Effect of obesity on the prognostic impact of atrial fibrillation in heart failure with preserved ejection fraction

West Tokyo Heart Failure (WET-HF) Registry Collaborative Group

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Although obesity is associated with left ventricular hypertrophy, diastolic dysfunction, and occurrence of atrial fibrillation (AF), obese heart failure (HF) patients have a more favorable clinical outcome (obesity paradox). The clinical impact of AF on obese or lean HF patients has not been fully elucidated. Methods and Results: We analyzed 1,681 patients who were enrolled in the West Tokyo Heart Failure Registry (WET-HF Registry), a multicenter, prospective cohort registry from 2005 through 2014. We assigned them to 3 categories based on body mass index (BMI): low, BMI <18.5; medium, BMI ≥18.5 and <25; and high, BMI ≥25 (n=182/915/400). The clinical endpoint was all-cause death or readmission for acute decompensated HF. During 406 days of follow-up (IQR, 116-739 days), AF was associated with a higher risk of the endpoint in the HF with preserved ejection fraction (HFpEF) group (P<0.001, log-rank test), but not in the HF with reduced EF (HFrEF) group. AF was associated with a higher risk of the endpoint in low and medium BMI patients with HFpEF (P=0.016 and 0.009, respectively). On Multivariate Cox proportional hazards analysis, AF was an independent predictor of the endpoint in patients with BMI <25 from the HFpEF group (hazard ratio, 1.74; 95% CI: 1.21-2.54, P=0.003), but not in the other subgroups. Conclusions: AF had a negative impact on clinical outcome in non-obese patients with HFpEF.

Original languageEnglish
Pages (from-to)966-973
Number of pages8
JournalCirculation Journal
Volume81
Issue number7
DOIs
Publication statusPublished - 2017

Fingerprint

Atrial Fibrillation
Body Mass Index
Heart Failure
Obesity
Registries
Tokyo
Left Ventricular Hypertrophy
Cause of Death

Keywords

  • Atrial fibrillation
  • Body mass index
  • Heart failure
  • Obesity paradox

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Effect of obesity on the prognostic impact of atrial fibrillation in heart failure with preserved ejection fraction. / West Tokyo Heart Failure (WET-HF) Registry Collaborative Group.

In: Circulation Journal, Vol. 81, No. 7, 2017, p. 966-973.

Research output: Contribution to journalArticle

West Tokyo Heart Failure (WET-HF) Registry Collaborative Group. / Effect of obesity on the prognostic impact of atrial fibrillation in heart failure with preserved ejection fraction. In: Circulation Journal. 2017 ; Vol. 81, No. 7. pp. 966-973.
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abstract = "Background: Although obesity is associated with left ventricular hypertrophy, diastolic dysfunction, and occurrence of atrial fibrillation (AF), obese heart failure (HF) patients have a more favorable clinical outcome (obesity paradox). The clinical impact of AF on obese or lean HF patients has not been fully elucidated. Methods and Results: We analyzed 1,681 patients who were enrolled in the West Tokyo Heart Failure Registry (WET-HF Registry), a multicenter, prospective cohort registry from 2005 through 2014. We assigned them to 3 categories based on body mass index (BMI): low, BMI <18.5; medium, BMI ≥18.5 and <25; and high, BMI ≥25 (n=182/915/400). The clinical endpoint was all-cause death or readmission for acute decompensated HF. During 406 days of follow-up (IQR, 116-739 days), AF was associated with a higher risk of the endpoint in the HF with preserved ejection fraction (HFpEF) group (P<0.001, log-rank test), but not in the HF with reduced EF (HFrEF) group. AF was associated with a higher risk of the endpoint in low and medium BMI patients with HFpEF (P=0.016 and 0.009, respectively). On Multivariate Cox proportional hazards analysis, AF was an independent predictor of the endpoint in patients with BMI <25 from the HFpEF group (hazard ratio, 1.74; 95{\%} CI: 1.21-2.54, P=0.003), but not in the other subgroups. Conclusions: AF had a negative impact on clinical outcome in non-obese patients with HFpEF.",
keywords = "Atrial fibrillation, Body mass index, Heart failure, Obesity paradox",
author = "{West Tokyo Heart Failure (WET-HF) Registry Collaborative Group} and Mayuko Yagawa and Yuji Nagatomo and Yuki Izumi and Keitaro Mahara and Hitonobu Tomoike and Yasuyuki Shiraishi and Takashi Kohno and Atsushi Mizuno and Ayumi Goda and Shun Kohsaka and Tsutomu Yoshikawa",
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T1 - Effect of obesity on the prognostic impact of atrial fibrillation in heart failure with preserved ejection fraction

AU - West Tokyo Heart Failure (WET-HF) Registry Collaborative Group

AU - Yagawa, Mayuko

AU - Nagatomo, Yuji

AU - Izumi, Yuki

AU - Mahara, Keitaro

AU - Tomoike, Hitonobu

AU - Shiraishi, Yasuyuki

AU - Kohno, Takashi

AU - Mizuno, Atsushi

AU - Goda, Ayumi

AU - Kohsaka, Shun

AU - Yoshikawa, Tsutomu

PY - 2017

Y1 - 2017

N2 - Background: Although obesity is associated with left ventricular hypertrophy, diastolic dysfunction, and occurrence of atrial fibrillation (AF), obese heart failure (HF) patients have a more favorable clinical outcome (obesity paradox). The clinical impact of AF on obese or lean HF patients has not been fully elucidated. Methods and Results: We analyzed 1,681 patients who were enrolled in the West Tokyo Heart Failure Registry (WET-HF Registry), a multicenter, prospective cohort registry from 2005 through 2014. We assigned them to 3 categories based on body mass index (BMI): low, BMI <18.5; medium, BMI ≥18.5 and <25; and high, BMI ≥25 (n=182/915/400). The clinical endpoint was all-cause death or readmission for acute decompensated HF. During 406 days of follow-up (IQR, 116-739 days), AF was associated with a higher risk of the endpoint in the HF with preserved ejection fraction (HFpEF) group (P<0.001, log-rank test), but not in the HF with reduced EF (HFrEF) group. AF was associated with a higher risk of the endpoint in low and medium BMI patients with HFpEF (P=0.016 and 0.009, respectively). On Multivariate Cox proportional hazards analysis, AF was an independent predictor of the endpoint in patients with BMI <25 from the HFpEF group (hazard ratio, 1.74; 95% CI: 1.21-2.54, P=0.003), but not in the other subgroups. Conclusions: AF had a negative impact on clinical outcome in non-obese patients with HFpEF.

AB - Background: Although obesity is associated with left ventricular hypertrophy, diastolic dysfunction, and occurrence of atrial fibrillation (AF), obese heart failure (HF) patients have a more favorable clinical outcome (obesity paradox). The clinical impact of AF on obese or lean HF patients has not been fully elucidated. Methods and Results: We analyzed 1,681 patients who were enrolled in the West Tokyo Heart Failure Registry (WET-HF Registry), a multicenter, prospective cohort registry from 2005 through 2014. We assigned them to 3 categories based on body mass index (BMI): low, BMI <18.5; medium, BMI ≥18.5 and <25; and high, BMI ≥25 (n=182/915/400). The clinical endpoint was all-cause death or readmission for acute decompensated HF. During 406 days of follow-up (IQR, 116-739 days), AF was associated with a higher risk of the endpoint in the HF with preserved ejection fraction (HFpEF) group (P<0.001, log-rank test), but not in the HF with reduced EF (HFrEF) group. AF was associated with a higher risk of the endpoint in low and medium BMI patients with HFpEF (P=0.016 and 0.009, respectively). On Multivariate Cox proportional hazards analysis, AF was an independent predictor of the endpoint in patients with BMI <25 from the HFpEF group (hazard ratio, 1.74; 95% CI: 1.21-2.54, P=0.003), but not in the other subgroups. Conclusions: AF had a negative impact on clinical outcome in non-obese patients with HFpEF.

KW - Atrial fibrillation

KW - Body mass index

KW - Heart failure

KW - Obesity paradox

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U2 - 10.1253/circj.CJ-16-1130

DO - 10.1253/circj.CJ-16-1130

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