Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Eur J Heart Fail. 2019 Sep;21(9):1093-1102. doi: 10.1002/ejhf.1552. Epub 2019 Jul 29.
To assess the association of body mass index (BMI) with heart failure (HF) outcomes after cardiac resynchronization therapy with defibrillator (CRT-D) implantation.
Medicare beneficiaries with HF aged ≥ 65 years (n = 18 922) undergoing first-time CRT-D from the National Cardiovascular Data Registry (NCDR) Implantable Cardioverter-Defibrillator Registry between 2010 and 2013, were followed for 3 years post-implantation. Survival curves and covariate adjusted hazard ratio (aHR) or odds ratio were used to assess the risks for death, readmission, and device-related complications by BMI status. Of 18 922 HF patients receiving CRT-D, 5265 (27.8%) were normal weight, 6896 (37%) were overweight, 6318 (33.4%) were obese, and 353 (1.8%) were underweight. Compared to those of normal weight (BMI 18.5-24.9 kg/m ), underweight patients had a higher 3-year post-device implantation risk of death [aHR: 1.34 (95% confidence interval 1.09-1.65); P < 0.001] and of readmission [sub-aHR: 1.25 (1.09-1.42); P < 0.001]. The corresponding 3-year aHRs for death were 0.83 (0.77-0.89) for overweight, 0.74 (0.67-0.82) for obesity class I (BMI 30-34.9 kg/m ), 0.78 (0.68-0.90) for obesity class II (BMI 35-39.9 kg/m ), and 0.75 (0.60-0.93) for obesity class III (BMI ≥ 40 kg/m , P for all categories < 0.001). Individuals with class III obesity had a higher risk of readmission [sub-aHR: 1.17 (1.06-1.30)]. There were no differences in rates of device-related complications within 90 days across BMI categories.
Most elderly patients with HF receiving CRT-D were overweight or obese. While being underweight was associated with greater risks of death and hospitalization, overweight and obese patients were at lower risk of death after CRT-D.
评估体重指数（BMI）与心脏再同步治疗除颤器（CRT-D）植入后心力衰竭（HF）结局的相关性。
从 2010 年至 2013 年，国家心血管数据登记处（NCDR）植入式心脏复律除颤器登记处中年龄≥65 岁的首次接受 CRT-D 的 HF 医疗保险受益患者（n=18922）进行了 3 年的随访。使用生存曲线和调整后的风险比（aHR）或优势比评估 BMI 状态下的死亡、再入院和与设备相关的并发症风险。在接受 CRT-D 的 18922 例 HF 患者中，5265 例（27.8%）为正常体重，6896 例（37%）为超重，6318 例（33.4%）为肥胖，353 例（1.8%）为体重不足。与正常体重（BMI 18.5-24.9kg/m2）相比，体重不足的患者在装置植入后 3 年内死亡风险更高[aHR：1.34（95%置信区间 1.09-1.65）；P<0.001]和再入院风险更高[亚 aHR：1.25（1.09-1.42）；P<0.001]。超重患者的相应 3 年 aHR 为 0.83（0.77-0.89），肥胖 I 级（BMI 30-34.9kg/m2）为 0.74（0.67-0.82），肥胖 II 级（BMI 35-39.9kg/m2）为 0.78（0.68-0.90），肥胖 III 级（BMI≥40kg/m2）为 0.75（0.60-0.93）（所有类别 P<0.001）。III 级肥胖患者的再入院风险更高[aHR：1.17（1.06-1.30）]。在 90 天内，BMI 类别之间的器械相关并发症发生率没有差异。
大多数接受 CRT-D 的老年 HF 患者超重或肥胖。虽然体重不足与死亡和住院风险增加相关，但超重和肥胖患者在 CRT-D 后死亡风险较低。
