title: Effect of Obesity on the Prognostic Impact of Atrial Fibrillation in Heart Failure With Preserved Ejection Fraction.
abstract: Although obesity is associated with left ventricular hypertrophy, diastolic dysfunction, and occurrence of atrial fibrillation (AF), obese heart failure (HF) patients have a more favorable clinical outcome (obesity paradox). The clinical impact of AF on obese or lean HF patients has not been fully elucidated.
  
  
  
  We analyzed 1,681 patients who were enrolled in the West Tokyo Heart Failure Registry (WET-HF Registry), a multicenter, prospective cohort registry from 2005 through 2014. We assigned them to 3 categories based on body mass index (BMI): low, BMI <18.5; medium, BMI ≥18.5 and <25; and high, BMI ≥25 (n=182/915/400). The clinical endpoint was all-cause death or readmission for acute decompensated HF. During 406 days of follow-up (IQR, 116-739 days), AF was associated with a higher risk of the endpoint in the HF with preserved ejection fraction (HFpEF) group (P<0.001, log-rank test), but not in the HF with reduced EF (HFrEF) group. AF was associated with a higher risk of the endpoint in low and medium BMI patients with HFpEF (P=0.016 and 0.009, respectively). On Multivariate Cox proportional hazards analysis, AF was an independent predictor of the endpoint in patients with BMI <25 from the HFpEF group (hazard ratio, 1.74; 95% CI: 1.21-2.54, P=0.003), but not in the other subgroups.
  
  
  
  AF had a negative impact on clinical outcome in non-obese patients with HFpEF.
authors.affiliation: Department of Cardiology, Sakakibara Heart Institute.
authors.forename: Mayuko
authors.initials: M
authors.lastname: Yagawa
authors.affiliation: Department of Cardiology, Sakakibara Heart Institute.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nagatomo
authors.affiliation: Department of Cardiology, Sakakibara Heart Institute.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Izumi
authors.affiliation: Department of Cardiology, Sakakibara Heart Institute.
authors.forename: Keitaro
authors.initials: K
authors.lastname: Mahara
authors.affiliation: Department of Cardiology, Sakakibara Heart Institute.
authors.forename: Hitonobu
authors.initials: H
authors.lastname: Tomoike
authors.affiliation: Department of Cardiology, Keio University School of Medicine.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Shiraishi
authors.affiliation: Department of Cardiology, Keio University School of Medicine.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kohno
authors.affiliation: Department of Cardiology, St. Luke's International Hospital.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Mizuno
authors.affiliation: Department of Cardiology, Kyorin University School of Medicine.
authors.forename: Ayumi
authors.initials: A
authors.lastname: Goda
authors.affiliation: Department of Cardiology, Keio University School of Medicine.
authors.forename: Shun
authors.initials: S
authors.lastname: Kohsaka
authors.affiliation: Department of Cardiology, Sakakibara Heart Institute.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Yoshikawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D010359:Patient Readmission; D012042:Registries; D013318:Stroke Volume
keywords: Atrial fibrillation; Body mass index; Heart failure; Obesity paradox