Abstract 14551: Impact of Cardiorespiratory Fitness on the Obesity Paradox in Patients with Heart Failure
Introduction: In systolic heart failure (HF), an obesity paradox has been well-described, but the impact of cardiorespiratory fitness (FIT) and adiposity has not been assessed. The goal of this study was to determine the impact of FIT on survival in relation with the obesity paradox in patients with HF.
Methods: We studied 2,066 patients (body mass index or BMI ≥18.5 kg/m2 ) with systolic HF from a multi-center cardiopulmonary exercise testing database who were followed for an average of 25.0 ±17.5 months to determine the impact of FIT (<14 and ≥14 mlO2•kg-1•min-1) on the obesity paradox.
Results: There were 212 deaths during follow-up (yearly mortality was 4.5%). In patients with low FIT, yearly mortality was 8.2% compared with a yearly mortality of 2.8% in those with higher FIT (p<0.0001). In the overall group, BMI was a significant predictor of mortality (p<0.05). In subjects with low FIT, continuous (p<0.01) and dichotomous (p<0.05) expressions of BMI were both significant predictors of mortality, which was not the case with higher FIT. In those with low FIT, progressively better survival was noted with BMI≥30kg/m2, 25-29.9 kg/m2, and 18.5-24.9 kg/m2 87.7% (A), 83.6% (B), and 78.1% (C), respectively; Log-rank 11.7, p<0.01, whereas there was no obesity paradox noted in those with higher FIT survival 94.4% (A), 92.7% (B), and 93.1% (C),respectively; Log-rank 1.72.p= 0.42. Figure.
Conclusion: These results indicate FIT modifies the relationship of BMI to mortality. Thus, assessing the obesity paradox in systolic HF may be misleading unless FIT is considered. Figure A - Kaplan-Meier Analysis according to BMI in low aerobic capacity group. Figure B - Kaplan-Meier Analysis according to BMI in high aerobic capacity group
- © 2012 by American Heart Association, Inc.