Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, NIHR Cardiovascular and Respiratory Biomedical Research Unit, Royal Brompton Hospital, London, UK.
Department of Cardiovascular Medicine, Division of Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany.
Heart. 2017 Aug;103(16):1250-1257. doi: 10.1136/heartjnl-2016-310571. Epub 2017 Feb 25.
Abnormal body mass index (BMI) is associated with higher mortality in various cardiovascular cohorts. The prognostic implications of BMI in adults with congenital heart disease (ACHD) are unknown. We aim to assess the distribution of BMI and its association with symptoms and survival in the ACHD population.
We included 3069 ACHD patients (median age 32.6 years) under follow-up at our institution between 2001 and 2015. Patients were classified based on BMI as underweight (<18.5), normal weight (18.5-25), overweight (25-30) or obese (>30), and symptoms, exercise capacity and mortality were assessed.
Overall, 6.2% of patients were underweight, 51.1% had normal weight, 28.2% were overweight and 14.6% were obese. Higher BMI values were associated with lower all-cause and cardiac mortality on univariable Cox analysis, and this effect persisted after adjustment for age, defect complexity, cyanosis and objective exercise capacity. Higher BMI was especially associated with better prognosis in symptomatic ACHD patients (HR 0.94 (95% CI 0.90 to 0.98), p=0.002) and those with complex underlying cardiac defects (HR 0.96 (95% CI 0.91 to 0.997), p=0.048) In patients with a complex cardiac defect who had repeated weight measurements, weight loss was also associated with a worse survival (HR 1.82 (95% CI 1.02 to 3.24), p=0.04).
ACHD patients with a higher BMI had a lower mortality. The association between BMI and mortality was especially pronounced in symptomatic patients with complex underlying cardiac defects, suggesting that cardiac cachexia may play a role. Indeed, weight loss in complex ACHD patients was linked to an even higher mortality.
异常体重指数（BMI）与各种心血管队列的死亡率升高有关。成人先天性心脏病（ACHD）患者的 BMI 的预后意义尚不清楚。我们旨在评估 BMI 在 ACHD 人群中的分布及其与症状和生存的关系。
我们纳入了 2001 年至 2015 年期间在我们机构接受随访的 3069 名 ACHD 患者（中位年龄 32.6 岁）。根据 BMI 将患者分为消瘦（<18.5）、正常体重（18.5-25）、超重（25-30）或肥胖（>30），评估症状、运动能力和死亡率。
总体而言，6.2%的患者消瘦，51.1%体重正常，28.2%超重，14.6%肥胖。单变量 Cox 分析显示，BMI 值越高，全因和心脏死亡率越低，这种影响在调整年龄、缺陷复杂性、发绀和客观运动能力后仍然存在。较高的 BMI 与有症状的 ACHD 患者（HR 0.94（95%CI 0.90 至 0.98），p=0.002）和存在复杂基础心脏缺陷的患者（HR 0.96（95%CI 0.91 至 0.997），p=0.048）的预后更好相关。在有重复体重测量的复杂心脏缺陷患者中，体重减轻也与生存率降低相关（HR 1.82（95%CI 1.02 至 3.24），p=0.04）。
BMI 较高的 ACHD 患者死亡率较低。BMI 与死亡率之间的关联在有症状的、存在复杂基础心脏缺陷的患者中更为明显，这表明心脏恶病质可能起作用。事实上，复杂 ACHD 患者的体重减轻与更高的死亡率相关。
