Abstract 16775: Body Mass Index Predicts Exercise Capacity in Patients With Hypertrophic Cardiomyopathy

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Caroline A Ball ◽  
Carolyn M Larsen ◽  
Virginia Hebl ◽  
Jeffrey B Geske ◽  
Kevin C Ong ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Hypertrophic Cardiomyopathy ◽  
Body Mass ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Normal Weight ◽  
Peak Vo2 ◽  
Significant Difference

Introduction: Impaired peak VO2 and obesity are known predictors of morbidity and mortality in Hypertrophic Cardiomyopathy (HCM). The purpose of this study is to determine the degree of exercise impairment due to excess weight in patients with HCM. Methods: Adult HCM patients who underwent cardiopulmonary treadmill testing at our tertiary referral center from 2006 - 2012 and had consented to research participation were identified retrospectively. Percent predicted peak VO2 was calculated by the Astrand formula for men and the Jones formula for women which adjust for age and gender. Baseline echocardiographic features obtained within 1 week of exercise testing and % predicted peak VO2 were compared among four groups of patients stratified by body mass index (BMI). Results: 510 patients were identified, with a mean age at diagnosis of 44.3 ± 16.1 years, 186 (36.5%) female. Mean BMI at the time of cardiopulmonary exercise testing was 29.7 ± 5.3 and 227 (44.6%) patients had a BMI ≥ 30. Overweight and obese patients were older and were more likely to be male than their normal weight peers. However, there was no significant difference in ejection fraction (EF), resting left ventricular outflow tract gradient, right ventricular systolic pressure (RVSP), or septal thickness among the groups. HCM patients show impaired peak VO2 across all BMI groups. While peak VO2 increased progressively across BMI groups consistent with greater O2 demand generated by higher body weight, the adjusted peak VO2 in mL/kg/min fell progressively, indicating progressively greater performance impairment with increasing BMI despite similar degrees of cardiac impairment (p <0.0001) (Table 1). Conclusion: Increased BMI is associated with reduced exercise performance in a graded manner in HCM patients independent of cardiac impairment identified on echocardiography.

Allometric correction of peak VO2 in obese adults undergoing cardiopulmonary exercise testing

2019 ◽  
Vol 15 (2) ◽  
pp. 77-83
Author(s):  
A.C. Matheus ◽  
A.R.T. Gagliardi ◽  
E.F. Sperandio ◽  
M. Romiti ◽  
R.L. Arantes ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Normal Weight ◽  
Analysis Of Covariance ◽  
Obesity Class ◽  
Cardiopulmonary Exercise ◽  
Wide Range ◽  
Ratio Standards

We hypothesised that the reduction in cardiorespiratory fitness (CRF) of individuals with less severe obesity is small or non-existent when the allometric rather than the ratio standard is used for the comparison. We aimed to evaluate the influence of obesity on CRF, and to compare peak VO2 using allometric corrections in asymptomatic adults with a wide range of body mass index. The results of 780 adults (age 41±13 years) who underwent cardiopulmonary exercise testing (CPET) were evaluated. Participants were stratified according to body mass index (BMI): normal weight (n=227), overweight (n=198), and obese class 1 (n=155), 2 (n=131), and 3 (n=69). After cardiovascular risk assessment, the participants underwent CPET on a treadmill ramp protocol. The allometric exponents calculated were 0.60 and 0.62 for obese and non-obese groups respectively, with no significant differences. After using BMI strata in a multivariate analysis of covariance, we found an allometric exponent of 0.65. Peak VO2 using ratio standards significantly declined among all stratified groups. After allometric correction, peak VO2 remained significantly reduced only in women with obesity class 3 and men with obesity classes 2 and 3. When ratio standards were used to compare peak VO2, the effect of obesity on CRF was overestimated. Allometric correction of peak VO2 is more reasonable, and should be adopted as a routine for CPET.

scholarly journals OP0220 ASSESSING THE EFFECT OF INCREASED BODY MASS INDEX ON RESPONSE TO TNF INHIBITORS IN ESTABLISHED RHEUMATOID ARTHRITIS: RESULTS FROM THE METEOR DATABASE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 137.1-137
Author(s):  
M. Dey ◽  
S. S. Zhao ◽  
R. J. Moots ◽  
R. B. M. Landewé ◽  
N. Goodson
Keyword(s):  
Rheumatoid Arthritis ◽  
Body Mass Index ◽  
Body Mass ◽  
Personalised Medicine ◽  
Normal Weight ◽  
Sensitivity Analyses ◽  
Established Rheumatoid Arthritis ◽  
Eular Response ◽  
Significant Difference ◽  
Das28 Remission

Background:Rheumatoid arthritis (RA) is associated with increased body mass index (BMI)- 60% of patients are either overweight or obese. Obesity in RA has been shown to predict reduced response to biologic therapy including tumour-necrosis-factor inhibitors (TNFi) [1]. However, it is not clear whether increased BMI influences response to all TNFi drugs in RA.Objectives:1.To explore whether BMI is associated with response to TNFi in patients with established rheumatoid arthritis (estRA), including those newly-starting on these drugs.Methods:Participants with estRA (>1year since diagnosis) taking biologic medications, registered on METEOR (international database of RA patients), 2008-2013, were included. EULAR response, DAS28 remission (including components), and treatment regimens were recorded at baseline, 6, and 12 months. WHO definitions of overweight (BMI≥ 25) and obese (BMI≥30) were explored as predictors of TNFi response (good EULAR response and DAS28 remission) using normal BMI as comparator. Logistic and linear regression models (controlling for age, gender, smoking, and baseline outcomes) and sensitivity analyses were performed. Subgroup analyses were performed for grouped TNFi and individual TNFi (infliximab, IFX; adalimumab, ADA; etanercept, ETN).Results:247 patients with estRA were taking a biologic at 6 months, and 231 patients were taking a biologic at 12 months. Obese patients taking any biologic were significantly less likely to achieve DAS28 remission (OR 0.33 [95%CI 0.12-0.80]) or good EULAR response (OR 0.37 [95%CI 0.16-0.81]) after 6 months, compared to those of normal BMI; this was also demonstrated in those co-prescribed methotrexate (DAS28 remission: OR 0.23 [95%CI 0.07-0.62]; good EULAR response: OR 0.39 [95%CI 0.15-0.92]). These associations did not remain statistically significant at the 12 months assessment.Regarding specific anti-TNF therapies, RA patients treated with monoclonal antibody (-mab) TNFis (IFX/ADA/ GOL) were significantly less likely to achieve good EULAR response at 6 months if they were obese RA (n=38), compared to those of normal weight (n=44) (OR 0.17 [95%CI 0.03-0.59]). A similar non-significant difference was demonstrated for DAS28 remission, and 12-month remission. Specifically, obese individuals were significantly less likely to achieve good EULAR response at 6 months with IFX (OR 0.09 [95%CI 0.00-0.61]; n=20), and significantly less likely to achieve DAS28 remission at 6 months when newly-starting ADA (OR 0.14 [95%CI 0.01-0.96]; n=17), compared to those of normal weight. There were no significant differences in remission outcomes between individuals of different BMI taking ETN. A small number of individuals stopped taking their respective biologic after 6months; reason for cessation was not recorded.Similar outcomes were seen in patients already established on anti-TNF therapy, with overweight and obese individuals less likely overall to be in DAS28 remission at all time points.Conclusion:In established RA, obesity is associated with reduced treatment response to -mab TNFi. No association between increased BMI and response to ETA was observed. Using BMI to direct biologic drug choice could prove to be a simple and cost-effective personalised-medicine approach to prescribing.References:[1]Schäfer M, Meißner Y, Kekow J, Berger S, Remstedt S, Manger B, et al. Obesity reduces the real-world effectiveness of cytokine-targeted but not cell-targeted disease-modifying agents in rheumatoid arthritis. Rheumatology. 2019 Nov 20.Disclosure of Interests:Mrinalini Dey: None declared, Sizheng Steven Zhao: None declared, Robert J Moots: None declared, Robert B.M. Landewé Consultant of: AbbVie; AstraZeneca; Bristol-Myers Squibb; Eli Lilly & Co.; Galapagos NV; Novartis; Pfizer; UCB Pharma, Nicola Goodson: None declared

scholarly journals Body mass index and clinical outcomes in patients with intracerebral haemorrhage: results from the China Stroke Center Alliance

2021 ◽  
pp. svn-2020-000534
Author(s):  
Zhentang Cao ◽  
Xinmin Liu ◽  
Zixiao Li ◽  
Hongqiu Gu ◽  
Yingyu Jiang ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Hospital Mortality ◽  
Body Mass ◽  
Intracerebral Haemorrhage ◽  
Final Analysis ◽  
Normal Weight ◽  
Discharge Disposition ◽  
Increased Risk ◽  
Significant Difference ◽  
Stroke Center

Background and aimObesity paradox has aroused increasing concern in recent years. However, impact of obesity on outcomes in intracerebral haemorrhage (ICH) remains unclear. This study aimed to evaluate association of body mass index (BMI) with in-hospital mortality, complications and discharge disposition in ICH.MethodsData were from 85 705 ICH enrolled in the China Stroke Center Alliance study. Patients were divided into four groups: underweight, normal weight, overweight and obese according to Asian-Pacific criteria. The primary outcome was in-hospital mortality. The secondary outcomes included non-routine discharge disposition and in-hospital complications. Discharge to graded II or III hospital, community hospital or rehabilitation facilities was considered non-routine disposition. Multivariable logistic regression analysed association of BMI with outcomes.Results82 789 patients with ICH were included in the final analysis. Underweight (OR=2.057, 95% CI 1.193 to 3.550) patients had higher odds of in-hospital mortality than those with normal weight after adjusting for covariates, but no significant difference was observed for patients who were overweight or obese. No significant association was found between BMI and non-disposition. Underweight was associated with increased odds of several complications, including pneumonia (OR 1.343, 95% CI 1.138 to 1.584), poor swallow function (OR 1.351, 95% CI 1.122 to 1.628) and urinary tract infection (OR 1.532, 95% CI 1.064 to 2.204). Moreover, obese patients had higher odds of haematoma expansion (OR 1.326, 95% CI 1.168 to 1.504), deep vein thrombosis (OR 1.506, 95% CI 1.165 to 1.947) and gastrointestinal bleeding (OR 1.257, 95% CI 1.027 to 1.539).ConclusionsIn patients with ICH, being underweight was associated with increased in-hospital mortality. Being underweight and obese can both increased risk of in-hospital complications compared with having normal weight.

Hypertrophic cardiomyopathy: diagnosis and assessment of symptoms

ESC CardioMed ◽  
2018 ◽  
pp. 1450-1455
Author(s):  
Albert Alain Hagège
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Exercise Testing ◽  
Imaging Modality ◽  
Functional Limitation ◽  
Cardiopulmonary Exercise Testing ◽  
Signs And Symptoms ◽  
Left Ventricular ◽  
Myocardial Segment ◽  
Apical Hypertrophy ◽  
Electrocardiogram Monitoring

The diagnosis of hypertrophic cardiomyopathy (HCM) in adults is based on the presence of left ventricular wall thickness greater than 15 mm using any imaging modality on at least one myocardial segment and not explained solely by abnormal cardiac loading conditions; a 13 mm threshold should be applied for familial screening in first-degree relatives. Diagnosis in children, in the elderly, in hypertensive individuals, and in elite athletes may be challenging. Initial evaluation should include a family pedigree, evaluation of signs and symptoms, electrocardiogram, and 48 h Holter electrocardiogram monitoring, exercise testing, imaging, and biochemistry. The presence of an intraventricular left ventricular obstruction, present in two-thirds of the patients at rest, during Valsalva or exercise, should be systematically evaluated using echocardiography. Cardiovascular magnetic resonance imaging with late gadolinium enhancement should always be considered, particularly to assess apical hypertrophy, left ventricular aneurysms, and fibrosis. This systematic approach is recommended to assist in the detection of HCM not caused by mutations in cardiac sarcomere protein genes (up to 10% of patients). Genetic tests should be performed and interpreted after a careful and complete clinical evaluation and genetic counselling. HCM is characterized by symptoms of dyspnoea, fatigue, chest pain, palpitations, and syncope, which are highly variable. Functional limitation may be difficult to evaluate and often necessitates cardiopulmonary exercise testing.

Hypertrophic cardiomyopathy: diagnosis and assessment of symptoms

ESC CardioMed ◽  
2018 ◽  
pp. 1450-1455
Author(s):  
Albert Alain Hagège
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Exercise Testing ◽  
Imaging Modality ◽  
Functional Limitation ◽  
Cardiopulmonary Exercise Testing ◽  
Signs And Symptoms ◽  
Left Ventricular ◽  
Myocardial Segment ◽  
Apical Hypertrophy ◽  
Electrocardiogram Monitoring

The diagnosis of hypertrophic cardiomyopathy (HCM) in adults is based on the presence of left ventricular wall thickness greater than 15 mm using any imaging modality on at least one myocardial segment and not explained solely by abnormal cardiac loading conditions; a 13 mm threshold should be applied for familial screening in first-degree relatives. Diagnosis in children, in the elderly, in hypertensive individuals, and in elite athletes may be challenging. Initial evaluation should include a family pedigree, evaluation of signs and symptoms, electrocardiogram, and 48 h Holter electrocardiogram monitoring, exercise testing, imaging, and biochemistry. The presence of an intraventricular left ventricular obstruction, present in two-thirds of the patients at rest, during Valsalva or exercise, should be systematically evaluated using echocardiography. Cardiovascular magnetic resonance imaging with late gadolinium enhancement should always be considered, particularly to assess apical hypertrophy, left ventricular aneurysms, and fibrosis. This systematic approach is recommended to assist in the detection of HCM not caused by mutations in cardiac sarcomere protein genes (up to 10% of patients). Genetic tests should be performed and interpreted after a careful and complete clinical evaluation and genetic counselling. HCM is characterized by symptoms of dyspnoea, fatigue, chest pain, palpitations, and syncope, which are highly variable. Functional limitation may be difficult to evaluate and often necessitates cardiopulmonary exercise testing.

scholarly journals 53 Exercise oxygen kinetic in hypertrophic cardiomyopathy: results from a multicentre cardiopulmonary exercise testing study

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Massimo Mapelli ◽  
Simona Romani ◽  
Damiano Magrì ◽  
Marco Merlo ◽  
Marco Cittar ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Hypertrophic Cardiomyopathy ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Systolic Pressure ◽  
Carbon Dioxide Production ◽  
Temporal Behaviour ◽  
Cardiopulmonary Exercise ◽  
O2 Pulse ◽  
Dynamic Relationships

Abstract Aims Reduced cardiac output (CO) has been considered crucial in symptoms’ genesis in hypertrophic cardiomyopathy (HCM). We evaluated the cardiopulmonary exercise testing (CPET) response in HCM focusing on parameters strongly associated with stroke volume (SV) and cardiac output (CO), such as oxygen uptake (VO2) and O2-pulse, considering both their absolute values and temporal behaviour during physical exercise. Methods and results We enrolled 312 non-end stage HCM patients, divided according to left ventricle outflow tract obstruction (LVOTO) at rest or during Valsalva manoeuver (72% with LVOTO &lt; 30; 10% between 30 and 49; and 18% ≥50 mmHg). Peak VO2 (percent of predicted), O2-pulse, and ventilation to carbon dioxide production (VE/VCO2) slope did not change across LVOTO groups. Ninety-six (31%) HCM patients presented an abnormal O2-pulse temporal behaviour, irrespective of LVOTO values. These patients showed lower peak systolic pressure, workload (106 ± 45 vs. 130 ± 49 W), VO2 (74 ± 17% vs. 80 ± 20%) and O2-pulse (12 [9–14] vs. 14 [11–17]ml/beat), with higher VE/VCO2 slope (28 [25–31] vs. 27 [24–31]) (P &lt; 0.005 for all). Only two patients had an abnormal VO2/work slope. Conclusions None of CPET parameters, either as absolute values or dynamic relationships, were associated with LVOTO. Differently, an abnormal O2-pulse exercise behaviour, which is strongly related to inadequate SV during exercise, correlates with reduced functional capacity (peak and anaerobic threshold VO2 and workload) and increased VE/VCO2 slope, helping identifying more advanced disease irrespectively of LVOTO. Adding O2-pulse kinetics evaluation to standard CPET could lead to a potential incremental benefit in terms of HCM prognostic stratification and, then, therapeutic management.

scholarly journals Is body mass index associated with irregular menstruation: A questionnaire study?

2020 ◽  
Author(s):  
Yunhui Tang ◽  
Yan Chen ◽  
Hua Feng ◽  
Chen Zhu ◽  
Mancy Tong ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Menstrual Cycle ◽  
Blood Loss ◽  
Body Mass ◽  
Odds Ratio ◽  
Normal Weight ◽  
Menstrual Blood ◽  
Menstrual Blood Loss ◽  
Menstrual Cycles ◽  
Significant Difference

Abstract Background: Irregular menstrual cycles including the length of cycles and menses, and heavy menstrual blood loss are linked to many gynaecological diseases. Obesity has been reported to be associated with irregular menstrual cycles. However, to date, most studies investigating this association are focused on adolescence or university students. Whether this association is also seen in adult women, especially women who had a history of birth has not been fully investigated. Methods: Questionnaire data were collected from 1012 women aged 17 to 53 years. Data on age, weight and height, gravida, the length of menstrual cycles and menses, and the number of pads used during menses were collected. Factors associated with menstrual cycle according to BMI categories were analysed.Results: There were no differences in the length of menstrual cycles and menses in women of different body mass index (BMI) groups. However, there was a significant difference in menstrual blood loss in women of different BMI categories. The odds ratio of having heavy menstrual blood loss in obese women was 2.28 (95% CL: 1.244, 4.193), compared to women with normal weight, while there was no difference in the odds ratio of having heavy menstrual blood loss in overweight, compared to normal weight, women. In contrast, the odds ratio of having heavy menstrual blood loss in underweight women was 0.4034 (95% CL: 0.224, 0.725), compared to women with normal weight. Conclusion: Although BMI was not correlated with the length of menstrual cycle and menses, BMI is positively associated with menstrual blood loss. Our data suggest that BMI influences menstrual blood loss in women of reproductive age and weight control is important in women’s reproductive years.

scholarly journals Serum Osteocalcin, P1NP, Alkaline Phosphase, and CrossLaps in Humans.The relationship with body mass index

2019 ◽  
Vol 70 (5) ◽  
pp. 1615-1618
Author(s):  
Mara Carsote ◽  
Smaranda Adelina Preda ◽  
Mihaela Mitroi ◽  
Adrian Camen ◽  
Lucretiu Radu
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Biochemical Markers ◽  
Mean Value ◽  
Normal Weight ◽  
P Value ◽  
Biochemical Bone Marker ◽  
Vitamin D Levels ◽  
Significant Difference ◽  
Coefficient Of Regression

This is a clinical study on 56 subjects included in normal weight (NW) group (N=17), overweight (OW) group (N=19) and grade I obese (O) group (N=20), based on BMI (Body Mass Index) values: NW group had a mean BMI of 22.2 � 2.14 kg/sqm, OW group had a BMI of 25.89 � 1.04 kg/sqm, and O group had an average BMI of 32.2 � 2.09 kg/sqm (p-value NW-OW, NW-O, respective OW-O groups was p[0.0005). The 3 groups were similar as age (p-value NW-OW groups = 0.7, between NW- O groups = 0.8, respective between OW - O group = 0.7). The circulating bone formation (osteocalcin, P1NP alkaline phosphatase) and resorption profile (CrossLaps) indicated no statistical significant difference between groups while the coefficient of regression r between each biochemical bone marker and BMI in every BMI group exceeded the value of p]0.05. All the 3 groups had a mean value of 25-hydroxycholecalciferol in deficiency ranges ([ 30 ng/mL, normal recommended values are above 30 ng/mL) without significant differences regarding BMI groups, except for obese group when compare to the other two groups. No secondary hyperparathyroidism was associated in any group despite low vitamin D levels. Based on our observation, bone turnover biochemical markers are not influenced by BMI.

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