TY - JOUR
T1 - Exercise tolerance can explain the obesity paradox in patients with systolic heart failure
T2 - Data from the MECKI Score Research Group
AU - Piepoli, Massimo F.
AU - Corra', Ugo
AU - Veglia, Fabrizio
AU - Bonomi, Alice
AU - Salvioni, Elisabetta
AU - Cattadori, Gaia
AU - Metra, Marco
AU - Lombardi, C.
AU - Sinagra, Gianfranco
AU - Limongelli, Giuseppe
AU - Raimondo, Rosa
AU - Re, Federica
AU - Magrì, Damiano
AU - Belardinelli, R.
AU - Parati, Gianfranco
AU - Minà, Chiara
AU - Scardovi, Angela Beatrice
AU - Guazzi, Marco
AU - Cicoira, Mariantonietta
AU - Scrutinio, Domenico
AU - Di Lenarda, Andrea
AU - Bussotti, Maurizio
AU - Frigerio, Maria
AU - Correale, Michele
AU - Villani, Giovanni Q.
AU - Paolillo, Stefania
AU - Passino, Claudio
AU - Agostoni, Piergiuseppe
PY - 2016/5/1
Y1 - 2016/5/1
N2 - Aims Obesity has been found to be protective in heart failure (HF), a finding leading to the concept of an obesity paradox. We hypothesized that a preserved cardiorespiratory fitness in obese HF patients may affect the relationship between survival and body mass index (BMI) and explain the obesity paradox in HF. Methods and results A total of 4623 systolic HF patients (LVEF 31.5 ± 9.5%, BMI 26.2 ± 3.6 kg/m2) were recruited and prospectively followed in 24 Italian HF centres belonging to the MECKI Score Research Group. Besides full clinical examination, patients underwent maximal cardiopulmonary exercise test at study enrolment. Median follow-up was 1113 (553-1803) days. The study population was divided according to BMI (30 to ≤35 kg/m2) and predicted peak oxygen consumption (peak VO2, 80%). Study endpoints were all-cause and cardiovascular deaths including urgent cardiac transplant. All-cause and cardiovascular deaths occurred in 951 (28.6%, 57.4 per person-years) and 802 cases (17.4%, 48.4 per 1000 person-years), respectively. In the high BMI groups, several prognostic parameters presented better values [LVEF, peak VO2, ventilation/carbon dioxide slope, renal function, and haemoglobin (P <0.01)] compared with the lower BMI groups. Both BMI and peak VO2 were significant positive predictors of longer survival: both higher BMI and peak VO2 groups showed lower mortality (P <0.001). At multivariable analysis and using a matching procedure (age, gender, LVEF, and peak VO2), the protective role of BMI disappeared. Conclusion Exercise tolerance affects the relationship between BMI and survival. Cardiorespiratory fitness mitigates the obesity paradox observed in HF patients.
AB - Aims Obesity has been found to be protective in heart failure (HF), a finding leading to the concept of an obesity paradox. We hypothesized that a preserved cardiorespiratory fitness in obese HF patients may affect the relationship between survival and body mass index (BMI) and explain the obesity paradox in HF. Methods and results A total of 4623 systolic HF patients (LVEF 31.5 ± 9.5%, BMI 26.2 ± 3.6 kg/m2) were recruited and prospectively followed in 24 Italian HF centres belonging to the MECKI Score Research Group. Besides full clinical examination, patients underwent maximal cardiopulmonary exercise test at study enrolment. Median follow-up was 1113 (553-1803) days. The study population was divided according to BMI (30 to ≤35 kg/m2) and predicted peak oxygen consumption (peak VO2, 80%). Study endpoints were all-cause and cardiovascular deaths including urgent cardiac transplant. All-cause and cardiovascular deaths occurred in 951 (28.6%, 57.4 per person-years) and 802 cases (17.4%, 48.4 per 1000 person-years), respectively. In the high BMI groups, several prognostic parameters presented better values [LVEF, peak VO2, ventilation/carbon dioxide slope, renal function, and haemoglobin (P <0.01)] compared with the lower BMI groups. Both BMI and peak VO2 were significant positive predictors of longer survival: both higher BMI and peak VO2 groups showed lower mortality (P <0.001). At multivariable analysis and using a matching procedure (age, gender, LVEF, and peak VO2), the protective role of BMI disappeared. Conclusion Exercise tolerance affects the relationship between BMI and survival. Cardiorespiratory fitness mitigates the obesity paradox observed in HF patients.
KW - Cardiopulmonary exercise testing
KW - Exercise tolerance
KW - Heart failure
KW - Matching analysis
KW - MECKI score
KW - Prognosis
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U2 - 10.1002/ejhf.534
DO - 10.1002/ejhf.534
M3 - Article
VL - 18
SP - 545
EP - 553
JO - European Journal of Heart Failure
JF - European Journal of Heart Failure
SN - 1388-9842
IS - 5
ER -