Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
J Am Coll Cardiol. 2013 Jul 30;62(5):449-57. doi: 10.1016/j.jacc.2013.03.062. Epub 2013 Apr 30.
This study sought to assess the impact of body mass index (BMI) on cardiac phenotypic and clinical course in a multicenter hypertrophic cardiomyopathy (HCM) cohort.
It is unresolved whether clinical variables promoting left ventricular (LV) hypertrophy in the general population, such as obesity, may influence cardiac phenotypic and clinical course in patients with HCM.
In 275 adult HCM patients (age 48 ± 14 years; 70% male), we assessed the relation of BMI to LV mass, determined by cardiovascular magnetic resonance (CMR) and heart failure progression.
At multivariate analysis, BMI proved independently associated with the magnitude of hypertrophy: pre-obese and obese HCM patients (BMI 25 to 30 kg/m(2) and >30 kg/m(2), respectively) showed a 65% and 310% increased likelihood of an LV mass in the highest quartile (>120 g/m(2)), compared with normal weight patients (BMI <25 kg/m(2); hazard ratio [HR]: 1.65; 95% confidence interval [CI]: 0.73 to 3.74, p = 0.22 and 3.1; 95% CI: 1.42 to 6.86, p = 0.004, respectively). Other features associated with LV mass >120 g/m(2) were LV outflow obstruction (HR: 4.9; 95% CI: 2.4 to 9.8; p < 0.001), systemic hypertension (HR: 2.2; 95% CI: 1.1 to 4.5; p = 0.026), and male sex (HR: 2.1; 95% CI: 0.9 to 4.7; p = 0.083). During a median follow-up of 3.7 years (interquartile range: 2.5 to 5.3), obese patients showed an HR of 3.6 (95% CI: 1.2 to 10.7, p = 0.02) for developing New York Heart Association (NYHA) functional class III to IV symptoms compared to nonobese patients, independent of outflow obstruction. Noticeably, the proportion of patients in NYHA functional class III at the end of follow-up was 13% among obese patients, compared with 6% among those of normal weight (p = 0.03).
In HCM patients, extrinsic factors such as obesity are independently associated with increase in LV mass and may dictate progression of heart failure symptoms.
本研究旨在评估体重指数（BMI）对多中心肥厚型心肌病（HCM）队列中心脏表型和临床过程的影响。
在一般人群中，促进左心室（LV）肥大的临床变量，如肥胖，是否会影响 HCM 患者的心脏表型和临床过程仍未得到解决。
在 275 名成年 HCM 患者（年龄 48 ± 14 岁；70%为男性）中，我们评估了 BMI 与心血管磁共振（CMR）确定的 LV 质量之间的关系，并评估了心力衰竭进展情况。
多变量分析显示，BMI 与肥大程度独立相关：与体重正常的患者（BMI <25 kg/m²）相比，超重和肥胖的 HCM 患者（BMI 为 25 至 30 kg/m² 和 >30 kg/m²）LV 质量处于最高四分位数（>120 g/m²）的可能性分别增加了 65%和 310%（危险比 [HR]：1.65；95%置信区间 [CI]：0.73 至 3.74，p = 0.22 和 3.1；95%CI：1.42 至 6.86，p = 0.004）。与 LV 质量>120 g/m²相关的其他特征包括 LV 流出道梗阻（HR：4.9；95%CI：2.4 至 9.8；p < 0.001）、高血压（HR：2.2；95%CI：1.1 至 4.5；p = 0.026）和男性（HR：2.1；95%CI：0.9 至 4.7；p = 0.083）。在中位随访 3.7 年（四分位间距：2.5 至 5.3）期间，与非肥胖患者相比，肥胖患者发生纽约心脏协会（NYHA）功能分级 III 至 IV 症状的 HR 为 3.6（95%CI：1.2 至 10.7，p = 0.02），这与流出道梗阻无关。值得注意的是，肥胖患者在随访结束时 NYHA 功能分级 III 的比例为 13%，而体重正常的患者为 6%（p = 0.03）。
在 HCM 患者中，肥胖等外在因素与 LV 质量增加独立相关，并可能决定心力衰竭症状的进展。
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