Body mass index is a useful predictor of prognosis after left ventricular assist system implantation.
BACKGROUND
The obesity paradox has recently attracted considerable interest in the study of many diseases. In this investigation we examine the relationship between body mass index (BMI) and prognosis after left ventricular assist system (LVAS) implantation.


METHODS
We measured the BMI of 64 patients 3 months after LVAS implantation for end-stage heart failure. The patients were classified according to BMI into Group A (BMI <16 kg/m(2)), Group B (BMI 16 to 18.4 kg/m(2)) or Group C (BMI > or =18.5 kg/m(2)). We compared the prognosis among these three groups after a mean follow-up period of 583 days.


RESULTS
Seven patients were weaned from their LVAS, 24 received heart transplantation, 25 died on the transplant waiting list, and 8 remain on the list. Long-term (>1 year) mortality was significantly higher in Group A than in Groups B and C (59% vs 40% and 18%, respectively; p < 0.05). The incidence of sepsis was also significantly higher in Group A than in Groups B and C (68% vs 45% and 32%, respectively; p < 0.05). After multivariate adjustment, BMI <16 kg/m(2) (hazard ratio [HR] 14.9; 95% confidence interval [CI] 2.61 to 86.0; p < 0.01) and levels of C-reactive protein (HR 1.56; 95% CI 1.15 to 2.13; p < 0.01) were independent predictors of mortality.


CONCLUSIONS
A lower BMI indicated a poor prognosis, as well as a higher incidence of a fatal complication, sepsis, after LVAS implantation. Control of BMI could be an effective way to improve management of patients with LVAS.
Department of Emergency and Critical Care Medicine, Tokushima University, Tokushima City, Tokushima, Japan. akkmano1972@kve.biglobe.ne.jp
Akiko
A
Mano
Kiyoharu
K
Fujita
Kaori
K
Uenomachi
Keiichi
K
Kazama
Mayumi
M
Katabuchi
Kyoichi
K
Wada
Nobue
N
Terakawa
Koji
K
Arai
Yumiko
Y
Hori
Syuji
S
Hashimoto
Takeshi
T
Nakatani
Soichiro
S
Kitamura
D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D018805:Sepsis / Q000401:mortality; D015996:Survival Rate
D002097:C-Reactive Protein