Obesity and its Association to Phenotype and Clinical Course in Hypertrophic Cardiomyopathy
Objectives This study sought to assess the impact of body mass index (BMI) on cardiac phenotypic and clinical course in a multicenter hypertrophic cardiomyopathy (HCM) cohort. Background It is unresolved whether clinical variables promoting left ventricular (LV) hypertrophy in the general population...
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| Veröffentlicht in: | Journal of the American College of Cardiology 2013-07, Vol.62 (5), p.449-457 |
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| creator | Olivotto, Iacopo, MD Maron, Barry J., MD Tomberli, Benedetta, MD Appelbaum, Evan, MD Salton, Carol, AB Haas, Tammy S., RN Gibson, C. Michael, MD Nistri, Stefano, MD Servettini, Eleonora, MD Chan, Raymond H., MD Udelson, James E., MD Lesser, John R., MD Cecchi, Franco, MD Manning, Warren J., MD Maron, Martin S., MD |
| description | Objectives This study sought to assess the impact of body mass index (BMI) on cardiac phenotypic and clinical course in a multicenter hypertrophic cardiomyopathy (HCM) cohort. Background It is unresolved whether clinical variables promoting left ventricular (LV) hypertrophy in the general population, such as obesity, may influence cardiac phenotypic and clinical course in patients with HCM. Methods In 275 adult HCM patients (age 48 ± 14 years; 70% male), we assessed the relation of BMI to LV mass, determined by cardiovascular magnetic resonance (CMR) and heart failure progression. Results At multivariate analysis, BMI proved independently associated with the magnitude of hypertrophy: pre-obese and obese HCM patients (BMI 25 to 30 kg/m2 and >30 kg/m2 , respectively) showed a 65% and 310% increased likelihood of an LV mass in the highest quartile (>120 g/m2 ), compared with normal weight patients (BMI 120 g/m2 were LV outflow obstruction (HR: 4.9; 95% CI: 2.4 to 9.8; p < 0.001), systemic hypertension (HR: 2.2; 95% CI: 1.1 to 4.5; p = 0.026), and male sex (HR: 2.1; 95% CI: 0.9 to 4.7; p = 0.083). During a median follow-up of 3.7 years (interquartile range: 2.5 to 5.3), obese patients showed an HR of 3.6 (95% CI: 1.2 to 10.7, p = 0.02) for developing New York Heart Association (NYHA) functional class III to IV symptoms compared to nonobese patients, independent of outflow obstruction. Noticeably, the proportion of patients in NYHA functional class III at the end of follow-up was 13% among obese patients, compared with 6% among those of normal weight (p = 0.03). Conclusions In HCM patients, extrinsic factors such as obesity are independently associated with increase in LV mass and may dictate progression of heart failure symptoms. |
| doi_str_mv | 10.1016/j.jacc.2013.03.062 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1413166262</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0735109713017312</els_id><sourcerecordid>1413166262</sourcerecordid><originalsourceid>FETCH-LOGICAL-c579t-674ca1271fd1745608b96c96cc9f135076dbab2b71104d5d6a3bba2fa95b44303</originalsourceid><addsrcrecordid>eNp9kkFr3DAQhUVpaTZJ_0APxVAKvXirkSxpBSUQTNMUAik0PfUgZFlm5XotV9IW_O8jZ7cJ5FB4oIO-ecy8GYTeAl4DBv6pX_famDXBQNc4i5MXaAWMbUrKpHiJVlhQVgKW4gSdxthjjPkG5Gt0QiivMkNX6NdtY6NLc6HHtnApFpcxeuN0cn4ski--b-3o0zzZB6Ae3OiMHora70O0hRuL6_wXUvDT1pmi1qF1fjf7SaftfI5edXqI9s3xPUM_r77c1dflze3Xb_XlTWmYkKnkojIaiICuBVExjjeN5CbLyA4ow4K3jW5IIwBw1bKWa9o0mnRasqaqKKZn6OPBdwr-z97GpHYuGjsMerR-HxVUQIFzwklG3z9D-zzJmLtTwCtG5EZKnilyoEzwMQbbqSm4nQ6zAqyW6FWvlujVEr3CWQ_W747W-2Zn28eSf1ln4MMR0DFn2AU9GhefOMEpEYJl7vOBszmzv84GFY2zo7GtC9Yk1Xr3_z4unpWb49Z-29nGp3lVJAqrH8uRLDcCFIOgQOg9H9m1pQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1645298996</pqid></control><display><type>article</type><title>Obesity and its Association to Phenotype and Clinical Course in Hypertrophic Cardiomyopathy</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Olivotto, Iacopo, MD ; Maron, Barry J., MD ; Tomberli, Benedetta, MD ; Appelbaum, Evan, MD ; Salton, Carol, AB ; Haas, Tammy S., RN ; Gibson, C. Michael, MD ; Nistri, Stefano, MD ; Servettini, Eleonora, MD ; Chan, Raymond H., MD ; Udelson, James E., MD ; Lesser, John R., MD ; Cecchi, Franco, MD ; Manning, Warren J., MD ; Maron, Martin S., MD</creator><creatorcontrib>Olivotto, Iacopo, MD ; Maron, Barry J., MD ; Tomberli, Benedetta, MD ; Appelbaum, Evan, MD ; Salton, Carol, AB ; Haas, Tammy S., RN ; Gibson, C. Michael, MD ; Nistri, Stefano, MD ; Servettini, Eleonora, MD ; Chan, Raymond H., MD ; Udelson, James E., MD ; Lesser, John R., MD ; Cecchi, Franco, MD ; Manning, Warren J., MD ; Maron, Martin S., MD</creatorcontrib><description>Objectives This study sought to assess the impact of body mass index (BMI) on cardiac phenotypic and clinical course in a multicenter hypertrophic cardiomyopathy (HCM) cohort. Background It is unresolved whether clinical variables promoting left ventricular (LV) hypertrophy in the general population, such as obesity, may influence cardiac phenotypic and clinical course in patients with HCM. Methods In 275 adult HCM patients (age 48 ± 14 years; 70% male), we assessed the relation of BMI to LV mass, determined by cardiovascular magnetic resonance (CMR) and heart failure progression. Results At multivariate analysis, BMI proved independently associated with the magnitude of hypertrophy: pre-obese and obese HCM patients (BMI 25 to 30 kg/m2 and >30 kg/m2 , respectively) showed a 65% and 310% increased likelihood of an LV mass in the highest quartile (>120 g/m2 ), compared with normal weight patients (BMI <25 kg/m2 ; hazard ratio [HR]: 1.65; 95% confidence interval [CI]: 0.73 to 3.74, p = 0.22 and 3.1; 95% CI: 1.42 to 6.86, p = 0.004, respectively). Other features associated with LV mass >120 g/m2 were LV outflow obstruction (HR: 4.9; 95% CI: 2.4 to 9.8; p < 0.001), systemic hypertension (HR: 2.2; 95% CI: 1.1 to 4.5; p = 0.026), and male sex (HR: 2.1; 95% CI: 0.9 to 4.7; p = 0.083). During a median follow-up of 3.7 years (interquartile range: 2.5 to 5.3), obese patients showed an HR of 3.6 (95% CI: 1.2 to 10.7, p = 0.02) for developing New York Heart Association (NYHA) functional class III to IV symptoms compared to nonobese patients, independent of outflow obstruction. Noticeably, the proportion of patients in NYHA functional class III at the end of follow-up was 13% among obese patients, compared with 6% among those of normal weight (p = 0.03). Conclusions In HCM patients, extrinsic factors such as obesity are independently associated with increase in LV mass and may dictate progression of heart failure symptoms.</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/j.jacc.2013.03.062</identifier><identifier>PMID: 23643593</identifier><identifier>CODEN: JACCDI</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adult ; Biological and medical sciences ; Body Mass Index ; cardiac magnetic resonance ; Cardiology ; Cardiology. Vascular system ; Cardiomyopathy, Hypertrophic - epidemiology ; Cardiovascular ; Cohort Studies ; Diabetes Mellitus, Type 2 - epidemiology ; Disease Progression ; Female ; Follow-Up Studies ; Heart ; Heart attacks ; Heart Failure - classification ; Heart Failure - epidemiology ; Heart Ventricles - pathology ; Humans ; Hypertension - epidemiology ; hypertrophic cardiomyopathy ; hypertrophy ; Internal Medicine ; Italy - epidemiology ; Likelihood Functions ; Magnetic Resonance Imaging, Cine ; Male ; Medical sciences ; Metabolic diseases ; Middle Aged ; Multivariate Analysis ; Myocarditis. Cardiomyopathies ; Obesity ; Obesity - epidemiology ; outcome ; Phenotype ; Sex Factors ; United States - epidemiology ; Ventricular Outflow Obstruction - epidemiology</subject><ispartof>Journal of the American College of Cardiology, 2013-07, Vol.62 (5), p.449-457</ispartof><rights>American College of Cardiology Foundation</rights><rights>2013 American College of Cardiology Foundation</rights><rights>2014 INIST-CNRS</rights><rights>Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Jul 30, 2013</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c579t-674ca1271fd1745608b96c96cc9f135076dbab2b71104d5d6a3bba2fa95b44303</citedby><cites>FETCH-LOGICAL-c579t-674ca1271fd1745608b96c96cc9f135076dbab2b71104d5d6a3bba2fa95b44303</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0735109713017312$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=27632775$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23643593$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Olivotto, Iacopo, MD</creatorcontrib><creatorcontrib>Maron, Barry J., MD</creatorcontrib><creatorcontrib>Tomberli, Benedetta, MD</creatorcontrib><creatorcontrib>Appelbaum, Evan, MD</creatorcontrib><creatorcontrib>Salton, Carol, AB</creatorcontrib><creatorcontrib>Haas, Tammy S., RN</creatorcontrib><creatorcontrib>Gibson, C. Michael, MD</creatorcontrib><creatorcontrib>Nistri, Stefano, MD</creatorcontrib><creatorcontrib>Servettini, Eleonora, MD</creatorcontrib><creatorcontrib>Chan, Raymond H., MD</creatorcontrib><creatorcontrib>Udelson, James E., MD</creatorcontrib><creatorcontrib>Lesser, John R., MD</creatorcontrib><creatorcontrib>Cecchi, Franco, MD</creatorcontrib><creatorcontrib>Manning, Warren J., MD</creatorcontrib><creatorcontrib>Maron, Martin S., MD</creatorcontrib><title>Obesity and its Association to Phenotype and Clinical Course in Hypertrophic Cardiomyopathy</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>Objectives This study sought to assess the impact of body mass index (BMI) on cardiac phenotypic and clinical course in a multicenter hypertrophic cardiomyopathy (HCM) cohort. Background It is unresolved whether clinical variables promoting left ventricular (LV) hypertrophy in the general population, such as obesity, may influence cardiac phenotypic and clinical course in patients with HCM. Methods In 275 adult HCM patients (age 48 ± 14 years; 70% male), we assessed the relation of BMI to LV mass, determined by cardiovascular magnetic resonance (CMR) and heart failure progression. Results At multivariate analysis, BMI proved independently associated with the magnitude of hypertrophy: pre-obese and obese HCM patients (BMI 25 to 30 kg/m2 and >30 kg/m2 , respectively) showed a 65% and 310% increased likelihood of an LV mass in the highest quartile (>120 g/m2 ), compared with normal weight patients (BMI <25 kg/m2 ; hazard ratio [HR]: 1.65; 95% confidence interval [CI]: 0.73 to 3.74, p = 0.22 and 3.1; 95% CI: 1.42 to 6.86, p = 0.004, respectively). Other features associated with LV mass >120 g/m2 were LV outflow obstruction (HR: 4.9; 95% CI: 2.4 to 9.8; p < 0.001), systemic hypertension (HR: 2.2; 95% CI: 1.1 to 4.5; p = 0.026), and male sex (HR: 2.1; 95% CI: 0.9 to 4.7; p = 0.083). During a median follow-up of 3.7 years (interquartile range: 2.5 to 5.3), obese patients showed an HR of 3.6 (95% CI: 1.2 to 10.7, p = 0.02) for developing New York Heart Association (NYHA) functional class III to IV symptoms compared to nonobese patients, independent of outflow obstruction. Noticeably, the proportion of patients in NYHA functional class III at the end of follow-up was 13% among obese patients, compared with 6% among those of normal weight (p = 0.03). Conclusions In HCM patients, extrinsic factors such as obesity are independently associated with increase in LV mass and may dictate progression of heart failure symptoms.</description><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Body Mass Index</subject><subject>cardiac magnetic resonance</subject><subject>Cardiology</subject><subject>Cardiology. Vascular system</subject><subject>Cardiomyopathy, Hypertrophic - epidemiology</subject><subject>Cardiovascular</subject><subject>Cohort Studies</subject><subject>Diabetes Mellitus, Type 2 - epidemiology</subject><subject>Disease Progression</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart</subject><subject>Heart attacks</subject><subject>Heart Failure - classification</subject><subject>Heart Failure - epidemiology</subject><subject>Heart Ventricles - pathology</subject><subject>Humans</subject><subject>Hypertension - epidemiology</subject><subject>hypertrophic cardiomyopathy</subject><subject>hypertrophy</subject><subject>Internal Medicine</subject><subject>Italy - epidemiology</subject><subject>Likelihood Functions</subject><subject>Magnetic Resonance Imaging, Cine</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Metabolic diseases</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Myocarditis. Cardiomyopathies</subject><subject>Obesity</subject><subject>Obesity - epidemiology</subject><subject>outcome</subject><subject>Phenotype</subject><subject>Sex Factors</subject><subject>United States - epidemiology</subject><subject>Ventricular Outflow Obstruction - epidemiology</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kkFr3DAQhUVpaTZJ_0APxVAKvXirkSxpBSUQTNMUAik0PfUgZFlm5XotV9IW_O8jZ7cJ5FB4oIO-ecy8GYTeAl4DBv6pX_famDXBQNc4i5MXaAWMbUrKpHiJVlhQVgKW4gSdxthjjPkG5Gt0QiivMkNX6NdtY6NLc6HHtnApFpcxeuN0cn4ski--b-3o0zzZB6Ae3OiMHora70O0hRuL6_wXUvDT1pmi1qF1fjf7SaftfI5edXqI9s3xPUM_r77c1dflze3Xb_XlTWmYkKnkojIaiICuBVExjjeN5CbLyA4ow4K3jW5IIwBw1bKWa9o0mnRasqaqKKZn6OPBdwr-z97GpHYuGjsMerR-HxVUQIFzwklG3z9D-zzJmLtTwCtG5EZKnilyoEzwMQbbqSm4nQ6zAqyW6FWvlujVEr3CWQ_W747W-2Zn28eSf1ln4MMR0DFn2AU9GhefOMEpEYJl7vOBszmzv84GFY2zo7GtC9Yk1Xr3_z4unpWb49Z-29nGp3lVJAqrH8uRLDcCFIOgQOg9H9m1pQ</recordid><startdate>20130730</startdate><enddate>20130730</enddate><creator>Olivotto, Iacopo, MD</creator><creator>Maron, Barry J., MD</creator><creator>Tomberli, Benedetta, MD</creator><creator>Appelbaum, Evan, MD</creator><creator>Salton, Carol, AB</creator><creator>Haas, Tammy S., RN</creator><creator>Gibson, C. Michael, MD</creator><creator>Nistri, Stefano, MD</creator><creator>Servettini, Eleonora, MD</creator><creator>Chan, Raymond H., MD</creator><creator>Udelson, James E., MD</creator><creator>Lesser, John R., MD</creator><creator>Cecchi, Franco, MD</creator><creator>Manning, Warren J., MD</creator><creator>Maron, Martin S., MD</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20130730</creationdate><title>Obesity and its Association to Phenotype and Clinical Course in Hypertrophic Cardiomyopathy</title><author>Olivotto, Iacopo, MD ; Maron, Barry J., MD ; Tomberli, Benedetta, MD ; Appelbaum, Evan, MD ; Salton, Carol, AB ; Haas, Tammy S., RN ; Gibson, C. Michael, MD ; Nistri, Stefano, MD ; Servettini, Eleonora, MD ; Chan, Raymond H., MD ; Udelson, James E., MD ; Lesser, John R., MD ; Cecchi, Franco, MD ; Manning, Warren J., MD ; Maron, Martin S., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c579t-674ca1271fd1745608b96c96cc9f135076dbab2b71104d5d6a3bba2fa95b44303</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>Body Mass Index</topic><topic>cardiac magnetic resonance</topic><topic>Cardiology</topic><topic>Cardiology. Vascular system</topic><topic>Cardiomyopathy, Hypertrophic - epidemiology</topic><topic>Cardiovascular</topic><topic>Cohort Studies</topic><topic>Diabetes Mellitus, Type 2 - epidemiology</topic><topic>Disease Progression</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart</topic><topic>Heart attacks</topic><topic>Heart Failure - classification</topic><topic>Heart Failure - epidemiology</topic><topic>Heart Ventricles - pathology</topic><topic>Humans</topic><topic>Hypertension - epidemiology</topic><topic>hypertrophic cardiomyopathy</topic><topic>hypertrophy</topic><topic>Internal Medicine</topic><topic>Italy - epidemiology</topic><topic>Likelihood Functions</topic><topic>Magnetic Resonance Imaging, Cine</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Metabolic diseases</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Myocarditis. Cardiomyopathies</topic><topic>Obesity</topic><topic>Obesity - epidemiology</topic><topic>outcome</topic><topic>Phenotype</topic><topic>Sex Factors</topic><topic>United States - epidemiology</topic><topic>Ventricular Outflow Obstruction - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Olivotto, Iacopo, MD</creatorcontrib><creatorcontrib>Maron, Barry J., MD</creatorcontrib><creatorcontrib>Tomberli, Benedetta, MD</creatorcontrib><creatorcontrib>Appelbaum, Evan, MD</creatorcontrib><creatorcontrib>Salton, Carol, AB</creatorcontrib><creatorcontrib>Haas, Tammy S., RN</creatorcontrib><creatorcontrib>Gibson, C. Michael, MD</creatorcontrib><creatorcontrib>Nistri, Stefano, MD</creatorcontrib><creatorcontrib>Servettini, Eleonora, MD</creatorcontrib><creatorcontrib>Chan, Raymond H., MD</creatorcontrib><creatorcontrib>Udelson, James E., MD</creatorcontrib><creatorcontrib>Lesser, John R., MD</creatorcontrib><creatorcontrib>Cecchi, Franco, MD</creatorcontrib><creatorcontrib>Manning, Warren J., MD</creatorcontrib><creatorcontrib>Maron, Martin S., MD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Olivotto, Iacopo, MD</au><au>Maron, Barry J., MD</au><au>Tomberli, Benedetta, MD</au><au>Appelbaum, Evan, MD</au><au>Salton, Carol, AB</au><au>Haas, Tammy S., RN</au><au>Gibson, C. Michael, MD</au><au>Nistri, Stefano, MD</au><au>Servettini, Eleonora, MD</au><au>Chan, Raymond H., MD</au><au>Udelson, James E., MD</au><au>Lesser, John R., MD</au><au>Cecchi, Franco, MD</au><au>Manning, Warren J., MD</au><au>Maron, Martin S., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Obesity and its Association to Phenotype and Clinical Course in Hypertrophic Cardiomyopathy</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>2013-07-30</date><risdate>2013</risdate><volume>62</volume><issue>5</issue><spage>449</spage><epage>457</epage><pages>449-457</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><coden>JACCDI</coden><abstract>Objectives This study sought to assess the impact of body mass index (BMI) on cardiac phenotypic and clinical course in a multicenter hypertrophic cardiomyopathy (HCM) cohort. Background It is unresolved whether clinical variables promoting left ventricular (LV) hypertrophy in the general population, such as obesity, may influence cardiac phenotypic and clinical course in patients with HCM. Methods In 275 adult HCM patients (age 48 ± 14 years; 70% male), we assessed the relation of BMI to LV mass, determined by cardiovascular magnetic resonance (CMR) and heart failure progression. Results At multivariate analysis, BMI proved independently associated with the magnitude of hypertrophy: pre-obese and obese HCM patients (BMI 25 to 30 kg/m2 and >30 kg/m2 , respectively) showed a 65% and 310% increased likelihood of an LV mass in the highest quartile (>120 g/m2 ), compared with normal weight patients (BMI <25 kg/m2 ; hazard ratio [HR]: 1.65; 95% confidence interval [CI]: 0.73 to 3.74, p = 0.22 and 3.1; 95% CI: 1.42 to 6.86, p = 0.004, respectively). Other features associated with LV mass >120 g/m2 were LV outflow obstruction (HR: 4.9; 95% CI: 2.4 to 9.8; p < 0.001), systemic hypertension (HR: 2.2; 95% CI: 1.1 to 4.5; p = 0.026), and male sex (HR: 2.1; 95% CI: 0.9 to 4.7; p = 0.083). During a median follow-up of 3.7 years (interquartile range: 2.5 to 5.3), obese patients showed an HR of 3.6 (95% CI: 1.2 to 10.7, p = 0.02) for developing New York Heart Association (NYHA) functional class III to IV symptoms compared to nonobese patients, independent of outflow obstruction. Noticeably, the proportion of patients in NYHA functional class III at the end of follow-up was 13% among obese patients, compared with 6% among those of normal weight (p = 0.03). Conclusions In HCM patients, extrinsic factors such as obesity are independently associated with increase in LV mass and may dictate progression of heart failure symptoms.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>23643593</pmid><doi>10.1016/j.jacc.2013.03.062</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Biological and medical sciences Body Mass Index cardiac magnetic resonance Cardiology Cardiology. Vascular system Cardiomyopathy, Hypertrophic - epidemiology Cardiovascular Cohort Studies Diabetes Mellitus, Type 2 - epidemiology Disease Progression Female Follow-Up Studies Heart Heart attacks Heart Failure - classification Heart Failure - epidemiology Heart Ventricles - pathology Humans Hypertension - epidemiology hypertrophic cardiomyopathy hypertrophy Internal Medicine Italy - epidemiology Likelihood Functions Magnetic Resonance Imaging, Cine Male Medical sciences Metabolic diseases Middle Aged Multivariate Analysis Myocarditis. Cardiomyopathies Obesity Obesity - epidemiology outcome Phenotype Sex Factors United States - epidemiology Ventricular Outflow Obstruction - epidemiology |
| title | Obesity and its Association to Phenotype and Clinical Course in Hypertrophic Cardiomyopathy |
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