.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11631315PMC
http://dx.doi.org/10.1002/ehf2.14961DOI Listing

Publication Analysis

Top Keywords

obesity paradox
8
cardiac resynchronization
8
resynchronization therapy
8
patients
6
obesity
4
paradox patients
4
patients reduced
4
reduced ejection
4
ejection fraction
4
fraction eligible
4

Similar Publications

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!