Indexed on: 11 Oct '16Published on: 15 Sep '16Published in: The American Journal of Cardiology®
Obesity confers a paradoxical survival benefit among patients with heart failure (HF), but this obesity paradox has not been well established in patients undergoing cardiac resynchronization therapy with a defibrillator (CRT-D). We sought to determine the impact of body mass index (BMI) on long-term survival in patients with HF following CRT-D. We identified 113 patients implanted with CRT-D at our institution from 5/2002-11/2003. Patients were divided into three categories by pre-implant BMI (kg/m2): normal-weight (BMI <25), overweight (BMI 25–29), and obese (BMI ≥30). Ten-year survival free from orthotopic heart transplant (OHT) or ventricular assist device (VAD) implantation was analyzed with Kaplan-Meier plots, the log-rank test and Cox proportional hazards modeling. Thirty-three patients (29%) were normal-weight, 47(42%) were overweight, and 33(29%) were obese. Median follow-up time was 4.5 years (IQR 1.9–8.7 years). Obese patients were younger and had a higher proportion of women (both p<0.05). Ten-year survival free of OHT or VAD was highest in obese patients (36.3%) followed by overweight (19.2%) and then normal-weight (12.1%) patients, log-rank p-trend=0.004. After adjustment for clinical risk factors, every 1 kg/m2 increase in BMI was associated with a 8% reduction in the risk of the primary endpoint (adj-HR 0.92, 95%CI:0.88-0.97, p=0.002). In conclusion, higher BMI is associated with improved long-term survival after CRT-D.