Obesity and its Association to Phenotype and Clinical Course in Hypertrophic Cardiomyopathy
Obesity and its Association to Phenotype and Clinical Course in Hypertrophic Cardiomyopathy
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DOI：
10.1016/j.jacc.2013.03.062
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发表时间：
2013-07-30
影响因子：
24
通讯作者：
Maron, Martin S.
中科院分区：
文献类型：
--
作者：
Olivotto, Iacopo;Maron, Barry J.;Maron, Martin S.
目的本研究旨在评估体重指数（BMI）对多中心肥厚型心肌病（HCM）队列中心脏表型和临床病程的影响。可能影响HCM患者的心脏表型和临床病程（年龄48 +/- 14岁; 70%男性），我们评估了BMI与LV质量的关系，通过心血管磁共振（CMR）和心力衰竭进展确定。肥胖前期和肥胖HCM患者（BMI分别为25 - 30 kg/m2和>30 kg/m2）显示，在最高四分位数中，左室肿块的可能性增加65%和310（>120 g/m2），与正常体重患者相比（BMI 120 g/m（2）为左室流出道梗阻（HR：4.9; 95% CI：2.4 - 9.8; p < 0.001），全身性高血压（HR：2.2; 95% CI：1.1至4.5; p = 0.026）和男性（HR：2.1; 95% CI：0.9至4.7; p = 0.083）。中位随访时间为3.7年（四分位距：2.5 - 5.3），与非肥胖患者相比，肥胖患者发生纽约心脏协会（NYHA）心功能III-IV级症状的HR为3.6（95% CI：1.2 - 10.7，p = 0.02），与流出道梗阻无关。值得注意的是，在随访结束时，肥胖患者中NYHA心功能III级的患者比例为13%，而正常体重患者中为6%（p = 0.03）。结论在HCM患者中，肥胖等外在因素与LV质量增加独立相关，并可能决定心力衰竭症状的进展。(C)2013年美国心脏病学会基金会
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/m(2) and >30 kg/m(2), respectively) showed a 65% and 310% increased likelihood of an LV mass in the highest quartile (>120 g/m(2)), compared with normal weight patients (BMI 120 g/m(2) 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. (C) 2013 by the American College of Cardiology Foundation