Relation of Body Mass Index to Long-Term Survival After Cardiac Resynchronization Therapy.
Obesity confers a paradoxical survival benefit in patients with heart failure, but this obesity paradox has not been well established in those who have undergone cardiac resynchronization therapy with a defibrillator (CRT-D). We sought to determine the impact of body mass index (BMI) on long-term survival in patients with heart failure after CRT-D. We identified 113 patients implanted with CRT-D at our institution from May 2002 to November 2003. Patients were divided into 3 categories by pre-implant BMI (kg/m2): normal weight (BMI <25), overweight (BMI 25-29), and obese (BMI ≥30). Ten-year survival free from orthotopic heart transplant or ventricular assist device implantation was analyzed with Kaplan-Meier plots, the log-rank test, and Cox proportional hazards modeling. Thirty-three patients (29%) were normal weight, 47 (42%) were overweight, and 33 were obese (29%). Median follow-up time was 4.5 years (interquartile range 1.9 to 8.7 years). Obese patients were younger and had a higher proportion of women (both p <0.05). Ten-year survival free of orthotopic heart transplant or ventricular assist device was highest in obese patients (36.3%) followed by overweight (19.2%) and then normal-weight patients (12.1%), log-rank p trend = 0.004. After adjustment for clinical risk factors, every 1 kg/m2increase in BMI was associated with a 8% reduction in the risk of the primary end point (adjusted hazard ratio 0.92, 95% confidence interval 0.88 to 0.97, p = 0.002). In conclusion, higher BMI is associated with improved long-term survival after CRT-D.
Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. Electronic address: wgrandin@bidmc.harvard.edu.
E Wilson
EW
Grandin
Division of Cardiovascular Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania.
Alison
A
Wand
Division of Cardiovascular Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania.
Payman
P
Zamani
Division of Cardiovascular Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania.
J Eduardo
JE
Rame
Division of Cardiovascular Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania.
Ralph J
RJ
Verdino
D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D058406:Cardiac Resynchronization Therapy; D058409:Cardiac Resynchronization Therapy Devices; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology; D009767:Obesity, Morbid / Q000453:epidemiology*; D050177:Overweight / Q000453:epidemiology; D016016:Proportional Hazards Models; D065840:Protective Factors; D012189:Retrospective Studies; D015996:Survival Rate