Barak Zafrir1, Nabeeh Salman2,3, Maria G Crespo-Leiro4, Stefan D Anker5, Andrew J Coats6, Roberto Ferrari7, Gerasimos Filippatos8, Aldo P Maggioni9, Alexandre Mebazaa10, Massimo Francesco Piepoli11, Frank Ruschitzka12, Maria J Paniagua-Martin4, Javier Segovia13, Cecile Laroche9, Offer Amir2,3. 1. Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel. 2. Department of Cardiovascular Medicine, Poriya Medical Center, Tiberius, Israel. 3. Faculty of Medicine, Bar-Ilan University, Israel. 4. Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Complexo Hospitalario Universitario A Coruna, CHUAC, La Coruna, Spain. 5. Innovative Clinical Trials, Department of Cardiology & Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany. 6. Monash University, Australia, and University of Warwick, Coventry, UK. 7. Department of Cardiology and LTTA Centre, University Hospital of Ferrara, and Maria Cecilia Hospital, GVM Care&Research, E.S: Health Science Foundation, Cotignola, Italy. 8. Heart Failure Unit, Department of Cardiology, Athens University Hospital Attikon, Athens, Greece. 9. EURObservational Research Programme, European Society of Cardiology, Sophia-Antipolis, France. 10. Hôpital Lariboisière, Université Paris Diderot, Inserm 942, Paris, France. 11. Heart Failure Unit, Cardiac Department, Guglielmo da Saliceto Hospital, AUSL, Piacenza, Italy. 12. Department of Cardiology, Heart Failure Clinic and Transplantation, University Heart Center Zurich, Zurich, Switzerland. 13. Advanced Heart Failure, Transplant and Pulmonary Hypertension Unit, Cardiology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.
Abstract
AIMS: The 'obesity paradox' is consistently observed in patients with heart failure (HF). We investigated the relationship of body surface area (BSA) to mortality and hospitalizations in patients with chronic HF. METHODS AND RESULTS: Data from the outpatient cohort of the observational, prospective, Heart Failure Long-Term Registry of the Heart Failure Association of the European Society of Cardiology was analysed in order to evaluate the prognostic significance of BSA in chronic HF. A total of 9104 chronic HF patients (age 64.8 ± 13.4 years; 71.6% males) were enrolled. Mortality during 1-year follow-up was observed in 718 of 8875 (8.1%) patients. A progressive, inverse relationship between all-cause mortality and BSA levels was observed; the adjusted hazard ratio (HR) for 1-year mortality was 1.823 [95% confidence interval (CI) 1.398-2.376], P < 0.001 for the lowest quartile of BSA <1.78 m(2) , and 1.255, 95% CI 1.000-1.576, P = 0.05 for the middle two quartiles (1.78 ≤BSA ≤2.07 m(2) ), compared with the highest quartile (BSA >2.07 m(2) ). For each increase of 0.1 m(2) in BSA, an adjusted HR of 0.908 (95% CI 0.870-0.948), P < 0.001 for mortality was calculated. HF hospitalizations were not associated with BSA subgroup distribution. In both genders, subjects within the lowest BSA quartile (males <1.84 m(2) and females <1.64 m(2) ) had significantly higher mortality rates during follow-up (log-rank P < 0.0001). However, the stepwise association with mortality was more distinct in males. CONCLUSIONS: Total and cardiovascular mortality, but not HF hospitalizations was inversely associated with BSA levels in chronic HF patients. BSA may serve as a prognostic indicator for adverse outcome in HF patients.
AIMS: The 'obesity paradox' is consistently observed in patients with heart failure (HF). We investigated the relationship of body surface area (BSA) to mortality and hospitalizations in patients with chronic HF. METHODS AND RESULTS: Data from the outpatient cohort of the observational, prospective, Heart Failure Long-Term Registry of the Heart Failure Association of the European Society of Cardiology was analysed in order to evaluate the prognostic significance of BSA in chronic HF. A total of 9104 chronic HF patients (age 64.8 ± 13.4 years; 71.6% males) were enrolled. Mortality during 1-year follow-up was observed in 718 of 8875 (8.1%) patients. A progressive, inverse relationship between all-cause mortality and BSA levels was observed; the adjusted hazard ratio (HR) for 1-year mortality was 1.823 [95% confidence interval (CI) 1.398-2.376], P < 0.001 for the lowest quartile of BSA <1.78 m(2) , and 1.255, 95% CI 1.000-1.576, P = 0.05 for the middle two quartiles (1.78 ≤BSA ≤2.07 m(2) ), compared with the highest quartile (BSA >2.07 m(2) ). For each increase of 0.1 m(2) in BSA, an adjusted HR of 0.908 (95% CI 0.870-0.948), P < 0.001 for mortality was calculated. HF hospitalizations were not associated with BSA subgroup distribution. In both genders, subjects within the lowest BSA quartile (males <1.84 m(2) and females <1.64 m(2) ) had significantly higher mortality rates during follow-up (log-rank P < 0.0001). However, the stepwise association with mortality was more distinct in males. CONCLUSIONS: Total and cardiovascular mortality, but not HF hospitalizations was inversely associated with BSA levels in chronic HF patients. BSA may serve as a prognostic indicator for adverse outcome in HF patients.
Authors: Andrew J Stewart Coats; Daniel E Forman; Mark Haykowsky; Dalane W Kitzman; Amy McNeil; Tavis S Campbell; Ross Arena Journal: Nat Rev Cardiol Date: 2017-05-18 Impact factor: 32.419
Authors: Janice Y Chyou; Wan Ting Tay; Inder S Anand; Tiew-Hwa Katherine Teng; Jonathan J L Yap; Michael R MacDonald; Vijay Chopra; Seet Yoong Loh; Wataru Shimizu; Imran Zainal Abidin; Arthur Mark Richards; Javed Butler; Carolyn S P Lam Journal: J Am Heart Assoc Date: 2021-03-13 Impact factor: 5.501
Authors: João Pedro Ferreira; Nicolas Girerd; Pierpaolo Pellicori; Kevin Duarte; Sophie Girerd; Marc A Pfeffer; John J V McMurray; Bertram Pitt; Kenneth Dickstein; Lotte Jacobs; Jan A Staessen; Javed Butler; Roberto Latini; Serge Masson; Alexandre Mebazaa; Hans Peter Brunner-La Rocca; Christian Delles; Stephane Heymans; Naveed Sattar; J Wouter Jukema; John G Cleland; Faiez Zannad; Patrick Rossignol Journal: BMC Med Date: 2016-11-10 Impact factor: 8.775
Authors: Imre Csige; Dóra Ujvárosy; Zoltán Szabó; István Lőrincz; György Paragh; Mariann Harangi; Sándor Somodi Journal: J Diabetes Res Date: 2018-11-04 Impact factor: 4.011