Fondazione Toscana G. Monasterio, Pisa, Italy.
Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain.
Eur J Prev Cardiol. 2021 Aug 9;28(9):948-955. doi: 10.1177/2047487320927610. Epub 2020 Jun 2.
Obesity is related to better prognosis in heart failure with either reduced (HFrEF; left ventricular ejection fraction (LVEF) < 40%) or preserved LVEF (HFpEF; LVEF ≥50%). Whether the obesity paradox exists in patients with heart failure and mid-range LVEF (HFmrEF; LVEF 40-49%) and whether it is independent of heart failure aetiology is unknown. Therefore, we aimed to test the prognostic value of body mass index (BMI) in ischaemic and non-ischaemic heart failure patients across the whole spectrum of LVEF.
Consecutive ambulatory heart failure patients were enrolled in two tertiary centres in Italy and Spain and classified as HFrEF, HFmrEF or HFpEF, of either ischaemic or non-ischaemic aetiology. Patients were stratified into underweight (BMI < 18.5 kg/m2), normal-weight (BMI 18.5-24.9 kg/m2), overweight (BMI 25-29.9 kg/m2), mild-obese (BMI 30-34.9 kg/m2), moderate-obese (BMI 35-39.9 kg/m2) and severe-obese (BMI ≥40 kg/m2) and followed up for the end-point of five-year all-cause mortality.
We enrolled 5155 patients (age 70 years (60-77); 71% males; LVEF 35% (27-45); 63% HFrEF, 18% HFmrEF, 19% HFpEF). At multivariable analysis, mild obesity was independently associated with a lower risk of all-cause mortality in HFrEF (hazard ratio, 0.78 (95% confidence interval (CI) 0.64-0.95), p = 0.020), HFmrEF (hazard ratio 0.63 (95% CI 0.41-0.96), p = 0.029), and HFpEF (hazard ratio 0.60 (95% CI 0.42-0.88), p = 0.008). Both overweight and mild-to-moderate obesity were associated with better outcome in non-ischaemic heart failure, but not in ischaemic heart failure.
Mild obesity is independently associated with better survival in heart failure across the whole spectrum of LVEF. Prognostic benefit of obesity is maintained only in non-ischaemic heart failure.
肥胖与心力衰竭患者的预后改善相关，无论射血分数降低（HFrEF；左心室射血分数（LVEF）<40%）还是射血分数保留（HFpEF；LVEF≥50%）。肥胖悖论是否存在于 LVEF 处于中间范围（HFmrEF；LVEF 40-49%）的心力衰竭患者中，以及它是否独立于心力衰竭病因，目前尚不清楚。因此，我们旨在检验体质量指数（BMI）在整个 LVEF 范围内对缺血性和非缺血性心力衰竭患者的预后价值。
连续入选意大利和西班牙的两个三级中心的门诊心力衰竭患者，并分为 HFrEF、HFmrEF 或 HFpEF，病因分别为缺血性或非缺血性。患者被分为体重不足（BMI<18.5kg/m2）、正常体重（BMI 18.5-24.9kg/m2）、超重（BMI 25-29.9kg/m2）、轻度肥胖（BMI 30-34.9kg/m2）、中度肥胖（BMI 35-39.9kg/m2）和重度肥胖（BMI≥40kg/m2），并随访 5 年全因死亡率终点。
我们共纳入 5155 例患者（年龄 70 岁（60-77）；71%为男性；LVEF 35%（27-45）；63%为 HFrEF，18%为 HFmrEF，19%为 HFpEF）。多变量分析显示，轻度肥胖与 HFrEF（风险比，0.78（95%置信区间（CI）0.64-0.95），p=0.020）、HFmrEF（风险比 0.63（95%CI 0.41-0.96），p=0.029）和 HFpEF（风险比 0.60（95%CI 0.42-0.88），p=0.008）患者的全因死亡率降低独立相关。超重和轻度至中度肥胖均与非缺血性心力衰竭患者的预后改善相关，但与缺血性心力衰竭患者无关。
轻度肥胖与整个 LVEF 范围内心力衰竭患者的生存率提高独立相关。肥胖的预后获益仅在非缺血性心力衰竭中维持。
