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Journal of Interventional Cardiac Electrophysiology

Erschienen in:

01.09.2015

Impact of cardiac resynchronization therapy-defibrillator implantation on the association between body mass index and prognosis in patients with heart failure

verfasst von: Satoshi Yanagisawa, Yasuya Inden, Masayuki Shimano, Naoki Yoshida, Shinji Ishikawa, Hiroyuki Kato, Satoshi Okumura, Aya Miyoshi-Fujii, Tomoyuki Nagao, Toshihiko Yamamoto, Yoshiaki Mizutani, Tadahiro Ito, Makoto Hirai, Toyoaki Murohara

Erschienen in: Journal of Interventional Cardiac Electrophysiology | Ausgabe 3/2015

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Abstract

Purpose

This study aimed to examine the association between body mass index (BMI) and prognosis in heart failure patients after cardiac resynchronization therapy-defibrillator (CRT-D) implantation.

Methods

We retrospectively investigated 125 patients (33 overweight [BMI ≥25 kg/m²], 75 normal weight [BMI 18.5–24.9 kg/m²], and 17 underweight patients [BMI <18.5 kg/m²]) who underwent CRT-D implantation. The clinical outcome endpoints were all-cause death and appropriate shock therapy.

Results

During the follow-up period (mean 3.1 ± 1.8 years), 23 patients died (1 [3.0 %] overweight, 17 [22.7 %] normal weight, and 5 [29.4 %] underweight patients), and appropriate shock events were observed in 14 patients (2 [6.1 %] overweight, 10 [13.3 %] normal weight, and 2 [11.8 %] underweight patients). All patients survived shock therapy. After adjusting for confounding factors, overweight patients had significantly fewer outcomes relating to all-cause death and appropriate shock events (hazard ratio 0.27, 95 % confidence interval 0.08–0.91, p = 0.034) than normal weight patients. However, the prognostic difference between overweight and normal weight patients could be diminished as a result of the successful shock therapies (p = 0.067). Additionally, prognosis did not differ between overweight and normal weight patients among the responders, but did differ among the non-responders. The underweight patients had a poorer prognosis after CRT-D implantation compared with the other groups.

Conclusions

Although high BMI was associated with better outcomes among heart failure patients with CRT-D implantations, the difference in the prognosis between overweight and normal weight patients was reduced because of defibrillator therapy and the improvement in cardiac function provided by CRT-D implantation.

Kenchaiah, S., Pocock, S. J., Wang, D., Finn, P. V., Zornoff, L. A., Skali, H., CHARM Investigators, et al. (2007). Body mass index and prognosis in patients with chronic heart failure: insights from the Candesartan in Heart failure: Assessment of reduction in Mortality and morbidity (CHARM) program. Circulation, 116(6), 627–636.PubMedCrossRef

Shah, R., Gayat, E., Januzzi, J. L., Jr., Sato, N., Cohen-Solal, A., diSomma, S., GREAT (Global Research on Acute Conditions Team) Network, et al. (2014). Body mass index and mortality in acutely decompensated heart failure across the world: a global obesity paradox. Journal of the American College of Cardiology, 63(8), 778–785.PubMedCrossRef

Kapoor, J. R., & Heidenreich, P. A. (2010). Obesity and survival in patients with heart failure and preserved systolic function: a U-shaped relationship. American Heart Journal, 159(1), 75–80.PubMedCrossRef

Zamora, E., Lupón, J., de Antonio, M., Urrutia, A., Coll, R., Díez, C., et al. (2013). The obesity paradox in heart failure: is etiology a key factor? International Journal of Cardiology, 166(3), 601–605.PubMedCrossRef

Hamaguchi, S., Tsuchihashi-Makaya, M., Kinugawa, S., Goto, D., Yokota, T., Goto, K., JCARE-CARD Investigators, et al. (2010). Body mass index is an independent predictor of long-term outcomes in patients hospitalized with heart failure in Japan. Circulation Journal, 74(12), 2605–2611.PubMedCrossRef

Abraham, W. T., Fisher, W. G., Smith, A. L., Delurgio, D. B., Leon, A. R., Loh, E., MIRACLE Study Group, et al. (2002). Multicenter InSync randomized clinical evaluation. Cardiac resynchronization in chronic heart failure. Multicenter InSync randomized clinical evaluation. New England Journal of Medicine, 346(24), 1845–1853.PubMedCrossRef

Cleland, J. G., Daubert, J. C., Erdmann, E., Freemantle, N., Gras, D., Kappenberger, L., Cardiac Resynchronization-Heart Failure (CARE-HF) Study Investigators, et al. (2005). The effect of cardiac resynchronization on morbidity and mortality in heart failure. New England Journal of Medicine, 352(15), 1539–1549.PubMedCrossRef

Bristow, M. R., Saxon, L. A., Boehmer, J., Krueger, S., Kass, D. A., De Marco, T., Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Investigators, et al. (2004). Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. New England Journal of Medicine, 350(21), 2140–2150.PubMedCrossRef

Yu, C. M., Bleeker, G. B., Fung, J. W., Schalij, M. J., Zhang, Q., van der Wall, E. E., et al. (2005). Left ventricular reverse remodeling but not clinical improvement predicts long-term survival after cardiac resynchronization therapy. Circulation, 112(11), 1580–1586.PubMedCrossRef

10.

Van Boven, N., Bogaard, K., Ruiter, J., Kimman, G., Theuns, D., Kardys, I., et al. (2013). Functional response to cardiac resynchronization therapy is associated with improved clinical outcome and absence of appropriate shocks. Journal of Cardiovascular Electrophysiology, 24(3), 316–322.PubMedCrossRef

11.

JCS Joint Working Group. (2013). Guidelines for non-pharmacotherapy of cardiac arrhythmias (JCS 2011). Circulation Journal, 77(1), 249–274.CrossRef

12.

Shan, D. J., De Maria, A., Kisslo, J., & Weiman, A. (1978). Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurement. Circulation, 58(6), 1072–1083.CrossRef

13.

Schiller, N. B., Shah, P. M., Crawford, M., DeMaria, A., Devereux, R., Feigenbaum, H., et al. (1989). Recommendations for quantification of the left ventricle by two-dimensional echocardiography. Journal of the American Society of Echocardiography, 2(5), 358–367.PubMedCrossRef

14.

Chung, E. S., Leon, A. R., Tavazzi, L., Sun, J. P., Nihoyannopoulos, P., Merlino, J., et al. (2008). Results of the predictors of response to CRT (PROSPECT) trial. Circulation, 117(20), 2608–2616.PubMedCrossRef

15.

Park, Y. W., Zhu, S., Palaniappan, L., Heshka, S., Carnethon, M. R., & Heymsfield, S. B. (2003). The metabolic syndrome: prevalence and associated risk factor findings in the US population from the third national health and nutrition examination survey, 1988-1994. Archives of Internal Medicine, 163(4), 427–436.PubMedCentralPubMedCrossRef

16.

Cai, C., Hua, W., Ding, L. G., Wang, J., Chen, K. P., Yang, X. W., et al. (2014). Association of body mass index with cardiac reverse remodeling and long-term outcome in advanced heart failure patients with cardiac resynchronization therapy. Circulation Journal, 78(12), 2899–2907.PubMedCrossRef

17.

Dorner, T. E., & Rieder, A. (2012). Obesity paradox in elderly patients with cardiovascular diseases. International Journal of Cardiology, 155(1), 56–65.PubMedCrossRef

18.

Steinberg, B. A., Cannon, C. P., Hernandez, A. F., Pan, W., Peterson, E. D., & Fonarow, G. C. (2007). Medical therapies and invasive treatments for coronary artery disease by body mass: the “obesity paradox” in the Get With The Guidelines database. American Journal of Cardiology, 100(9), 1331–1335.PubMedCrossRef

19.

Lancefield, T., Clark, D. J., Andrianopoulos, N., Brennan, A. L., Reid, C. M., Johns, J., MIG (Melbourne Interventional Group) Registry, et al. (2010). Is there an obesity paradox after percutaneous coronary intervention in the contemporary era? An analysis from a multicenter Australian registry. JACC. Cardiovascular Interventions, 3(6), 660–668.PubMedCrossRef

20.

Mohamed-Ali, V., Goodrick, S., Bulmer, K., Holly, J. M., Yudkin, J. S., & Coppack, S. W. (1999). Production of soluble tumor necrosis factor receptors by human subcutaneous adipose tissue in vivo. American Journal of Physiology, 277(6), E971–E975.PubMed

21.

Sood, N., Ruwald, A. C., Solomon, S., Daubert, J. P., McNitt, S., Polonsky, B., et al. (2014). Association between myocardial substrate, implantable cardioverter defibrillator shocks and mortality in MADIT-CRT. European Heart Journal, 35(2), 106–115.PubMedCrossRef

22.

Anker, S. D., Chua, T. P., Ponikowski, P., Harrington, D., Swan, J. W., Kox, W. J., et al. (1997). Hormonal changes and catabolic/anabolic imbalance in chronic heart failure and their importance for cardiac cachexia. Circulation, 96(2), 526–534.PubMedCrossRef

23.

Heineke, J., Auger-Messier, M., Xu, J., Sargent, M., York, A., Welle, S., et al. (2010). Genetic deletion of myostatin from the heart prevents skeletal muscle atrophy in heart failure. Circulation, 121(3), 419–425.PubMedCentralPubMedCrossRef

24.

Poole, J. E., Johnson, G. W., Hellkamp, A. S., Anderson, J., Callans, D. J., Raitt, M. H., et al. (2008). Prognostic importance of defibrillator shocks in patients with heart failure. New England Journal of Medicine, 359(10), 1009–1017.PubMedCentralPubMedCrossRef

25.

Gelber, R. P., Gaziano, J. M., Orav, E. J., Manson, J. E., Buring, J. E., & Kurth, T. (2008). Measures of obesity and cardiovascular risk among men and women. Journal of the American College of Cardiology, 52(8), 605–615.PubMedCentralPubMedCrossRef

Titel: Impact of cardiac resynchronization therapy-defibrillator implantation on the association between body mass index and prognosis in patients with heart failure
verfasst von: Satoshi Yanagisawa
Yasuya Inden
Masayuki Shimano
Naoki Yoshida
Shinji Ishikawa
Hiroyuki Kato
Satoshi Okumura
Aya Miyoshi-Fujii
Tomoyuki Nagao
Toshihiko Yamamoto
Yoshiaki Mizutani
Tadahiro Ito
Makoto Hirai
Toyoaki Murohara
Publikationsdatum: 01.09.2015
Verlag: Springer US
Erschienen in: Journal of Interventional Cardiac Electrophysiology / Ausgabe 3/2015
Print ISSN: 1383-875X
Elektronische ISSN: 1572-8595
DOI: https://doi.org/10.1007/s10840-015-0015-3

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Impact of cardiac resynchronization therapy-defibrillator implantation on the association between body mass index and prognosis in patients with heart failure