Szepietowska Barbara, Polonsky Bronislava, Sherazi Saadia, Biton Yitschak, Kutyifa Valentina, McNitt Scott, Aktas Mehmet, Moss Arthur J, Zareba Wojciech
Heart Research Follow-up Program, Cardiology Division, University of Rochester Medical Center, 265 Crittenden Blvd., PO Box 653, Rochester, NY, 14642, USA.
Cardiovasc Diabetol. 2016 Jul 7;15:93. doi: 10.1186/s12933-016-0401-x.
Obesity is associated with multiple adverse cardiovascular conditions and may increase the risk of ventricular tachyarrhythmias (VT/VF). There is limited data on the association between obesity and risk of VT/VF requiring appropriate implantable cardioverter-defibrillator (ICD) therapies and the effectiveness of cardiac resynchronization therapy (CRT) to reduce risk for VT/VF. The multicenter automatic defibrillator implantation trial with cardiac resynchronization therapy (MADIT-CRT) was design to investigate effectiveness of CRT therapy to reduce cardiovascular outcome for patients with heart failure (HF) and reduced ejection fraction.
We identified patients enrolled in the MADIT CRT trial as obese (n = 433) and non-obese (n = 845) and analyzed their risk for appropriate device therapy for VT/VF, repeated VT/VF events, fast VT/VF, as well as events after first VT/VF episodes. Obesity was defined as body mass index (BMI) ≥30 kg/m(2). Among ICD patients, the risk of first appropriate ICD therapy for VT/VF at 3 years was similar between obese and non-obese patients (23 vs. 21 %, p = 0.76). CRT-D treatment reduced the risk of first appropriate ICD therapy both in non-obese ([HR]; 0.58 [CI]: 0.42-0.79; p < 0.001) and obese patients (HR 0.75, 95 % CI 0.5-1.38; p = 0.179) (interaction p value 0.323). Similarly, a significant reduction in the risk of fast VT/VF was observed in non-obese patients ([HR]; 0.49 [CI]: 0.33-0.73; p < 0.001) and obese ([HR]; 0.49 [CI]: 0.29-0.81; p < 0.01), (interaction p value 0.984).
Obese and non-obese patients with mild heart failure have a similar risk of ventricular tachyarrhythmias. Obesity in mild heart failure did not diminish the clinical benefit of cardiac resynchronization therapy to reduce risk for appropriate ICD therapy. Clinical trial registration http://clinicaltrials.gov/ct2/show/NCT00180271.
肥胖与多种不良心血管状况相关，可能增加室性快速心律失常（VT/VF）的风险。关于肥胖与需要适当植入式心脏复律除颤器（ICD）治疗的VT/VF风险之间的关联以及心脏再同步治疗（CRT）降低VT/VF风险的有效性的数据有限。多中心心脏再同步治疗自动除颤器植入试验（MADIT-CRT）旨在研究CRT治疗对心力衰竭（HF）且射血分数降低患者心血管结局的有效性。
我们将参加MADIT CRT试验的患者分为肥胖组（n = 433）和非肥胖组（n = 845），并分析他们接受VT/VF适当器械治疗的风险、反复发生的VT/VF事件、快速VT/VF以及首次VT/VF发作后的事件。肥胖定义为体重指数（BMI）≥30 kg/m²。在ICD患者中，肥胖和非肥胖患者在3年时首次接受VT/VF适当ICD治疗的风险相似（23%对21%，p = 0.76）。CRT-D治疗在非肥胖患者（[风险比（HR）]；0.58 [可信区间（CI）]：0.42 - 0.79；p < 0.001）和肥胖患者（HR 0.75，95% CI 0.5 - 1.38；p = 0.179）中均降低了首次接受适当ICD治疗的风险（交互p值0.323）。同样，在非肥胖患者（[HR]；0.49 [CI]：0.33 - 0.73；p < 0.001）和肥胖患者（[HR]；0.49 [CI]：0.29 - 0.81；p < 0.01）中观察到快速VT/VF风险显著降低（交互p值0.984）。
轻度心力衰竭的肥胖和非肥胖患者发生室性快速心律失常的风险相似。轻度心力衰竭患者的肥胖并未削弱心脏再同步治疗降低适当ICD治疗风险的临床益处。临床试验注册：http://clinicaltrials.gov/ct2/show/NCT00180271 。
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