title: Impact of body mass index on mortality in heart failure patients.
abstract: BACKGROUND
  Higher body mass index (BMI) is associated with incident heart failure (HF), but paradoxically associated with better prognosis, recognized as the obesity paradox in HF. However, the impact of BMI on detailed prognosis on HF and the mechanism of obesity paradox remain still unclear.
  
  
  METHODS
  We researched consecutive 648 patients admitted for HF as follows: underweight (BMI < 18·5 kg/m(2) , n = 86), normal (18·5 ≤ BMI < 25, n = 380), overweight (25 ≤ BMI < 30, n = 147) and obese (30 ≤ BMI, n = 35) and compared the results from their laboratory tests and echocardiography. We also followed cardiac and all-cause mortality.
  
  
  RESULTS
  Obese group had a higher prevalence of obesity-related comorbidity (hypertension, diabetes, dyslipidemia); however, tumour necrosis factor-α, adiponectin, troponin T and systolic pulmonary arterial pressure were higher in the underweight group than in the other groups (P < 0·05, respectively). Left and right ventricular systolic function did not differ among the groups. In the Kaplan-Meier analysis, cardiac and all-cause mortality progressively increased from obese to overweight, normal and underweight group. Importantly, in the Cox proportional hazard analyses after adjusting for known risk factors, BMI was an independent predictor of cardiac and all-cause mortality (P < 0·01, respectively) in HF patients.
  
  
  CONCLUSIONS
  Body mass index was an independent predictor of cardiac death and all-cause mortality in HF patients. Furthermore, lower BMI was associated with higher circulating levels of tumour necrosis factor-α, adiponectin and troponin T and higher systolic pulmonary arterial pressure.
authors.affiliation: Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan.
authors.forename: Mai
authors.initials: M
authors.lastname: Takiguchi
authors.forename: Akiomi
authors.initials: A
authors.lastname: Yoshihisa
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Miura
authors.forename: Takeshi
authors.initials: T
authors.lastname: Shimizu
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yamauchi
authors.forename: Shoji
authors.initials: S
authors.lastname: Iwaya
authors.forename: Takashi
authors.initials: T
authors.lastname: Owada
authors.forename: Makiko
authors.initials: M
authors.lastname: Miyata
authors.forename: Satoshi
authors.initials: S
authors.lastname: Abe
authors.forename: Takamasa
authors.initials: T
authors.lastname: Sato
authors.forename: Satoshi
authors.initials: S
authors.lastname: Suzuki
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Suzuki
authors.forename: Shu-Ichi
authors.initials: S
authors.lastname: Saitoh
authors.forename: Yasuchika
authors.initials: Y
authors.lastname: Takeishi
mesh_terms: D052242:Adiponectin / Q000378:metabolism; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D015992:Body Mass Index; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009765:Obesity / Q000150:complications / Q000401:mortality*; D011446:Prospective Studies; D012307:Risk Factors; D020107:Troponin T / Q000378:metabolism; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
chemical_list: D052242:Adiponectin; D015415:Biomarkers; D020107:Troponin T; D014409:Tumor Necrosis Factor-alpha
keywords: Adiponectin; body mass index; heart failure; right heart function; troponin T; tumour necrosis factor-α