90 Is the paradoxical relationship between body mass index and mortality in patients with heart failure influenced by left ventricle ejection fraction?

2007 ◽  
Vol 6 (1) ◽  
pp. 20-20
Author(s):  
E ZAMORA ◽  
J LUPON ◽  
A URRUTIA ◽  
B GONZALEZ ◽  
D MAS ◽  
...  
Keyword(s):  
Heart Failure ◽  
Body Mass Index ◽  
Left Ventricle ◽  
Ejection Fraction ◽  
Body Mass ◽  
Left Ventricle Ejection Fraction ◽  
Patients With Heart Failure

Association of Body Mass Index With Clinical Outcomes in Patients With Heart Failure With Reduced Ejection Fraction Treated With Sacubitril/Valsartan

2021 ◽  
pp. 107424842110244
Author(s):  
Kazuhiko Kido ◽  
Christopher Bianco ◽  
Marco Caccamo ◽  
Wei Fang ◽  
George Sokos
Keyword(s):  
Heart Failure ◽  
Body Mass Index ◽  
Propensity Score ◽  
Ejection Fraction ◽  
Clinical Outcomes ◽  
Body Mass ◽  
Normal Weight ◽  
Reduced Ejection Fraction ◽  
Propensity Score Weighting ◽  
Patients With Heart Failure

Background: Only limited data are available that address the association between body mass index (BMI) and clinical outcomes in patients with heart failure with reduced ejection fraction who are receiving sacubitril/valsartan. Methods: We performed a retrospective multi-center cohort study in which we compared 3 body mass index groups (normal, overweight and obese groups) in patients with heart failure with reduced ejection fraction receiving sacubitril/valsartan. The follow-up period was at least 1 year. Propensity score weighting was performed. The primary outcomes were hospitalization for heart failure and all-cause mortality. Results: Of the 721 patients in the original cohort, propensity score weighting generated a cohort of 540 patients in 3 groups: normal weight (n = 78), overweight (n = 181), and obese (n = 281). All baseline characteristics were well-balanced between 3 groups after propensity score weighting. Among our results, we found no significant differences in hospitalization for heart failure (normal weight versus overweight: average hazard ratio [AHR] 1.29, 95% confidence interval [CI] = 0.76-2.20, P = 0.35; normal weight versus obese: AHR 1.04, 95% CI = 0.63-1.70, P = 0.88; overweight versus obese groups: AHR 0.81, 95% CI = 0.54-1.20, P = 0.29) or all-cause mortality (normal weight versus overweight: AHR 0.99, 95% CI = 0.59-1.67, P = 0.97; normal weight versus obese: AHR 0.87, 95% CI = 0.53-1.42, P = 0.57; overweight versus obese: AHR 0.87, 95% CI = 0.58-1.32, P = 0.52). Conclusion: We identified no significant associations between BMI and clinical outcomes in patients diagnosed with heart failure with a reduced ejection fraction who were treated with sacubitril/valsartan. A large-scale study should be performed to verify these results.

Abstract 10390: Impact of Diabetes Mellitus on the Prognosis of Patients With Heart Failure and Preserved Left Ventricle Ejection Fraction: Insights From the TOPCAT Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Thao Huynh ◽  
Brian Harty ◽  
Susan Assmann ◽  
Eileen O'Meara ◽  
Inder Anand ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Left Ventricle ◽  
Ejection Fraction ◽  
Left Ventricle Ejection Fraction ◽  
Patients With Heart Failure ◽  
All Cause Mortality ◽  
Insulin Dependent ◽  
Secondary Outcomes ◽  
The Impact

Background: The impact of diabetes mellitus (DM) for patients with heart failure and preserved left ventricle ejection fraction (HFpEF) remains unclear. We aimed to determine the impact of DM on the prognosis of patients with DM and HFpEF enrolled in the TOPCAT trial. Methods: We classified TOPCAT patients into three groups: insulin-dependent DM (IDDM), non-insulin dependent DM (NIDDM) and non-DM. We investigated the occurrence of a major adverse cardiovascular event (MACE), defined as CV mortality, hospitalization for HF, non-fatal myocardial infarction (MI), non-fatal non-hemorrhagic stroke, or aborted cardiac arrest. Secondary outcomes included the individual components of MACE and all-cause mortality. We used multivariate Cox proportional hazards regression models to evaluate the independent associations of DM on time to MACE. Results: There were 1,134 DM patients (439 IDDM and 695 NIDDM) and 2,307 non-DM patients. The IDDM patients were younger and more likely to be male, non-white, and from the Americas. Despite having the highest median left ventricle’s ejection fraction (LVEF) (58%) compared to NIDDM and non-DM patients (57% and 56%, respectively, p=0.007), they were more symptomatic. Forty-eight percent of IDDM patients were of New York Heart Association (NYHA) III/IV functional classes compared to 36% of NIDDM and 29% of non-DM patients (p<0.001). IDDM patients had significantly increased risks for MACE, CV mortality, MI, HF hospitalization, and all-cause mortality when compared to non-DM patients (p-values<0.01). NIDDM patients had similar risks for MACE and the secondary outcomes as the non-DM patients. The effect of diabetes on outcomes was similar between regions. Conclusion: Among HFpEF patients, IDDM but not NIDDM was independently associated with increased risks of MACEs. Future research is needed to evaluate whether optimal medications and lifestyle interventions may reduce MACE in these high-risk patients.

Body Habitus and Prognosis in Patients With Heart Failure After Acute Decompensation. A Comparison of Survival According to Body-Mass Index

2010 ◽  
Vol 16 (9) ◽  
pp. S172
Author(s):  
Aya Banno ◽  
Shun Kohsaka ◽  
Kazuki Ohshima ◽  
Yutaka Endo ◽  
Masashi Takahashi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Body Mass Index ◽  
Body Mass ◽  
Body Habitus ◽  
Patients With Heart Failure ◽  
Acute Decompensation

Abstract 13497: Prognostic Value of the Combination of the Echocardiographic Derived Pulmonary Artery Wedge Pressure and Body Mass Index in Patients With Heart Failure With Preserved Ejection Fraction: Insights From PURSUIT-HFpEF Registry

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Kumpei Ueda ◽  
Shungo Hikoso ◽  
Daisaku D Nakatani ◽  
Shunsuke Tamaki ◽  
Masamichi Yano ◽  
...  
Keyword(s):  
Heart Failure ◽  
Body Mass Index ◽  
Ejection Fraction ◽  
Prognostic Value ◽  
Left Ventricular ◽  
Preserved Ejection Fraction ◽  
Pulmonary Artery Wedge Pressure ◽  
Patients With Heart Failure ◽  
Wedge Pressure

Background: An elevated pulmonary artery wedge pressure (PAWP), a surrogate of left ventricular filling pressure, is associated with poor outcomes in patients with heart failure (HF). In addition, obesity paradox is well recognized in HF patients and body mass index (BMI) also provides a prognostic information. However, there is little information available on the prognostic value of the combination of the echocardiographic derived PAWP and BMI in patients with HF with preserved ejection fraction (HFpEF). Methods and Results: Patients data were extracted from The Prospective mUlticenteR obServational stUdy of patIenTs with Heart Failure with Preserved Ejection Fraction (PURSUIT HFpEF) study, which is a prospective multicenter observational registry for acute decompensated heart failure (ADHF) patients with HFpEF. We analyzed 548 patients after exclusion of patients undergoing hemodialysis, patients with in-hospital death, missing follow-up data, or missing data to calculate PAWP or BMI. Body weight measurement and echocardiography were performed just before discharge. PAWP was calculated using the Nagueh formula [PAWP = 1.24* (E/e’) + 1.9] with e’ = [(e’ septal + e’ lateral ) /2]. During a mean follow up period of 1.5±0.8 years, 86 patients had all-cause death (ACD). Multivariate Cox analysis showed that both PAWP (p=0.020) and BMI (p=0.0001) were significantly associated with ACD, independently of age and previous history of HF hospitalization, after the adjustment with gender, left ventricular ejection fraction, NT-proBNP and estimated glomerular filtration rate. Kaplan-Meier curve analysis revealed that there was a significant difference in the risk of ACD when patients were stratified into 3 groups based on the median values of PAWP (17.3) and BMI (21.4). Conclusions: The combination of the echocardiographic derived PAWP and BMI might be useful for stratifying ADHF patients with HFpEF at risk for the total mortality.

P2607Quick nutritional assessment and prognosis in outpatients with heart failure with mid-range ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Zamora ◽  
B Gonzalez ◽  
C Rivas ◽  
V Diaz ◽  
P Velayos ◽  
...  
Keyword(s):  
Heart Failure ◽  
Body Mass Index ◽  
At Risk ◽  
Ejection Fraction ◽  
Nutritional Status ◽  
Body Mass ◽  
Screening Tool ◽  
Nutritional Assessment ◽  
Functional Class ◽  
Nyha Functional Class

Abstract Background Nutritional status is an important prognostic factor in patients with heart failure (HF) beyond body mass index, although its prognostic value in patients with mid-range left ventricular ejection fraction (HFmrEF) is not completely elucidated. In a pilot study we observed that the Mini Nutritional Assessment Short Form (MNA-SF) was the best approach for the screening of nutritional status in HF outpatients over others screening tools. Purpose To assess the prognostic role of malnutrition or risk of malnutrition in HFmrEF outpatients after the implementation of the MNA-SF screening tool in a routine way in a multidisciplinary HF. Methods The MNA-SF screening tool was administered during the global nurse evaluation of patients. The scoring ranges from 0 to 14, being 0 to7 as malnutrition status, 8 to 11 as at risk of malnutrition and 12 to 14 as normal nutritional status. For the present study those patients with malnutrition and at risk of malnutrition were merged and considered abnormal nutritional status. All-cause death was the primary end-point. Univariate and multivariate (backward conditional stepwise) Cox regression analyses were performed. Results Since October 2016 to November 2017, 153 HFmrEF patients were studied (mean age 68.8±11.7 years, 72.5% men, body mass index 28.4±4.4, LVEF 44% ± 3, NYHA class I 5.9%, II 86.3%, and III 7.8%). According to the MNA-SF 25 patients were (16.3%) fulfilled criteria of malnutrition (4) or where at risk of malnutrition (21). During a mean follow-up of 17.4±6.1 months, 23 patients died (15%). In the univariate analysis, nutritional abnormal status was significantly associated with all-cause death (HR 2.93 [1.23–7], p=0.02). In the multivariate analysis which included age, sex, NYHA functional class, body mass index, ischemic aetiology of HF and years of duration of HF, abnormal nutritional status remained significantly associated with all-cause mortality (HR 3.64 [1.39–9.54], p=0.009), together with NYHA functional class (HR 7.93 [2.69–23.4], p<0.001) and years of HF duration (HR 1.10 [1.04–1.16], p=0.001). Conclusions Nutritional status assessed with the screening MNA-SF was an independent predictor of all-cause death in ambulatory patients with HFmrEF – beyond BMI – together with NYHA functional class and HF duration.

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