Impact of Cardiorespiratory Fitness on the Obesity Paradox in Heart Failure with Reduced Ejection Fraction
BACKGROUND: Higher body mass index (BMI) has been associated with improved outcomes in heart failure with reduced ejection fraction. This finding has led to the concept of the obesity paradox.
OBJECTIVE: To investigate the impact of exercise tolerance and cardiorespiratory capacity on the obesity paradox.
METHODS: Outpatients with symptomatic heart failure and left ventricular ejection fraction (LVEF) ≤ 40%, followed up in our center, prospectively underwent baseline comprehensive evaluation including clinical, laboratorial, electrocardiographic, echocardiographic, and cardiopulmonary exercise testing parameters. The study population was divided according to BMI (< 25, 25 - 29.9, and ≥ 30 kg/m2). All patients were followed for 60 months. The combined endpoint was defined as cardiac death, urgent heart transplantation, or need for mechanical circulatory support. P value < 0.05 was considered significant.
RESULTS: In the 282 enrolled patients (75% male, 54 ± 12 years, BMI 27 ± 4 kg/m2, LVEF 27% ± 7%), the composite endpoint occurred in 24.4% during follow-up. Patients with higher BMI were older, and they had higher LVEF and serum sodium levels, as well as lower ventilatory efficiency (VE/VCO2) slope. VE/VCO2 and peak oxygen consumption (pVO2) were strong predictors of prognosis (p < 0.001). In univariable Cox regression analysis, higher BMI was associated with better outcomes (HR 0.940, CI 0.886 - 0.998, p 0.042). However, after adjusting for either VE/VCO2 slope or pVO2, the protective role of BMI disappeared. Survival benefit of BMI was not evident when patients were grouped according to cardiorespiratory fitness class (VE/VCO2, cut-off value 35, and pVO2, cut-off value 14 mL/kg/min).
CONCLUSION: These results suggest that cardiorespiratory fitness outweighs the relationship between BMI and survival in patients with heart failure.
| Errataetall: |
CommentIn: Arq Bras Cardiol. 2020 Oct;115(4):646-648. - PMID 33111863 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:115 |
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| Enthalten in: |
Arquivos brasileiros de cardiologia - 115(2020), 4 vom: 21. Okt., Seite 639-645 |
| Sprache: |
Englisch |
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| Weiterer Titel: |
O Impacto da Aptidão Cardiorrespiratória no Paradoxo da Obesidade em Insuficiência Cardíaca com Fração de Ejeção Reduzida |
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| Beteiligte Personen: |
Moreira, Rita Ilhão [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 04.12.2020 Date Revised 28.08.2021 published: Print CommentIn: Arq Bras Cardiol. 2020 Oct;115(4):646-648. - PMID 33111863 Citation Status MEDLINE |
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| doi: |
10.36660/abc.20190337 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM316805033 |
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| 245 | 1 | 0 | |a Impact of Cardiorespiratory Fitness on the Obesity Paradox in Heart Failure with Reduced Ejection Fraction |
| 246 | 3 | 3 | |a O Impacto da Aptidão Cardiorrespiratória no Paradoxo da Obesidade em Insuficiência Cardíaca com Fração de Ejeção Reduzida |
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| 500 | |a Date Revised 28.08.2021 | ||
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| 500 | |a CommentIn: Arq Bras Cardiol. 2020 Oct;115(4):646-648. - PMID 33111863 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: Higher body mass index (BMI) has been associated with improved outcomes in heart failure with reduced ejection fraction. This finding has led to the concept of the obesity paradox | ||
| 520 | |a OBJECTIVE: To investigate the impact of exercise tolerance and cardiorespiratory capacity on the obesity paradox | ||
| 520 | |a METHODS: Outpatients with symptomatic heart failure and left ventricular ejection fraction (LVEF) ≤ 40%, followed up in our center, prospectively underwent baseline comprehensive evaluation including clinical, laboratorial, electrocardiographic, echocardiographic, and cardiopulmonary exercise testing parameters. The study population was divided according to BMI (< 25, 25 - 29.9, and ≥ 30 kg/m2). All patients were followed for 60 months. The combined endpoint was defined as cardiac death, urgent heart transplantation, or need for mechanical circulatory support. P value < 0.05 was considered significant | ||
| 520 | |a RESULTS: In the 282 enrolled patients (75% male, 54 ± 12 years, BMI 27 ± 4 kg/m2, LVEF 27% ± 7%), the composite endpoint occurred in 24.4% during follow-up. Patients with higher BMI were older, and they had higher LVEF and serum sodium levels, as well as lower ventilatory efficiency (VE/VCO2) slope. VE/VCO2 and peak oxygen consumption (pVO2) were strong predictors of prognosis (p < 0.001). In univariable Cox regression analysis, higher BMI was associated with better outcomes (HR 0.940, CI 0.886 - 0.998, p 0.042). However, after adjusting for either VE/VCO2 slope or pVO2, the protective role of BMI disappeared. Survival benefit of BMI was not evident when patients were grouped according to cardiorespiratory fitness class (VE/VCO2, cut-off value 35, and pVO2, cut-off value 14 mL/kg/min) | ||
| 520 | |a CONCLUSION: These results suggest that cardiorespiratory fitness outweighs the relationship between BMI and survival in patients with heart failure | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Silva, Tiago Pereira |e verfasserin |4 aut | |
| 700 | 1 | |a Gonçalves, António Valentim |e verfasserin |4 aut | |
| 700 | 1 | |a Feliciano, Joana |e verfasserin |4 aut | |
| 700 | 1 | |a Rio, Pedro |e verfasserin |4 aut | |
| 700 | 1 | |a Soares, Rui |e verfasserin |4 aut | |
| 700 | 1 | |a Ferreira, Rui Cruz |e verfasserin |4 aut | |
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