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The Obesity Paradox has been reported in patients with advanced heart failure (HF). However, there is limited data regarding the effect of weight changes associated with cardiac resynchronization therapy on the risk of HF or death. This study was designed to evaluate the risk of HF or death in patients implanted with cardiac resynchronization therapy with cardioverter defibrillator (CRT-D).
The risk of HF or death was compared between patients with and without weight loss (>0 kg at 1-year) in the CRT-D arm of MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy).
In 476 of 994 (48%) patients implanted with CRT-D weight loss was observed at 12 months. The cumulative probability of HF or death was significantly higher in patients with weight loss compared to those without weight loss (Figure). Multivariate analysis showed a significant increase in the risk of HF or death among patients with weight loss compared to those without weight loss (HR=1.49, 95% CI: 1.08–2.06, p=0.02). When analyzed in a continuous fashion, each kilogram of weight loss was associated with a 4% increase in the risk of HF or death (p=0.008). In left bundle branch block patients with CRT-D, there was a doubling in the risk of HF or death with weight loss (HR=2.03, 95% CI: 1.32–3.12, p=0.001, interaction p-value =0.06).
In patients with mild symptoms of heart failure receiving CRT-D, weight loss is associated with a significantly worse clinical outcome.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Heart Failure: Cardiac Resynchronization Therapy
Abstract Category: 17. Heart Failure: Therapy
Presentation Number: 1177-308
- 2013 American College of Cardiology Foundation