1
|
Impact of Body Mass Index on Mortality in Hospitalized Patients With Hypertrophic Cardiomyopathy. Am J Cardiol 2022; 175:106-109. [PMID: 35595554 DOI: 10.1016/j.amjcard.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 03/30/2022] [Accepted: 04/01/2022] [Indexed: 11/21/2022]
Abstract
Although obesity is associated with increased phenotypic expression in patients with hypertrophic cardiomyopathy (HC), the effect of body mass index (BMI) on in-hospital mortality in hospitalized patients with HC has not been established. We evaluated the National Inpatient Sample in the United States to identify all adults with HC hospitalized for cardiac illnesses between 2008 and 2017. Using International Classification of Diseases codes, the study cohort was stratified into underweight (BMI ≤19.9 kg/m2), normal weight (BMI 20.0 to 24.9 kg/m2), overweight (BMI 25.0 to 29.9 kg/m2), class I (BMI 30.0 to 34.9 kg/m2), class II (BMI 35.0 to 39.9 kg/m2), and class III (BMI ≥40.0 kg/m2) obesity. Multiple logistic regression analysis was used to analyze the independent association of various BMI categories and mortality. The study included a total of 2,392,325 hospitalizations (mean age-66.1 ± 12.2 years; 42.0% female). The patients with class III obesity (adjusted mortality rate [AMR] 3.3%, adjusted odds ratio [AOR] 1.53, 95% confidence interval [CI] 1.29 to 1.82, p <0.001) and underweight patients (AMR 4.4%, AOR 2.07, 95% CI 1.74-2.46, p <0.001) had higher in-hospital mortality whereas overweight patients (AMR 1.6%, AOR 0.26, 95% CI 0.19 to 0.34, p <0.001), patients with class I obesity (AMR 0.8%, AOR 0.35, 95% CI 0.27 to 0.45, p <0.001) and patients with class II obesity (AMR 0.8%, AOR 0.34, 95% CI 0.26 to 0.45, p <0.001) had lower mortality compared with patients with normal BMI (AMR 2.9%). In conclusion, BMI has a nonlinear U-shaped relation with in-hospital mortality in patients with HC. The patients who were underweight and morbidly obese had significantly higher mortality, whereas those patients with overweight, class I, and class II obesity had lower mortality than normal BMI.
Collapse
|
2
|
Elbaz-Greener G, Rozen G, Carasso S, Yarkoni M, Wijeysundera HC, Alcalai R, Gotsman I, Rahamim E, Planer D, Amir O. The Relationship Between Body Mass Index and In-hospital Survival in Patients Admitted With Acute Heart Failure. Front Cardiovasc Med 2022; 9:855525. [PMID: 35571201 PMCID: PMC9097269 DOI: 10.3389/fcvm.2022.855525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 03/22/2022] [Indexed: 11/23/2022] Open
Abstract
Background The association between Body Mass Index (BMI) and clinical outcomes following acute heart failure (AHF) hospitalization is debated in the literature. Our objective was to study the real-world relationship between BMI and in-hospital mortality in patients who were admitted with AHF. Methods In this retrospective, multi-center study, we utilized the National Inpatient Sample (NIS) database to identify a sampled cohort of patients who were hospitalized with AHF between October 2015 and December 2016. Outcomes of interest included in-hospital mortality and length of stay (LOS). Patients were divided into 6 BMI (kg/m2) subgroups according to the World Health Organization (WHO) classification: (1) underweight ≤ 19, (2) normal weight 20–25, (3) overweight 26–30, (4) obese I 31–35, (5) obese II 36–39, and (6) extremely obese ≥40. A multivariable logistic regression model was used to identify predictors of in-hospital mortality and to identify predictors of LOS. Results A weighted total of 219,950 hospitalizations for AHF across the US were analyzed. The mean age was 66.3 ± 31.5 years and most patients (51.8%) were male. The crude data showed a non-linear complex relationship between BMI and AHF population outcomes. Patients with elevated BMI exhibited significantly lower in-hospital mortality compared to the underweight and normal weight study participants (5.5, 5,5, 2,8, 1.6, 1.4, 1.6% in groups by BMI ≤ 19, 20–25, 26–30, 31–35, 36–39, and, ≥40 respectively, p < 0.001) and shorter LOS. In the multivariable regression model, BMI subgroups of ≤ 25kg/m2 were found to be independent predictors of in-hospital mortality. Age and several comorbidities, and also the Deyo Comorbidity Index, were found to be independent predictors of increased mortality in the study population. Conclusion A reverse J-shaped relationship between BMI and mortality was documented in patients hospitalized for AHF in the recent years confirming the “obesity paradox” in the real-world setting.
Collapse
Affiliation(s)
- Gabby Elbaz-Greener
- Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- *Correspondence: Gabby Elbaz-Greener
| | - Guy Rozen
- Cardiology Division, Hillel Yaffe Medical Center, Hadera, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
- Cardiology Division, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
| | - Shemy Carasso
- Division of Cardiovascular Medicine, Baruch Padeh Medical Center, Poriya, Israel
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Merav Yarkoni
- Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Harindra C. Wijeysundera
- Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Ronny Alcalai
- Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Israel Gotsman
- Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eldad Rahamim
- Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - David Planer
- Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Offer Amir
- Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| |
Collapse
|
3
|
Kobayashi M, Voors AA, Ouwerkerk W, Duarte K, Girerd N, Rossignol P, Metra M, Lang CC, Ng LL, Filippatos G, Dickstein K, van Veldhuisen DJ, Zannad F, Ferreira JP. Perceived risk profile and treatment optimization in heart failure: an analysis from BIOlogy Study to TAilored Treatment in chronic heart failure. Clin Cardiol 2021; 44:780-788. [PMID: 33960439 PMCID: PMC8207977 DOI: 10.1002/clc.23576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/07/2021] [Accepted: 02/08/2021] [Indexed: 12/21/2022] Open
Abstract
Background Achieving target doses of angiotensin‐converting‐enzyme inhibitor/angiotensin‐receptor blockers (ACEi/ARB) and beta‐blockers in heart failure with reduced ejection fraction (HFrEF) is often underperformed. In BIOlogy Study to TAilored Treatment in chronic heart failure (BIOSTAT‐CHF) study, many patients were not up‐titrated for which no clear reason was reported. Therefore, we hypothesized that perceived‐risk profile might influence treatment optimization. Methods We studied 2100 patients with HFrEF (LVEF≤40%) to compare the clinical characteristics and adverse events associated with treatment up‐titration (after a 3‐month titration protocol) between; a) patients not reaching target doses for unclear reason; b) patients not reaching target doses due to symptoms and/or side effects; c) patients reaching target doses. Results For ACEi/ARB, (a), (b) and (c) was observed in 51.3%, 25.9% and 22.7% of patients, respectively. For beta‐blockers, (a), (b) and (c) was observed in 67.5%, 20.2% and 12.3% of patients, respectively. By multinomial logistic regression analysis for ACEi/ARB, patients in group (a) and (b) had lower blood pressure and poorer renal function, and patients in group (a) were older and had lower ejection fraction. For beta‐blockers, patients in group (a) and (b) had more severe congestion and lower heart rate. At 9 months, adverse events (i.e., hypotension, bradycardia, renal impairment, and hyperkalemia) occurred similarly among the three groups. Conclusions Patients in whom clinicians did not give a reason why up‐titration was missed were older and had more co‐morbidities. Patients in whom up‐titration was achieved did not have excess adverse events. However, from these observational findings, the pattern of subsequent adverse events among patients in whom up‐titration was missed cannot be determined.
Collapse
Affiliation(s)
- Masatake Kobayashi
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
| | - Adriaan A Voors
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Wouter Ouwerkerk
- National Heart Centre Singapore, Hospital Drive, Singapore.,Department of Dermatology, Amsterdam UMC, Amsterdam Infection & Immunity Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Kevin Duarte
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
| | - Nicolas Girerd
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
| | - Patrick Rossignol
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
| | - Marco Metra
- Cardiology. University and Civil hospitals of Brescia, Brescia, Italy
| | - Chim C Lang
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - Leong L Ng
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | | | - Kenneth Dickstein
- Department of Internal Medicine, University of Bergen, Bergen, Norway.,Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Dirk J van Veldhuisen
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Faiez Zannad
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
| | - João Pedro Ferreira
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
| |
Collapse
|
4
|
Krishnan A, Bigelow B, Hsu S, Gilotra NA, Sharma K, Choi CW, Kilic A. Decreased Nutritional Risk Index is associated with mortality after heart transplantation. Clin Transplant 2021; 35:e14253. [PMID: 33576056 DOI: 10.1111/ctr.14253] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Validated scoring tools, such as the Nutritional Risk Index (NRI), can aid clinicians in quantifying the degree of malnourishment in patients prior to an operation. We evaluated the association between NRI and outcomes after heart transplantation. METHODS The United Network for Organ Sharing (UNOS) database was used to identify adult patients (age > 18) undergoing heart transplantation between 1987 and 2016. NRI was calculated and categorized into previously established groupings representing severity of malnutrition. Multivariate Cox proportional hazards modeling were used to assess the primary outcome of all-cause mortality. RESULTS A total of 25,236 patients were included in the analysis. Most patients (75.4%) were male. Malnourishment was absent (NRI ≥ 100) in 11,022 (44%) patients, while 2,898 (12%) were mildly malnourished (97.5 ≤ NRI < 100), 8,685 (34%) were moderately malnourished (83.5 ≤ NRI < 97.5), and 2,631 (10%) were severely malnourished (NRI < 83.5). Moderate-to-severe malnutrition was associated with increased mortality (HR = 1.18, p < .001, 95%CI: 1.13-1.24), and post-transplant renal failure requiring dialysis (OR: 1.13, p < .001, 95%CI: 1.03-1.23). CONCLUSION Malnourishment determined by NRI is independently associated with mortality and post-transplant dialysis after heart transplant. This is the largest study of NRI in heart transplant recipients.
Collapse
Affiliation(s)
- Aravind Krishnan
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Benjamin Bigelow
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Steven Hsu
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nisha A Gilotra
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kavita Sharma
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chun Woo Choi
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ahmet Kilic
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
5
|
Seo M, Yamada T, Tamaki S, Morita T, Furukawa Y, Iwasaki Y, Kawasaki M, Kikuchi A, Kawai T, Abe M, Nakamura J, Yamamoto K, Kayama K, Kawahira M, Tanabe K, Kimura T, Ueda K, Sakamoto D, Sakata Y, Fukunami M. Prognostic significance of serum cholinesterase in patients with acute decompensated heart failure: a prospective comparative study with other nutritional indices. Am J Clin Nutr 2019; 110:330-339. [PMID: 31161211 DOI: 10.1093/ajcn/nqz103] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 05/01/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Nutritional status is associated with poor outcomes in patients with heart failure. Serum cholinesterase (CHE) concentration, a marker of malnutrition, was reported to be a prognostic factor in patients with chronic heart failure. The geriatric nutritional risk index (GNRI), the controlling nutritional status (CONUT) score, and the prognostic nutritional index (PNI) are established objective nutritional indices. OBJECTIVE The aim of this study was to clarify the prognostic significance of CHE concentration and to compare it with other well-established objective nutritional indices in patients with acute decompensated heart failure (ADHF). METHODS We prospectively enrolled 371 consecutive patients admitted for ADHF with survival discharge. Laboratory data including CHE and the objective nutritional indices were obtained at discharge. The primary endpoint of this study was all-cause mortality. RESULTS During a mean ± SD follow-up period of 2.5 ± 1.4 y, 112 patients died. CHE concentration was significantly associated with all-cause mortality independently of GNRI, CONUT score, or PNI, after adjustment for major confounders including other nutritional indices, such as age, sex, systolic blood pressure, BMI, left ventricular ejection fraction, history of hypertension, diabetes mellitus, dyslipidemia, prior heart failure hospitalization, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use, β-blocker use, statin use, hemoglobin, sodium, blood urea nitrogen, albumin, C-reactive protein, and brain natriuretic peptide concentrations via multivariable Cox analysis. Kaplan-Meier analysis revealed that the risk of all-cause mortality significantly increased in accordance with CHE stratum [lowest tertile: 53%, adjusted HR: 6.92; 95% CI: 3.87, 12.36, compared with middle tertile: 28%, adjusted HR: 2.72; 95% CI: 1.45, 5.11, compared with highest tertile: 11%, adjusted HR: 1.0 (reference), P < 0.0001]. CHE showed the best area under the curve value (0.745) for the prediction of all-cause mortality compared with the other objective nutritional indices. Net reclassification improvement afforded by adding CHE to the fully adjusted multivariable model was statistically significant for all-cause mortality (0.330; 95% CI: 0.112, 0.549, P = 0.0030). CONCLUSION CHE is a simple, strong prognostic marker for the prediction of all-cause mortality in patients with ADHF.
Collapse
Affiliation(s)
- Masahiro Seo
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Takahisa Yamada
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Shunsuke Tamaki
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Takashi Morita
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Yoshio Furukawa
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Yusuke Iwasaki
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Masato Kawasaki
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Atsushi Kikuchi
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Tsutomu Kawai
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Makoto Abe
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Jun Nakamura
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Kyoko Yamamoto
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Kiyomi Kayama
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | | | - Kazuya Tanabe
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Takanari Kimura
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Kunpei Ueda
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Daisuke Sakamoto
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Yasushi Sakata
- Division of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | | |
Collapse
|
6
|
Uribarri A, Rojas SV, Hanke JS, Dogan G, Siemeni T, Kaufeld T, Ius F, Goecke T, Rojas-Hernandez S, Warnecke G, Bara C, Avsar M, Haverich A. Valor pronóstico del índice de riesgo nutricional para los candidatos a implante de un dispositivo de asistencia ventricular izquierda de flujo continuo. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.05.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
7
|
Nutritional risk index predicts survival in patients undergoing transcatheter aortic valve replacement. Int J Cardiol 2019; 276:66-71. [DOI: 10.1016/j.ijcard.2018.11.097] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/12/2018] [Accepted: 11/15/2018] [Indexed: 11/21/2022]
|
8
|
Agra-Bermejo R, Eiras S, Varela-Román A. Body composition in acute heart failure patients: Relationship with gender and left ventricular ejection fraction. Med Clin (Barc) 2018; 151:291-292. [PMID: 29402436 DOI: 10.1016/j.medcli.2017.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/06/2017] [Accepted: 12/14/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Rosa Agra-Bermejo
- Servicio de Cardiología y Unidad Coronaria, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Santiago de Compostela, A Coruña, Spain; CIBER de Enfermedades Cardiovasculares, Spain.
| | - Sonia Eiras
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), SERGAS, Santiago de Compostela, A Coruña, Spain; CIBER de Enfermedades Cardiovasculares, Spain
| | - Alfonso Varela-Román
- Servicio de Cardiología y Unidad Coronaria, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Santiago de Compostela, A Coruña, Spain; CIBER de Enfermedades Cardiovasculares, Spain
| |
Collapse
|
9
|
Uribarri A, Rojas SV, Hanke JS, Dogan G, Siemeni T, Kaufeld T, Ius F, Goecke T, Rojas-Hernandez S, Warnecke G, Bara C, Avsar M, Haverich A. Prognostic Value of the Nutritional Risk Index in Candidates for Continuous Flow Left Ventricular Assist Device Therapy. ACTA ACUST UNITED AC 2018; 72:608-615. [PMID: 30078744 DOI: 10.1016/j.rec.2018.05.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/23/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES Malnutrition has been shown to affect clinical outcomes in patients with heart failure. The aim of this study was to analyze the impact of preoperative nutritional status assessed by the nutritional risk index (NRI) on the prognosis of patients with a continuous-flow left ventricular assist device (cf-LVAD). METHODS We performed a retrospective study of 279 patients who underwent cf-LVAD implantation between 2009 and 2015 in our center. Preoperative NRI was calculated and the patients were followed-up for 1 year. The association between preoperative NRI and postoperative clinical events was analyzed using multivariable logistic regression. RESULTS The prevalence of severe (NRI <83.5), moderate (83.5 ≤ NRI <97.5) and mild (97.5 ≤ NRI <100) nutritional risk was 5.4%, 21.5%, and 9.3%. Mortality rates 1 year after cf-LVAD implantation in these 3 categories were 53.3%, 31.7%, 23.1% vs 18.0% (P <.001) in patients with a normal IRN. A normal preoperative NRI value was an independent predictor of lower risk of death from any cause during follow-up (aHR per 1 unit, 0.961; 95%CI, 0.941-0.981; P <.001) was and a predictor for a lower risk of postoperative infections (aOR, 0.968; 95%CI, 0.946-0.991; P=.007), respiratory failure (aOR, 0,961; 95%CI, 0.936-0.987; P=.004), and right heart failure (aOR, 0.963; 95%CI, 0.934-0.992; P=.014). CONCLUSIONS Malnourished patients are at increased risk for postoperative complications and death after cf-LVAD implantation. Assessment of nutritional risk could improve patient selection and the early initiation of nutritional support.
Collapse
Affiliation(s)
- Aitor Uribarri
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
| | - Sebastian V Rojas
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jasmin S Hanke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Günes Dogan
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Thierry Siemeni
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Tim Kaufeld
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Fabio Ius
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Tobias Goecke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | | | - Gregor Warnecke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christoph Bara
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| |
Collapse
|
10
|
Streng KW, Voors AA, Hillege HL, Anker SD, Cleland JG, Dickstein K, Filippatos G, Metra M, Ng LL, Ponikowski P, Samani NJ, van Veldhuisen DJ, Zwinderman AH, Zannad F, Damman K, van der Meer P, Lang CC. Waist-to-hip ratio and mortality in heart failure. Eur J Heart Fail 2018; 20:1269-1277. [DOI: 10.1002/ejhf.1244] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/03/2018] [Accepted: 05/21/2018] [Indexed: 12/22/2022] Open
Affiliation(s)
- Koen W. Streng
- University of Groningen, Department of Cardiology; University Medical Center Groningen; Groningen The Netherlands
| | - Adriaan A. Voors
- University of Groningen, Department of Cardiology; University Medical Center Groningen; Groningen The Netherlands
| | - Hans L. Hillege
- University of Groningen, Department of Cardiology; University Medical Center Groningen; Groningen The Netherlands
| | - Stefan D. Anker
- Division of Cardiology and Metabolism, Department of Cardiology (CVK); and Berlin-Brandenburg Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin; Berlin Germany
| | - John G. Cleland
- National Heart and Lung Institute, Imperial College London; and Robertson Centre for Biostatistics and Clinical Trials; University of Glasgow; Glasgow UK
| | - Kenneth Dickstein
- University of Bergen; Bergen Norway
- Stavanger University Hospital; Stavanger Norway
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, School of Medicine, Department of Cardiology, Heart Failure Unit; Athens University Hospital Attikon; Athens Greece
| | - Marco Metra
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health; University of Brescia; Brescia Italy
| | - Leong L. Ng
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, and NIHR Leicester Biomedical Research Centre; Glenfield Hospital; Leicester UK
| | - Piotr Ponikowski
- Department of Heart Diseases; Wroclaw Medical University, and Cardiology Department, Military Hospital; Wroclaw Poland
| | - Nilesh J. Samani
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, and NIHR Leicester Biomedical Research Centre; Glenfield Hospital; Leicester UK
| | - Dirk J. van Veldhuisen
- University of Groningen, Department of Cardiology; University Medical Center Groningen; Groningen The Netherlands
| | - Aeilko H. Zwinderman
- Department of Epidemiology, Biostatistics and Bioinformatics; Academic Medical Centre; Amsterdam The Netherlands
| | - Faiez Zannad
- Inserm CIC 1433, Université de Lorraine; CHU de Nancy; Nancy France
| | - Kevin Damman
- University of Groningen, Department of Cardiology; University Medical Center Groningen; Groningen The Netherlands
| | - Peter van der Meer
- University of Groningen, Department of Cardiology; University Medical Center Groningen; Groningen The Netherlands
| | - Chim C. Lang
- School of Medicine Centre for Cardiovascular and Lung Biology, Division of Medical Sciences; University of Dundee, Ninewells Hospital & Medical School; Dundee UK
| |
Collapse
|
11
|
Hong S, Lee JH, Kim KM, Lee JW, Youn YJ, Ahn MS, Ahn SG, Lee SH, Yoon J, Choe KH, Yoo BS. Is There a Sex-Related Difference in the Obesity Paradox in Systolic Heart Failure? Sex-Related Difference in the Obesity Paradox. Yonsei Med J 2018; 59:57-62. [PMID: 29214777 PMCID: PMC5725365 DOI: 10.3349/ymj.2018.59.1.57] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/11/2017] [Accepted: 09/09/2017] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Obesity is often associated with better clinical outcomes in heart failure (HF). This so-called obesity paradox remains controversial. The aim of present study was to investigate the prognostic value of obesity in patients hospitalized for systolic HF. MATERIALS AND METHODS We performed a pooled analysis of data from two multicenter, observational HF studies. Patients hospitalized for systolic HF were eligible for the present study. We divided the subjects into two groups, a normal body mass index (BMI) group and a high BMI group. Study endpoints included all-cause mortality and any re-hospitalization within 1 year. RESULTS We enrolled 3145 patients (male, 1824; female, 1321). The high BMI group was significantly associated with lower 1-year mortality rate [odds ratio (OR), 0.543; 95% confidence interval (CI), 0.355-0.832] after adjusting for age, hypertension, diabetes, ischemic HF, previous myocardial infarction, serum creatinine level, anemia, and ejection fraction in men. After adjustment for clinical characteristics, high BMI was not significantly associated with 1-year mortality (OR, 0.739; 95% CI, 0.450-1.216) or 1-year re-hospitalization (OR, 0.958; 95% CI, 0.696-1.319) in women. CONCLUSION In pooled analysis of data from two Korean HF registries, the high BMI group was independently associated with lower 1-year mortality rate from systolic HF, especially in men.
Collapse
Affiliation(s)
- Soonchang Hong
- Department of Thoracic and Cardiovascular Surgery, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Ji Hyun Lee
- Department of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Kyung Min Kim
- Department of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Jun Won Lee
- Department of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Young Jin Youn
- Department of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Min Soo Ahn
- Department of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Sung Gyun Ahn
- Department of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Seung Hwan Lee
- Department of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Junghan Yoon
- Department of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Kyung Hoon Choe
- Department of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Byung Su Yoo
- Department of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea.
| |
Collapse
|
12
|
|
13
|
Abstract
Obesity is increasingly prevalent, and abnormal body mass index is a risk factor for cardiovascular disease. There are limited data published regarding body mass index and CHD. We tested the hypothesis that body mass index and obesity prevalence are increasing in patients with tetralogy of Fallot over time by analysing time since surgery, age, height, weight, and body mass index among tetralogy of Fallot patients and demographic data from age-matched controls. NYHA class and left ventricular ejection fraction were analysed in adults. Body mass index was categorised into normal, overweight, and obese in this single-centre, retrospective chart review. Data were collected from 137 tetralogy of Fallot patients (71 men:66 women), of whom 40 had body mass index >25 kg/m2. Tetralogy of Fallot patients aged <6 years had lower body mass index (15.9 versus 17.1; p=0.042) until 16-20 years of age (27.4 versus 25.4; p=0.43). For adult tetralogy of Fallot patients, the mean body mass index was 26.5 but not statistically significantly different from the control cohort. Obese adult patients had significantly higher average NYHA class compared with those of normal weight (p=0.03), but no differences in left ventricular ejection fraction by echocardiography (p=0.55) or cardiac MRI (p=0.26) were noted. Lower body mass index was observed initially in tetralogy of Fallot patients, but by late adolescence no significant difference was observed. As adults, tetralogy of Fallot patients with higher body mass index had increased NYHA class but similar left ventricular ejection fraction.
Collapse
|
14
|
Ishida J, Saitoh M, Doehner W, von Haehling S, Anker M, Anker SD, Springer J. Animal models of cachexia and sarcopenia in chronic illness: Cardiac function, body composition changes and therapeutic results. Int J Cardiol 2017; 238:12-18. [DOI: 10.1016/j.ijcard.2017.03.154] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 03/31/2017] [Accepted: 03/31/2017] [Indexed: 02/07/2023]
|
15
|
Ishida J, Konishi M, Saitoh M, Anker M, Anker SD, Springer J. Myostatin signaling is up-regulated in female patients with advanced heart failure. Int J Cardiol 2017; 238:37-42. [DOI: 10.1016/j.ijcard.2017.03.153] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 03/31/2017] [Accepted: 03/31/2017] [Indexed: 12/20/2022]
|
16
|
Effect of body mass index on clinical outcome and all-cause mortality in patients undergoing transcatheter aortic valve implantation. Neth Heart J 2017; 25:498-509. [PMID: 28536936 PMCID: PMC5571592 DOI: 10.1007/s12471-017-1003-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objectives To assess the effect of body mass index (BMI) on outcome among patients with severe aortic stenosis (AS) admitted for transcatheter aortic valve implantation (TAVI). Background Being overweight or obese is associated with improved outcome following certain medical treatments, suggesting the existence of a BMI paradox. However, the relationship between BMI and mortality after TAVI remains controversial. Methods Patients were classified according to World Health Organisation criteria such as normal weight, overweight, or obesity according to their BMI (18.5 to 24.9 kg/m2, 25.0 to 29.9 kg/m2, and ≥30.0 kg/m2, respectively). Results A total of 549 consecutive patients (age: 80.2 ± 7.5 years; logistic European system for cardiac operative risk evaluation [EuroSCORE]: 17.3 ± 9.9%) who underwent TAVI for AS were included. Of these patients, 43% (n = 237) had normal weight, 36% (n = 200) were overweight, and 20% (n = 112) were obese. There were no differences in peri-operative bleeding or vascular complication rates between the groups. All-cause mortality after 30 days, and 1 year, were higher in normal weight patients compared with overweight and obese patients (7% vs. 5 and 4%, p = 0.383, and 19% vs. 9 and 10%, p = 0.006, respectively). After adjustment for several confounding factors, overweight was associated with a decreased 30-day and 1‑year all-cause mortality outcome (hazard ratio [HR] 0.69; 95% confidence interval [CI] 0.47–0.99, and HR 0.65; 95% CI 0.45–0.94, respectively). Conclusions Despite the well-documented adverse effects of increased body weight on health, being overweight is associated with improved survival following TAVI when compared with normal weight.
Collapse
|
17
|
Martínez F, Martínez-Ibañez L, Pichler G, Ruiz A, Redon J. Multimorbidity and acute heart failure in internal medicine. Int J Cardiol 2017; 232:208-215. [DOI: 10.1016/j.ijcard.2017.01.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 12/28/2016] [Accepted: 01/03/2017] [Indexed: 12/13/2022]
|
18
|
Abi Khalil C, Sulaiman K, Singh R, Jayyousi A, Asaad N, AlHabib KF, Alsheikh-Ali A, Al-Jarallah M, Bulbanat B, AlMahmeed W, Dargham S, Ridha M, Bazargani N, Amin H, Al-Motarreb A, AlFaleh H, Elasfar A, Panduranga P, Al Suwaidi J. BMI is inversely correlated to the risk of mortality in patients with type 2 diabetes hospitalized for acute heart failure: Findings from the Gulf aCute heArt failuRE (Gulf-CARE) registry. Int J Cardiol 2017; 241:262-269. [PMID: 28291623 DOI: 10.1016/j.ijcard.2017.02.119] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 02/21/2017] [Accepted: 02/24/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND A U-shaped relationship has been reported between BMI and cardiovascular events among patients with acute heart failure (AHF). We hypothesized that an obesity paradox also governs the relationship between BMI and mortality in patients with type 2 diabetes (T2D) and AHF. METHODS We studied 3-month and 12-month mortality in patients with T2D hospitalized for AHF according to 5 BMI categories: Underweight (<20kg/m2), normal weight (referent group, 20-24.9kg/m2), overweight, (25-29.9kg/m2), obese (30-34.9kg/m2) and severely obese (≥35kg/m2), in the Gulf aCute heArt failuRe rEgistry (GULF-CARE). RESULTS Among the 5005 participants in this cohort, 2492 (49.8%) had T2D. Underweight patients had a higher 3-month and 12-month mortality risk (OR 2.04, 95% CI [1.02-4.08]; OR 2.44, 95% CI [1.35-4.3]; respectively), compared to normal weight. Severe obesity was associated with a lower 3-month and 12-month mortality risk (OR 0.53, 95% CI [0.34-0.83]; OR 0.58, 95% CI [0.42-0.81]; respectively). After adjustment for several risk variables in 2 different models, the primary outcome was still significantly increased in underweight patients, and decreased in severely obese patients, at 3months and 12months. Further, the odds of mortality decreases with increasing BMI by 0.38 at 3months and at 0.45 at 12months in a near-linear shape (p=0.007; p=0.037; respectively). CONCLUSIONS In this cohort of patients with AHF, BMI was inversely correlated to the risk of mortality in patients with T2D. Moreover, severe obesity was associated with less mortality risk.
Collapse
Affiliation(s)
- Charbel Abi Khalil
- Department of Medicine, Weill Cornell Medicine, Doha, Qatar; Department of Genetic Medicine, Weill Cornell Medicine, Doha, Qatar; Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
| | | | - Rajvir Singh
- Biostatistics Section, Cardiovascular Research, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Amin Jayyousi
- Department of Endocrinology and Diabetes, Hamad Medical Corporation, Doha, Qatar
| | - Nidal Asaad
- Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Khalid F AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Alawi Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Heath Sciences Dubai, United Arab Emirates
| | | | - Bassam Bulbanat
- Department of Medicine, Al-Amiri Hospital, Kuwait City, Kuwait
| | - Wael AlMahmeed
- Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, UAE
| | | | - Mustafa Ridha
- Department of Epidemiology and Global Health, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Nooshin Bazargani
- Department of Cardiology, Dubai Hospital, Dubai, United Arab Emirates
| | - Haitham Amin
- Department of Cardiology, Mohammed Bin Khalifa Cardiac Center, Manamah, Bahrain
| | - Ahmed Al-Motarreb
- Department of Cardiology, Faculty of Medicine, Sana'a University, Sana'a, Yemen
| | - Husam AlFaleh
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Jassim Al Suwaidi
- Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| |
Collapse
|
19
|
Barge-Caballero E, García-López F, Marzoa-Rivas R, Barge-Caballero G, Couto-Mallón D, Paniagua-Martín MJ, Solla-Buceta M, Velasco-Sierra C, Pita-Gutiérrez F, Herrera-Noreña JM, Cuenca-Castillo JJ, Vázquez-Rodríguez JM, Crespo-Leiro MG. Prognostic Value of the Nutritional Risk Index in Heart Transplant Recipients. ACTA ACUST UNITED AC 2017; 70:639-645. [PMID: 28209304 DOI: 10.1016/j.rec.2017.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 11/10/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES To study the prognostic impact of preoperative nutritional status, as assessed through the nutritional risk index (NRI), on postoperative outcomes after heart transplantation (HT). METHODS We conducted a retrospective, single-center study of 574 patients who underwent HT from 1991 to 2014. Preoperative NRI was calculated as 1.519 × serum albumin (g/L) + 41.7 × (body weight [kg] / ideal body weight [kg]). The association between preoperative NRI and postoperative outcomes was analyzed by means of multivariable logistic regression and multivariable Cox regression. RESULTS Mean NRI before HT was 100.9 ± 9.9. According to this parameter, the prevalence of severe nutritional risk (NRI < 83.5), moderate nutritional risk (83.5 ≤ NRI < 97.5), and mild nutritional risk (97.5 ≤ NRI < 100) was 5%, 22%, and 10%, respectively. One year post-transplant mortality rates in these 4 categories were 18.2%, 25.3%, 7.9% and 10.2% (P < .001), respectively. The NRI was independently associated with a lower risk of postoperative infection (adjusted OR, 0.97; 95%CI, 0.95-1.00; P = .027) and prolonged postoperative ventilator support (adjusted OR, 0.96; 95%CI, 0.94-0.98; P = .001). Patients at moderate or severe nutritional risk had significantly higher 1-year post-HT mortality (adjusted HR, 1.55; 95%CI, 1.22-1.97; P < .001). CONCLUSIONS Malnourished patients have a higher risk of postoperative complications and mortality after HT. Preoperative NRI determination may help to identify HT candidates who might benefit from nutritional intervention.
Collapse
Affiliation(s)
- Eduardo Barge-Caballero
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain; Instituto de Investigación Biomédica, A Coruña, Spain.
| | - Fernando García-López
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain; Instituto de Investigación Biomédica, A Coruña, Spain
| | - Raquel Marzoa-Rivas
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain; Instituto de Investigación Biomédica, A Coruña, Spain
| | - Gonzalo Barge-Caballero
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain; Instituto de Investigación Biomédica, A Coruña, Spain
| | - David Couto-Mallón
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain; Instituto de Investigación Biomédica, A Coruña, Spain
| | - María J Paniagua-Martín
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain; Instituto de Investigación Biomédica, A Coruña, Spain
| | - Miguel Solla-Buceta
- Instituto de Investigación Biomédica, A Coruña, Spain; Servicio de Medicina Intensiva, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Carlos Velasco-Sierra
- Instituto de Investigación Biomédica, A Coruña, Spain; Servicio de Cirugía Cardiaca, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Francisco Pita-Gutiérrez
- Instituto de Investigación Biomédica, A Coruña, Spain; Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - José M Herrera-Noreña
- Instituto de Investigación Biomédica, A Coruña, Spain; Servicio de Cirugía Cardiaca, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - José J Cuenca-Castillo
- Instituto de Investigación Biomédica, A Coruña, Spain; Servicio de Cirugía Cardiaca, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - José Manuel Vázquez-Rodríguez
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain; Instituto de Investigación Biomédica, A Coruña, Spain
| | - María G Crespo-Leiro
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain; Instituto de Investigación Biomédica, A Coruña, Spain
| |
Collapse
|
20
|
Okabe T, Yakushiji T, Kido T, Oyama Y, Igawa W, Ono M, Ebara S, Yamashita K, Yamamoto MH, Saito S, Amemiya K, Isomura N, Araki H, Ochiai M. Relationship between worsening renal function and long-term cardiovascular mortality in heart failure patients. Int J Cardiol 2016; 230:47-52. [PMID: 28038802 DOI: 10.1016/j.ijcard.2016.12.101] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/28/2016] [Accepted: 12/17/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Recently several studies showed that worsening renal function (WRF) during hospitalization might be a strong independent predictor of poor prognosis in decompensated heart failure (HF) patients. However, these studies had a relatively short follow-up duration and their data were limited to in-hospital outcomes. Our purpose was to assess the relationship between WRF and long-term cardiovascular mortality in HF patients. METHODS We enrolled decompensated HF patients who were admitted to our hospital between April 2010 and March 2015. WRF was defined as a relative increase in serum creatinine of at least 25% or an absolute increase in serum creatinine ≥0.3mg/dL from the baseline. We assessed the cardiovascular mortality and all-cause mortality in HF patients with WRF (WRF group) and without WRF (no WRF group). RESULTS Among 301 patients enrolled, WRF developed in 118 patients (39.2%). During a median follow-up period of 537days [interquartile range, 304.3 to 1025.8days], cardiovascular mortality and all-cause mortality were significantly higher in the WRF group than in the no WRF group (23.2% vs. 6.1%, P<0.001; 30.3% vs. 14.7%, P<0.001, respectively). In the multivariate Cox proportional hazards model, age and serum B-type natriuretic peptide (BNP) level were associated with both cardiovascular death and all-cause death. However, WRF was not the independent predictor of cardiovascular death (P=0.19) nor all-cause death (P=0.57). CONCLUSIONS WRF was associated with cardiovascular death in patients with HF. Although not an independent predictor, WRF might be one of useful markers to identify patients who should be followed carefully after discharge.
Collapse
Affiliation(s)
- Toshitaka Okabe
- Showa University Northern Yokohama Hospital, Division of Cardiology and Cardiac Catheterization Laboratories, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama 224-8503, Japan.
| | - Tadayuki Yakushiji
- Showa University Northern Yokohama Hospital, Division of Cardiology and Cardiac Catheterization Laboratories, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama 224-8503, Japan
| | - Takehiko Kido
- Showa University Northern Yokohama Hospital, Division of Cardiology and Cardiac Catheterization Laboratories, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama 224-8503, Japan
| | - Yuji Oyama
- Showa University Northern Yokohama Hospital, Division of Cardiology and Cardiac Catheterization Laboratories, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama 224-8503, Japan
| | - Wataru Igawa
- Showa University Northern Yokohama Hospital, Division of Cardiology and Cardiac Catheterization Laboratories, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama 224-8503, Japan
| | - Morio Ono
- Showa University Northern Yokohama Hospital, Division of Cardiology and Cardiac Catheterization Laboratories, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama 224-8503, Japan
| | - Seitaro Ebara
- Showa University Northern Yokohama Hospital, Division of Cardiology and Cardiac Catheterization Laboratories, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama 224-8503, Japan
| | - Kennosuke Yamashita
- Showa University Northern Yokohama Hospital, Division of Cardiology and Cardiac Catheterization Laboratories, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama 224-8503, Japan
| | - Myong Hwa Yamamoto
- Showa University Northern Yokohama Hospital, Division of Cardiology and Cardiac Catheterization Laboratories, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama 224-8503, Japan
| | - Shigeo Saito
- Showa University Northern Yokohama Hospital, Division of Cardiology and Cardiac Catheterization Laboratories, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama 224-8503, Japan
| | - Kisaki Amemiya
- Showa University Northern Yokohama Hospital, Division of Cardiology and Cardiac Catheterization Laboratories, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama 224-8503, Japan
| | - Naoei Isomura
- Showa University Northern Yokohama Hospital, Division of Cardiology and Cardiac Catheterization Laboratories, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama 224-8503, Japan
| | - Hiroshi Araki
- Showa University Northern Yokohama Hospital, Division of Cardiology and Cardiac Catheterization Laboratories, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama 224-8503, Japan
| | - Masahiko Ochiai
- Showa University Northern Yokohama Hospital, Division of Cardiology and Cardiac Catheterization Laboratories, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama 224-8503, Japan
| |
Collapse
|
21
|
Farmakis D, Simitsis P, Bistola V, Triposkiadis F, Ikonomidis I, Katsanos S, Bakosis G, Hatziagelaki E, Lekakis J, Mebazaa A, Parissis J. Acute heart failure with mid-range left ventricular ejection fraction: clinical profile, in-hospital management, and short-term outcome. Clin Res Cardiol 2016; 106:359-368. [PMID: 27999929 DOI: 10.1007/s00392-016-1063-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 12/12/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Heart failure with mid-range left ventricular ejection fraction (HFmrEF) is a poorly characterized population as it has been studied either in the context of HF with reduced (HFrEF) or preserved (HFpEF) left ventricular ejection fraction (LVEF) depending on applied LVEF cutoffs. We sought to investigate the clinical profile, in-hospital management, and short-term outcome of HFmrEF patients in comparison with those with HFrEF or HFpEF in a large acute HF cohort. METHODS AND RESULTS The Acute Heart Failure Global Registry of Standard Treatment (ALARM-HF) included 4953 patients hospitalized for HF in nine countries in Europe, Latin America, and Australia. Baseline characteristics, clinical presentation, in-hospital therapies, and short-term mortality (all-cause in-hospital or 30-day mortality, whichever first) were compared among HFrEF (LVEF <40%), HFmrEF (LVEF 40-49%), and HFpEF (LVEF ≥50%) patients. Among 3257 patients with documented LVEF, 52% had HFrEF, 25% HFmrEF, and 23% HFpEF. Patients with HFmrEF had a distinct demographic and clinical profile with many intermediate features between HFrEF and HFpEF. In addition, they had a higher prevalence of hypertension (p < 0.001), a lower prevalence of chronic renal disease (p = 0.003), more hospitalizations for acute coronary syndrome (p < 0.001), or infection (p = 0.003), and were more frequently treated with intravenous vasodilators compared to HFrEF or HFpEF. Adjusted short-term mortality in HFmrEF was lower than HFrEF [hazard ratio (HR) = 0.635 (0.419, 0.963), p = 0.033] but similar to HFpEF [HR = 1.026 (0.605, 1.741), p = 0.923]. CONCLUSION Hospitalized HFmrEF patients represent a demographically and clinically diverse group with many intermediate features compared to HFrEF and HFpEF and carry a lower risk of short-term mortality than HFrEF but a similar risk with HFpEF.
Collapse
Affiliation(s)
- Dimitrios Farmakis
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini St, 12462, Athens, Greece
| | - Panagiotis Simitsis
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini St, 12462, Athens, Greece
| | - Vasiliki Bistola
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini St, 12462, Athens, Greece
| | | | - Ignatios Ikonomidis
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini St, 12462, Athens, Greece
| | - Spyridon Katsanos
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini St, 12462, Athens, Greece
| | - George Bakosis
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini St, 12462, Athens, Greece
| | - Erifili Hatziagelaki
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini St, 12462, Athens, Greece
| | - John Lekakis
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini St, 12462, Athens, Greece
| | - Alexandre Mebazaa
- Department of Anesthesiology and Intensive Care, Lariboisière University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Paris, France
| | - John Parissis
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini St, 12462, Athens, Greece.
| |
Collapse
|
22
|
Agra Bermejo RM, González Ferreiro R, Varela Román A, Gómez Otero I, Kreidieh O, Conde Sabarís P, Rodríguez-Mañero M, Moure González M, Seoane Blanco A, Virgós Lamela A, García Castelo A, González Juanatey JR. Nutritional status is related to heart failure severity and hospital readmissions in acute heart failure. Int J Cardiol 2016; 230:108-114. [PMID: 28038805 DOI: 10.1016/j.ijcard.2016.12.067] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 11/24/2016] [Accepted: 12/16/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND Malnutrition is common in hospitalized heart failure (HF) patients and predicts adverse outcomes. The relationship between nutritional status and outcomes in HF has been partially studied. Our aim was to determine the relationship between the nutritional status and the long-term prognosis in patients hospitalized for acute HF. METHODS We analyzed 145 patients admitted consecutively to a cardiology department for acute HF. Nutritional status was measured with the CONUT method, a validated scale based on laboratory testing (albumin; cholesterol; lymphocytes) during hospitalization. Patients were classified as normal, mildly, moderately or severely malnourished, and followed in a HF clinic. RESULTS The mean aged of the population was 69.6years and 61% of patients were men, 54 had previous HF hospitalization (37%), 112 had hypertension (77%), 67 were diabetic (46%) and 135 had class III or IV NYHA (93%). Forty eight patients (33%) had normal nutritional status, 75 were mildly malnourished (52%), and 22 were moderately or severely malnourished (15%). Age, sex, hypertension, diabetes mellitus, or NYHA class among the three groups were not statistically different. ProBNP was directly correlated with the nutritional status. After a mean follow-up of 326days, 27 had a HF hospitalization (19%) and 61 (42,1%) had a hospitalization not related to HF. The analysis by Kaplan-Meier curves and log rank test showed that these differences were statistically significant. CONCLUSION Malnutrition is common in patients hospitalized for HF. It seems to be a mediator of disease progression and determines a poor prognosis especially in advanced stages.
Collapse
Affiliation(s)
- Rosa María Agra Bermejo
- Cardiology Department, Clinical Universitary Hospital, Santiago de Compostela, A Coruña, Spain.
| | - Rocío González Ferreiro
- Cardiology Department, Clinical Universitary Hospital, Santiago de Compostela, A Coruña, Spain
| | - Alfonso Varela Román
- Cardiology Department, Clinical Universitary Hospital, Santiago de Compostela, A Coruña, Spain
| | - Inés Gómez Otero
- Cardiology Department, Clinical Universitary Hospital, Santiago de Compostela, A Coruña, Spain
| | - Omar Kreidieh
- University of Miami Miller School of Medicine: JFK Medical Center, Miami, United States
| | - Patricia Conde Sabarís
- Cardiology Department, Clinical Universitary Hospital, Santiago de Compostela, A Coruña, Spain
| | - Moisés Rodríguez-Mañero
- Cardiology Department, Clinical Universitary Hospital, Santiago de Compostela, A Coruña, Spain
| | - María Moure González
- Cardiology Department, Clinical Universitary Hospital, Santiago de Compostela, A Coruña, Spain
| | - Ana Seoane Blanco
- Cardiology Department, Clinical Universitary Hospital, Santiago de Compostela, A Coruña, Spain
| | - Alejandro Virgós Lamela
- Cardiology Department, Clinical Universitary Hospital, Santiago de Compostela, A Coruña, Spain
| | - Alberto García Castelo
- Cardiology Department, Clinical Universitary Hospital, Santiago de Compostela, A Coruña, Spain
| | | |
Collapse
|
23
|
Metra M. March 2016 at a glance. Focus on right ventricular failure and acute heart failure. Eur J Heart Fail 2016. [DOI: 10.1002/ejhf.512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; University of Brescia; Brescia Italy
| |
Collapse
|