title: Effects of left ventricular geometry and obesity on mortality in women with normal ejection fraction.
abstract: Left ventricular (LV) geometry is an independent predictor of cardiovascular morbidity and mortality. Although obesity is a known risk factor for cardiovascular diseases, studies have suggested a paradoxical relation between obesity and prognosis. We retrospectively assessed 26,126 female patients with normal LV ejection fraction to determine the impact of LV geometry, including normal structure, concentric remodeling, and eccentric or concentric LV hypertrophy, and obesity on mortality during an average follow-up of 1.7 years. Abnormal LV geometry occurred more commonly in obese (body mass index ≥30 kg/m(2), n = 10,465) compared with nonobese (body mass index <30 kg/m(2), n = 15,661) patients (56% vs 47%, respectively, p <0.0001). Overall mortality, however, was considerably less in obese compared with nonobese patients (5.6% vs 8.7%, respectively, p <0.0001). In both groups, progressive increases in mortality were observed from normal structure to concentric remodeling and then to eccentric and concentric LV hypertrophy (obese patients 2.9%, 6.5%, 6.7%, and 11.1%, respectively, and nonobese patients 5.3%, 10.6%, 11.4%, and 16.8%, respectively, p <0.0001 for trend). In conclusion, although an obesity paradox exists, in that obesity in women is associated with abnormal LV geometry but less mortality, our data demonstrate that abnormal LV geometric patterns are highly prevalent in both obese and nonobese female patients with normal ejection fraction and are associated with greater mortality.
authors.affiliation: UT Erlanger Cardiology, Erlanger Health System, Chattanooga, Tennessee.
authors.forename: Dharmendrakumar A
authors.initials: DA
authors.lastname: Patel
authors.affiliation: Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana; Department of Preventive Medicine, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana. Electronic address: clavie@ochsner.org.
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Lavie
authors.affiliation: Sanford Cardiology, Bismarck, North Dakota.
authors.forename: Surya M
authors.initials: SM
authors.lastname: Artham
authors.affiliation: Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana.
authors.forename: Richard V
authors.initials: RV
authors.lastname: Milani
authors.affiliation: Palm Beach Heart Associates and University of Miami-Miller School of Medicine, Atlantis, Florida.
authors.forename: Gustavo A
authors.initials: GA
authors.lastname: Cardenas
authors.affiliation: Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana.
authors.forename: Hector O
authors.initials: HO
authors.lastname: Ventura
mesh_terms: D000368:Aged; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000401:mortality*; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology* / Q000503:physiopathology*; D012189:Retrospective Studies; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology* / Q000401:mortality; D020257:Ventricular Remodeling