Long-Term Impact of Body Mass Index on Survival of Patients Undergoing Cardiac Resynchronization Therapy: A
Nikolaos Papageorgiou1, Alexandros Briasoulis2, Sergio Barra3
1Department of Electrophysiology, Barts Heart Centre, St. Bartholomew's Hospital, London; Institute of Cardiovascular Science, UCL, London; University College London Hospital, London.
Insights
Overweight patients (BMI 25-29.9) receiving cardiac resynchronization therapy with defibrillator backup (CRT-D) showed improved long-term survival. CRT-D use benefits survival across all body mass index groups.
Area of Science:
- Cardiology
- Clinical Research
Background:
- Obesity is a known risk factor for heart failure (HF).
- However, obesity may be associated with better outcomes in HF patients.
- Long-term outcomes after cardiac resynchronization therapy (CRT) in relation to body mass index (BMI) require further investigation.
Purpose of the Study:
- To investigate long-term outcomes in heart failure patients after CRT implantation across different BMI categories.
- To determine if defibrillator backup (CRT-D) improves survival in these patients.
- To assess the impact of BMI on survival post-CRT.
Main Methods:
- A cohort of 1,277 patients undergoing CRT implantation between 2000-2014 was analyzed.
- Patients were categorized by BMI: normal (<25.0 Kg/m²), overweight (25.0-29.9 Kg/m²), and obese (≥30.0 Kg/m²).
- Long-term follow-up (median 4.9 years, up to ≥10 years) assessed all-cause mortality or cardiac transplant/LVAD.
Main Results:
- The composite endpoint occurred in 50.9% of patients.
- Overweight patients (BMI 25-29.9 Kg/m²) had a significantly lower risk of mortality or transplant/LVAD (HR=0.73, p=0.023).
- CRT-D use was independently associated with improved survival (HR=0.74, p=0.039) regardless of BMI.
Conclusions:
- An overweight BMI (25-29.9 Kg/m²) at the time of CRT implantation is linked to favorable 10-year survival.
- Cardiac resynchronization therapy with defibrillator backup (CRT-D) enhances survival outcomes in heart failure patients across all BMI classifications.
Abstract:
Obesity is a risk factor for heart failure (HF), but its presence among HF patients may be associated with favorable outcomes. We investigated the long-term outcomes across different body mass index (BMI) groups, after cardiac resynchronization therapy (CRT), and whether defibrillator back-up (CRT-D) confers survival benefit. One thousand two-hundred seventy-seven (1,277) consecutive patients (mean age: 67.0 ± 12.7 years, 44.1% women, and mean BMI: 28.3 ± 5.6 Kg/m2) who underwent CRT implantation in 5 centers between 2000-2014 were followed-up for a median period of 4.9 years (IQR 2.4 to 7.5). More than 10% of patients had follow-up for ≥10 years. Patients were classified according to BMI as normal: <25.0 Kg/m2, overweight: 25.0 to 29.9 Kg/m2 and obese: ≥30.0 Kg/m2. 364 patients had normal weight, 494 were overweight and 419 were obese. CRT-Ds were implanted in >75% of patients, but were used less frequently in obese individuals. The composite endpoint of all-cause mortality or cardiac transplant/left ventricular assist device (LVAD) occurred in 50.9% of patients. At 10-year follow-up, less than a quarter of patients in the lowest and highest BMI categories were still alive and free from heart transplant/LVAD. After adjustment BMI of 25 to 29.9 Kg/m2 (HR = 0.73 [95%CI 0.56 to 0.96], p = 0.023) and use of CRT-D (HR = 0.74 [95% CI 0.55 to 0.98], p = 0.039) were independent predictors of survival free from LVAD/heart transplant. BMI of 25 to 29.9 Kg/m2 at the time of implant was independently associated with favourable long-term 10-year survival. Use of CRT-D was associated with improved survival irrespective of BMI class.
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