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Exercise tolerance can explain the obesity paradox in patients with systolic heart failure: data from the MECKI Score Research Group
Author(s) -
Piepoli Massimo F.,
Corrà Ugo,
Veglia Fabrizio,
Bonomi Alice,
Salvioni Elisabetta,
Cattadori Gaia,
Metra Marco,
Lombardi Carlo,
Sinagra Gianfranco,
Limongelli Giuseppe,
Raimondo Rosa,
Re Federica,
Magrì Damiano,
Belardinelli Romualdo,
Parati Gianfranco,
Minà Chiara,
Scardovi Angela B.,
Guazzi Marco,
Cicoira Mariantonietta,
Scrutinio Domenico,
Di Lenarda Andrea,
Bussotti Maurizio,
Frigerio Maria,
Correale Michele,
Villani Giovanni Quinto,
Paolillo Stefania,
Passino Claudio,
Agostoni Piergiuseppe
Publication year - 2016
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.534
Subject(s) - medicine , heart failure , obesity paradox , ejection fraction , cardiorespiratory fitness , body mass index , cardiology , obesity , population , vo2 max , heart rate , overweight , blood pressure , environmental health
Abstract 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/m 2 ) 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 (<25, 25–30, >30 to ≤35 kg/m 2 ) and predicted peak oxygen consumption (peak VO 2 , <50%, 50–80%, >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 VO 2 , ventilation/carbon dioxide slope, renal function, and haemoglobin ( P < 0.01)] compared with the lower BMI groups. Both BMI and peak VO 2 were significant positive predictors of longer survival: both higher BMI and peak VO 2 groups showed lower mortality ( P < 0.001). At multivariable analysis and using a matching procedure (age, gender, LVEF , and peak VO 2 ), 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.