Body mass indices and outcome in patients with chronic heart failure.
ABSTRACT There is an inverse relation between body mass and mortality in large populations of patients with chronic heart failure with a broad range of disease severity. The best measure of body size to describe the relation is not clear.
Patients with chronic heart failure (n = 2271, age 71.9 ± 11.3 years; 74.6% male) due to left ventricular systolic dysfunction were followed for a median of 1785 days (inter-quartile range, 874-2311 days) in survivors. We measured body mass index (BMI: weight/height²), ponderal index (PI: weight/height³), and body surface area (BSA). In a subset of 1025 patients, we also calculated the 'Charles index' [weight/(waist² × height)] together with bioimpedance data. During follow-up, 912 patients died. Measures of body mass were strong univariable predictors of outcome, and BSA (χ² = 71.3) was the strongest predictor followed by height (χ² = 68.6), weight (χ² = 57.4), then BMI (χ² = 15.2). The larger the patient's size, the lower the risk of mortality. Body surface area was the single strongest predictor of outcome in a multivariable model including 14 variables. In the subset with bioimpedance data, basal metabolic rate, BSA, weight, BMI, percentage body fat, fat mass, PI, and fat-free mass were all univariable predictors of outcome.
Measures of body size are strongly related to outcome in patients with chronic heart failure. Body surface area is a stronger predictor of mortality than other measures of body habitus, irrespective of height correction. The greater the overall bulk of the body, the better the survival.
- Journal of the American College of Cardiology 09/2014; 64(11):1103–1105. · 15.34 Impact Factor
- Journal of the American College of Cardiology 08/2014; 176(3). · 15.34 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Pulmonary arterial hypertension is a progressive disease that is characterized by dyspnea and exercise intolerance. Impairment in skeletal muscle has recently been described in PAH, although the degree to which this impairment is solely determined by the hemodynamic profile remains uncertain. The aim of this study was to verify the association of structural and functional skeletal muscle characteristics with maximum exercise in PAH. The exercise capacity, body composition, CT area of limb muscle, quality of life, quadriceps biopsy and hemodynamics of 16 PAH patients were compared with those of 10 controls. PAH patients had a significantly poorer quality of life, reduced percentage of lean body mass, reduced respiratory muscle strength, reduced resistance and strength of quadriceps and increased functional limitation at 6MWT and CPET. VO2 max was correlated with muscular variables and cardiac output. Bivariate linear regression models showed that the association between muscular structural and functional variables remained significant even after correcting for cardiac output. Our study showed the coexistence of ventilatory and quadriceps weakness in face of exercise intolerance in the same group of PAH patients. More interestingly, it is the first time that the independent association between muscular pattern and maximum exercise capacity is evidenced in PAH, independently of cardiac index highlighting the importance of considering rehabilitation in the treatment strategy for PAH.PLoS ONE 12/2014; 9(12):e114101. · 3.53 Impact Factor