Mehmet K Aktas1, Wojciech Zareba2, David T Huang2, Scott McNitt2, Slava Polonsky2, Leway Chen2, Martin Stockburger3, Bela Merkely4, Arthur J Moss2, Valentina Kutyifa5. 1. Department of Cardiovascular Disease, University of Rochester Medical Center, Rochester, New York. Electronic address: mehmet_aktas@urmc.rochester.edu. 2. Department of Cardiovascular Disease, University of Rochester Medical Center, Rochester, New York. 3. Charite-University Medicine, Experimental and Clinical Research Center, Berlin, Germany. 4. Heart Center, Semmelweis University, Budapest, Hungary. 5. Department of Cardiovascular Disease, University of Rochester Medical Center, Rochester, New York; Heart Center, Semmelweis University, Budapest, Hungary.
Abstract
BACKGROUND: There are no data regarding the effect of weight loss on clinical outcomes in patients undergoing cardiac resynchronization therapy. This study was designed to evaluate the effect of weight loss on clinical outcomes in patients implanted with a cardiac resynchronization therapy with defibrillator (CRT-D). METHODS AND RESULTS: The risk of heart failure (HF) or death, and of death alone, was compared between patients with and without weight loss of ≥2 kg or more at 1 year in the CRT-D arm of the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT). Weight loss was observed in 170 of 994 patients (17%) implanted with a CRT-D. Multivariate analysis showed a significant increase in the risk of HF or death among patients with weight loss compared with those without weight loss (hazard ratio [HR] 1.82, 95% confidence interval [CI] 1.26-2.63; P = .001). Weight loss was associated with a 79% increase in the risk of all-cause mortality (HR 1.79, 95% CI 1.16-3.34; P = .01). When analyzed in a continuous fashion, each kg of weight loss was associated with a 4% increase in the risk of HF or death (P = .03). In left bundle branch block (LBBB) patients with a CRT-D, weight loss was associated with an especially high risk of HF or death (HR 2.23, 95% CI 1.36-3.65; P = .002) and of death alone (HR 2.33, 95% CI 1.07-5.06; P = .03; interaction P = .26). CONCLUSIONS: In patients with mild symptoms of HF receiving CRT-D, weight loss observed at 1 year is associated with adverse clinical outcomes, especially in those with a LBBB electrocardiographic pattern.
RCT Entities:
BACKGROUND: There are no data regarding the effect of weight loss on clinical outcomes in patients undergoing cardiac resynchronization therapy. This study was designed to evaluate the effect of weight loss on clinical outcomes in patients implanted with a cardiac resynchronization therapy with defibrillator (CRT-D). METHODS AND RESULTS: The risk of heart failure (HF) or death, and of death alone, was compared between patients with and without weight loss of ≥2 kg or more at 1 year in the CRT-D arm of the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT). Weight loss was observed in 170 of 994 patients (17%) implanted with a CRT-D. Multivariate analysis showed a significant increase in the risk of HF or death among patients with weight loss compared with those without weight loss (hazard ratio [HR] 1.82, 95% confidence interval [CI] 1.26-2.63; P = .001). Weight loss was associated with a 79% increase in the risk of all-cause mortality (HR 1.79, 95% CI 1.16-3.34; P = .01). When analyzed in a continuous fashion, each kg of weight loss was associated with a 4% increase in the risk of HF or death (P = .03). In left bundle branch block (LBBB) patients with a CRT-D, weight loss was associated with an especially high risk of HF or death (HR 2.23, 95% CI 1.36-3.65; P = .002) and of death alone (HR 2.33, 95% CI 1.07-5.06; P = .03; interaction P = .26). CONCLUSIONS: In patients with mild symptoms of HF receiving CRT-D, weight loss observed at 1 year is associated with adverse clinical outcomes, especially in those with a LBBB electrocardiographic pattern.
Authors: A Jahangir; M Mirza; M Shahreyar; T Mengesha; R Shearer; S Sultan; A Jahangir; I Choudhuri; V Nangia; A Dhala; A Bhatia; I Niazi; J Sra; A J Tajik Journal: Int J Obes (Lond) Date: 2017-08-30 Impact factor: 5.095
Authors: Elisabet Zamora; Carles Díez-López; Josep Lupón; Marta de Antonio; Mar Domingo; Javier Santesmases; María Isabel Troya; Crisanto Díez-Quevedo; Salvador Altimir; Antoni Bayes-Genis Journal: J Am Heart Assoc Date: 2016-03-24 Impact factor: 5.501