Obesity is a risk factor for heart failure (HF), but its presence among
HF patients may be associated with favorable outcomes. We investigated
the long-term outcomes across different body mass index (BMI) groups,
after cardiac resynchronization therapy (CRT), and whether defibrillator
back-up (CRT-D) confers survival benefit. One thousand two-hundred
seventy-seven (1,277) consecutive patients (mean age: 67.0 +/- 12.7
years, 44.1% women, and mean BMI: 28.3 +/- 5.6 Kg/m(2)) who underwent
CRT implantation in 5 centers between 2000-2014 were followed-up for a
median period of 4.9 years (IQR 2.4 to 7.5). More than 10% of patients
had follow-up for >10 years. Patients were classified according to BMI
as normal: <25.0 Kg/m(2), overweight: 25.0 to 29.9 Kg/m(2) and obese: >=
30.0 Kg/m(2). 364 patients had normal weight, 494 were overweight and
419 were obese. CRT-Ds were implanted in >75% of patients, but were
used less frequently in obese individuals. The composite endpoint of
all-cause mortality or cardiac transplant/left ventricular assist device
(LVAD) occurred in 50.9% of patients. At 10-year follow-up, less than a
quarter of patients in the lowest and highest BMI categories were still
alive and free from heart transplant/LVAD. After adjustment BMI of 25 to
29.9 Kg/m(2) (HR = 0.73 [95%CI 0.56 to 0.96], p = 0.023) and use of
CRT-D (HR = 0.74 [95% CI 0.55 to 0.98], p = 0.039) were independent
predictors of survival free from LVAD/heart transplant. BMI of 25 to
29.9 Kg/m(2) at the time of implant was independently associated with
favourable long-term 10-year survival. Use of CRT-D was associated with
improved survival irrespective of BMI class. (C) 2021 Elsevier Inc. All
rights reserved
