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A. Basics
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01. History of Cardiology
02. Clinical Skills
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05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
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32. Cardiovascular Nursing
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Impact of cardiorespiratory fitness in the obesity paradox in heart failure with reduced ejection fraction
Session:
CO 07 - IC -Prognóstico
Speaker:
Rita Loreto Ilhão Moreira
Congress:
CPC 2018
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Rita Ilhão Moreira; Tiago Pereira Da Silva; António Valentim Gonçalves; João Pedro Reis; Tânia Branco Mano; Tiago Mendonça; Madalena Coutinho Cruz; Luís Almeida Morais; Dra. Inês Rodrigues; Pedro Modas Daniel; Pedro Rio; Joana Gomes Feliciano; Ana Abreu; Rui M. Soares; Rui Cruz Ferreira
Abstract
<p><strong>Aims: </strong>High body mass index (BMI) is associated with improved outcomes in heart failure with reduced ejection fraction, a finding leading to the concept of an obesity paradox. We aim at investigating the impact of exercise tolerance and cardiorespiratory capacity on the obesity paradox.</p> <p><strong>Methods</strong><strong>:</strong> Ambulatory patients with symptomatic heart failure and left ventricular ejection fraction ≤40%, followed in our center, prospectively underwent a baseline comprehensive evaluation including clinical, laboratorial, electrocardiographic, echocardiographic, and cardiopulmonary exercise testing parameters. Peak VO2 (pVO2) was normalized for body mass and in obese patients adjusted to lean body mass. The study population was divided according to BMI (<25, 25–30, >30 kg/m<sup>2</sup>). A sub-analysis of patients of the BMI <25 kg/m<sup>2</sup> group, differentiating BMI <20 and 20-25 kg/m<sup>2</sup> was also performed. All patients were followed for 60 months and the combined endpoint was defined as cardiac death, urgent heart transplantation or need for mechanical circulatory support.</p> <p><strong>Results:</strong> In the 263 enrolled patients (75% male, 54 ±12 years, LVEF 28±7%, BMI 27±4 kg/m<sup>2</sup>), 74 events occurred. Patients with higher BMI had better LVEF (p 0.003), percentage of predicted pVO2 (p<0.001), ventilation equivalent of carbon dioxide (VE/VCO2) slope (p 0.006), serum sodium concentration (p 0.021) and Heart Failure Survival Score (p 0.046) compared with the lower BMI groups. At univariable analysis, both BMI, pVO2 and VE/VCO2 slope were significant predictors of outcome (HR 0.940, 95% CI 0.886-0.998, p 0.042; HR 0.791, 95% CI 0.742-0.842, p <0.001 and HR 1.164, 95% CI 1.135-1.194, p<0.001, respectively). In the sub-analysis of patients with BMI < 25 kg/m<sup>2</sup>, very low BMI was associated with worse outcomes (log-rank p 0.014). At multivariable Cox regression analysis adjusting for pVO2 or for VE/VCO2 slope, the protective role of BMI disappeared (p 0.101 and p 0.786, respectively).</p> <p><strong>Conclusion:</strong> These results suggest that exercise tolerance affects the relationship between BMI and survival. Thus, cardiorespiratory fitness may mitigate the obesity paradox in heart failure patients.</p>
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