title: Body surface area as a prognostic marker in chronic heart failure patients: results from the Heart Failure Registry of the Heart Failure Association of the European Society of Cardiology.
abstract: The 'obesity paradox' is consistently observed in patients with heart failure (HF). We investigated the relationship of body surface area (BSA) to mortality and hospitalizations in patients with chronic HF.
  
  
  
  Data from the outpatient cohort of the observational, prospective, Heart Failure Long-Term Registry of the Heart Failure Association of the European Society of Cardiology was analysed in order to evaluate the prognostic significance of BSA in chronic HF. A total of 9104 chronic HF patients (age 64.8 ± 13.4 years; 71.6% males) were enrolled. Mortality during 1-year follow-up was observed in 718 of 8875 (8.1%) patients. A progressive, inverse relationship between all-cause mortality and BSA levels was observed; the adjusted hazard ratio (HR) for 1-year mortality was 1.823 [95% confidence interval (CI) 1.398-2.376], P < 0.001 for the lowest quartile of BSA <1.78 m(2) , and 1.255, 95% CI 1.000-1.576, P = 0.05 for the middle two quartiles (1.78 ≤BSA ≤2.07 m(2) ), compared with the highest quartile (BSA >2.07 m(2) ). For each increase of 0.1 m(2) in BSA, an adjusted HR of 0.908 (95% CI 0.870-0.948), P < 0.001 for mortality was calculated. HF hospitalizations were not associated with BSA subgroup distribution. In both genders, subjects within the lowest BSA quartile (males <1.84 m(2) and females <1.64 m(2) ) had significantly higher mortality rates during follow-up (log-rank P < 0.0001). However, the stepwise association with mortality was more distinct in males.
  
  
  
  Total and cardiovascular mortality, but not HF hospitalizations was inversely associated with BSA levels in chronic HF patients. BSA may serve as a prognostic indicator for adverse outcome in HF patients.
authors.affiliation: Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel.
authors.forename: Barak
authors.initials: B
authors.lastname: Zafrir
authors.affiliation: Department of Cardiovascular Medicine, Poriya Medical Center, Tiberius, Israel.|Faculty of Medicine, Bar-Ilan University, Israel.
authors.forename: Nabeeh
authors.initials: N
authors.lastname: Salman
authors.affiliation: Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Complexo Hospitalario Universitario A Coruna, CHUAC, La Coruna, Spain.
authors.forename: Maria G
authors.initials: MG
authors.lastname: Crespo-Leiro
authors.affiliation: Innovative Clinical Trials, Department of Cardiology & Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany.
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
authors.affiliation: Monash University, Australia, and University of Warwick, Coventry, UK.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Coats
authors.affiliation: Department of Cardiology and LTTA Centre, University Hospital of Ferrara, and Maria Cecilia Hospital, GVM Care&Research, E.S: Health Science Foundation, Cotignola, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Ferrari
authors.affiliation: Heart Failure Unit, Department of Cardiology, Athens University Hospital Attikon, Athens, Greece.
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Filippatos
authors.affiliation: EURObservational Research Programme, European Society of Cardiology, Sophia-Antipolis, France.
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
authors.affiliation: Hôpital Lariboisière, Université Paris Diderot, Inserm 942, Paris, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mebazaa
authors.affiliation: Heart Failure Unit, Cardiac Department, Guglielmo da Saliceto Hospital, AUSL, Piacenza, Italy.
authors.forename: Massimo Francesco
authors.initials: MF
authors.lastname: Piepoli
authors.affiliation: Department of Cardiology, Heart Failure Clinic and Transplantation, University Heart Center Zurich, Zurich, Switzerland.
authors.forename: Frank
authors.initials: F
authors.lastname: Ruschitzka
authors.affiliation: Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Complexo Hospitalario Universitario A Coruna, CHUAC, La Coruna, Spain.
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Paniagua-Martin
authors.affiliation: Advanced Heart Failure, Transplant and Pulmonary Hypertension Unit, Cardiology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Segovia
authors.affiliation: EURObservational Research Programme, European Society of Cardiology, Sophia-Antipolis, France.
authors.forename: Cecile
authors.initials: C
authors.lastname: Laroche
authors.affiliation: Department of Cardiovascular Medicine, Poriya Medical Center, Tiberius, Israel.|Faculty of Medicine, Bar-Ilan University, Israel.
authors.forename: Offer
authors.initials: O
authors.lastname: Amir
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001830:Body Surface Area; D002309:Cardiology; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D002908:Chronic Disease; D015331:Cohort Studies; D015897:Comorbidity; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000401:mortality*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D012737:Sex Factors; D012955:Societies, Medical
keywords: Body surface area; Heart failure; Obesity; Prognosis