Arena Ross, Myers Jonathan, Abella Joshua, Pinkstaff Sherry, Brubaker Peter, Moore Brian, Kitzman Dalane, Peberdy Mary Ann, Bensimhon Daniel, Chase Paul, Forman Daniel, West Erin, Guazzi Marco
Department of Physical Therapy, Virginia Commonwealth University, Richmond, Virginia, USA.
Am J Cardiol. 2009 Oct 15;104(8):1116-21. doi: 10.1016/j.amjcard.2009.05.059. Epub 2009 Aug 28.
Several investigations have demonstrated that higher body weight, as assessed by the body mass index, is associated with improved prognosis in patients with heart failure (HF). The purpose of the present investigation was to assess the influence of HF etiology on the prognostic ability of the body mass index in a cohort undergoing cardiopulmonary exercise testing. A total of 1,160 subjects were included in the analysis. All subjects underwent cardiopulmonary exercise testing, at which the minute ventilation/carbon dioxide production slope and peak oxygen consumption were determined. In the overall group, 193 cardiac deaths occurred during a mean follow-up of 30.7 +/- 25.6 months (annual event rate 6.0%). The subjects classified as obese consistently had improved survival compared to those classified as normal weight (overall survival rate 88.0% vs <or=81.1%, p <0.001). Differences in survival according to HF etiology were observed for those classified as overweight. In the ischemic subgroup, the survival characteristics for the overweight subjects (75.5%) were similar those for subjects classified as normal weight (81.1%). The converse was true for the nonischemic subgroup, for whom the survival trends for the obese (86.4%) and overweight subjects (88.4%) were similar. The minute ventilation/carbon dioxide production slope was the strongest prognostic marker (chi-square >or=43.4, p <0.001) for both etiologies, and the body mass index added prognostic value (residual chi-square >or=4.7, p <0.05). In conclusion, these results further support the notion that obesity confers improved prognosis in patients with HF, irrespective of the HF etiology. Moreover, the body mass index appears to add predictive value during the cardiopulmonary exercise testing assessment. However, survival appears to differ according to HF etiology in subjects classified as overweight.
多项研究表明，通过体重指数评估的较高体重与心力衰竭（HF）患者预后改善相关。本研究的目的是评估HF病因对接受心肺运动试验的队列中体重指数预后能力的影响。分析共纳入1160名受试者。所有受试者均接受了心肺运动试验，测定了每分通气量/二氧化碳产生斜率和峰值耗氧量。在整个队列中，平均随访30.7±25.6个月期间发生了193例心源性死亡（年事件发生率6.0%）。与体重正常者相比，被归类为肥胖的受试者生存率持续改善（总生存率88.0%对≤81.1%，p<0.001）。超重者中观察到根据HF病因的生存差异。在缺血性亚组中，超重受试者（75.5%）的生存特征与体重正常受试者（81.1%）相似。非缺血性亚组情况相反，肥胖（86.4%）和超重受试者（88.4%）的生存趋势相似。每分通气量/二氧化碳产生斜率是两种病因最强的预后标志物（卡方≥43.4，p<0.001），体重指数增加了预后价值（残差卡方≥4.7，p<0.05）。总之，这些结果进一步支持了肥胖可改善HF患者预后这一观点，无论HF病因如何。此外，在心肺运动试验评估期间，体重指数似乎增加了预测价值。然而，超重受试者的生存情况似乎因HF病因不同而有所差异。
