title: The effect of weight loss on clinical outcomes in patients implanted with a cardiac resynchronization therapy device-A MADIT-CRT substudy.
abstract: BACKGROUND
  There are no data regarding the effect of weight loss on clinical outcomes in patients undergoing cardiac resynchronization therapy. This study was designed to evaluate the effect of weight loss on clinical outcomes in patients implanted with a cardiac resynchronization therapy with defibrillator (CRT-D).
  
  
  RESULTS
  The risk of heart failure (HF) or death, and of death alone, was compared between patients with and without weight loss of ≥2 kg or more at 1 year in the CRT-D arm of the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT). Weight loss was observed in 170 of 994 patients (17%) implanted with a CRT-D. Multivariate analysis showed a significant increase in the risk of HF or death among patients with weight loss compared with those without weight loss (hazard ratio [HR] 1.82, 95% confidence interval [CI] 1.26-2.63; P = .001). Weight loss was associated with a 79% increase in the risk of all-cause mortality (HR 1.79, 95% CI 1.16-3.34; P = .01). When analyzed in a continuous fashion, each kg of weight loss was associated with a 4% increase in the risk of HF or death (P = .03). In left bundle branch block (LBBB) patients with a CRT-D, weight loss was associated with an especially high risk of HF or death (HR 2.23, 95% CI 1.36-3.65; P = .002) and of death alone (HR 2.33, 95% CI 1.07-5.06; P = .03; interaction P = .26).
  
  
  CONCLUSIONS
  In patients with mild symptoms of HF receiving CRT-D, weight loss observed at 1 year is associated with adverse clinical outcomes, especially in those with a LBBB electrocardiographic pattern.
authors.affiliation: Department of Cardiovascular Disease, University of Rochester Medical Center, Rochester, New York. Electronic address: mehmet_aktas@urmc.rochester.edu.
authors.forename: Mehmet K
authors.initials: MK
authors.lastname: Aktas
authors.affiliation: Department of Cardiovascular Disease, University of Rochester Medical Center, Rochester, New York.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Zareba
authors.affiliation: Department of Cardiovascular Disease, University of Rochester Medical Center, Rochester, New York.
authors.forename: David T
authors.initials: DT
authors.lastname: Huang
authors.affiliation: Department of Cardiovascular Disease, University of Rochester Medical Center, Rochester, New York.
authors.forename: Scott
authors.initials: S
authors.lastname: McNitt
authors.affiliation: Department of Cardiovascular Disease, University of Rochester Medical Center, Rochester, New York.
authors.forename: Slava
authors.initials: S
authors.lastname: Polonsky
authors.affiliation: Department of Cardiovascular Disease, University of Rochester Medical Center, Rochester, New York.
authors.forename: Leway
authors.initials: L
authors.lastname: Chen
authors.affiliation: Charite-University Medicine, Experimental and Clinical Research Center, Berlin, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Stockburger
authors.affiliation: Heart Center, Semmelweis University, Budapest, Hungary.
authors.forename: Bela
authors.initials: B
authors.lastname: Merkely
authors.affiliation: Department of Cardiovascular Disease, University of Rochester Medical Center, Rochester, New York.
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Moss
authors.affiliation: Department of Cardiovascular Disease, University of Rochester Medical Center, Rochester, New York; Heart Center, Semmelweis University, Budapest, Hungary.
authors.forename: Valentina
authors.initials: V
authors.lastname: Kutyifa
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects / Q000401:mortality* / Q000639:trends*; D058409:Cardiac Resynchronization Therapy Devices / Q000009:adverse effects / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000401:mortality* / Q000503:physiopathology; D012307:Risk Factors; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology
keywords: Weight loss; cardiac resynchronization therapy; left bundle branch block