PhD Scientific Days 2023

Clinical Medicine - Posters I

Obesity’s impact on short and long-term outcomes after cardiac resynchronization therapy

Text of the abstract

Introduction: Obese patients have a higher risk for heart failure (HF), however, a subset of them may have a more favorable outcome, known as the obesity paradox.
Aims: We sought to assess the association of body mass index on all-cause mortality in candidates for cardiac resynchronization therapy (CRT).
Methods: We studied retrospectively 1585 patients undergoing CRT implantation at our clinic between 2000-2020. Patients were categorized into three groups: normal weight (BMI ‹25 kg/m2) overweight (BMI 25-‹30 kg/m2) and obese (BMI ≥30 kg/m2). The composite primary endpoint was all-cause mortality, heart transplantation or implantation of a left ventricular assist device. Survival was studied by log-rank and Cox regression analysis. Our secondary and tertiary endpoints were the rate of periprocedural complications and echocardiographic response.
Results: During the follow-up time, 973 (61%) reached our primary endpoint, 302 (66%) in the BMI ‹25 kg/m2 group, 389 (61%) in the BMI 25-‹30 kg/m2 group and 282 (58%) in the BMI ≥30 kg/m2 group (p‹0.05). Obese patients showed mortality benefit over normal-weighed patients (HR 0.78; 95%CI 0.66-0.92; p=0.003). Patients with a BMI ‹25 kg/m2 showed a 19% higher risk of all-cause mortality than overweight and obese patients (HR 1.19; 95%CI 1.03-1.38; p=0.02) at multivariate analysis. The obesity paradox was not present in patients with diabetes (HR 0.85; 95% CI 0.66-1.10; p= 0.20), with atrial fibrillation (HR 0.89; 95% CI 0.77-1.11; p=0.30), in patients of ischemic etiology (HR 0.94; 95% CI 0.78-1.13; p=0.51) and in the elderly (HR 1.01; 95% CI 0.86-1.20; p=0.86).
Periprocedural complication rates did not differ in the three groups. In all patient groups, a significant improvement in LVEF at 6 months can be observed (p<0.001). No difference was seen in the proportion of developing reverse remodeling (p=0.75).
Conclusion: The obesity paradox was present in our CRT patient cohort, however, mainly patients free of comorbidities showed survival benefit with obesity. Periprocedural complications did not occur more frequently in obese or overweight patients. The echocardiographic response did not vary across the patient groups.
Funding: Project no. RRF-2.3.1-21-2022-00003 has been implemented with the support provided by the European Union.