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Impact of an optical coherence tomography guided approach in acute coronary syndromes: A propensity matched analysis from the international FORMIDABLE-CARDIOGROUP IV and USZ registry Retrospective Comparison of Long-Term Clinical Outcomes Between Percutaneous Coronary Intervention and Medical Therapy in Stable Coronary Artery Disease With Gray Zone Fractional Flow Reserve - COMFORTABLE Retrospective Study Optical Coherence Tomography-Guided Percutaneous Coronary Intervention in ST-Segment-Elevation Myocardial Infarction: A Prospective Propensity-Matched Cohort of the Thrombectomy Versus Percutaneous Coronary Intervention Alone Trial A Randomized Trial Evaluating Online 3-Dimensional Optical Frequency Domain Imaging-Guided Percutaneous Coronary Intervention in Bifurcation Lesions Experimental basis of determining maximum coronary, myocardial, and collateral blood flow by pressure measurements for assessing functional stenosis severity before and after percutaneous transluminal coronary angioplasty Left main coronary artery compression in pulmonary hypertension Robustness of Fractional Flow Reserve for Lesion Assessment in Non-Infarct-Related Arteries of Patients With Myocardial Infarction Rotational Atherectomy in acute STEMI with heavily calcified culprit lesion is a rule breaking solution Optimal threshold of postintervention minimum stent area to predict in-stent restenosis in small coronary arteries: An optical coherence tomography analysis PCI for obstructive bifurcation lesions the 14th consensus document from the european bifurcation club
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Clinical Trial2018 May 22. [Epub ahead of print]

JOURNAL：Chest. Article Link

The association between body mass index and obesity with survival in pulmonary arterial hypertension

Weatherald J, Huertas A, Boucly A et al. Keywords: body mass index; obesity; prognosis; pulmonary arterial hypertension; survival

ABSTRACT

BACKGROUND - An obesity paradox, wherein obese patients have lower mortality, has been described in cardiopulmonary diseases, including pulmonary arterial hypertension (PAH). Our objective was to determine whether obesity and body mass index (BMI) are associated with mortality in patients with PAH.


METHODS - We assessed incident patients with idiopathic, drug-induced, and heritable PAH from the French PAH Registry. Cox regression and Kaplan-Meier analysis were used to assess the association between BMI and obesity with all-cause mortality.

RESULTS - Of 1255 patients included, 30% were obese. A higher proportion of females (65.1% vs 53.4%, p<0.01), drug-induced PAH (28.9% vs 9.2%, p<0.01), systemic hypertension, diabetes, and hypothyroidism were present in the obese group. More obese patients were in New York Heart Association class III (66.4% vs. 57.1%), fewer were class IV (11.8% vs 16.9%) (p<0.01), and 6-minute walk distance was lower (276±121 vs 324±146, p<0.01). Right atrial pressure, pulmonary wedge pressure and cardiac index were higher while pulmonary vascular resistance was lower in obese patients. Neither BMI (HR 0.99, 95%CI 0.97-1.01, p=0.41) nor obesity (HR 1.0, 95%CI 0.99-1.01, p=0.46) were associated with mortality in multivariable analyses. There was a significant interaction between age and obesity such that mortality increased among morbidly obese patients under 65 years old (HR 3.01, 95%CI 1.56-5.79, p=0.001).

CONCLUSIONS - Obesity was not associated with mortality in the overall population, but there was an age-obesity interaction with increased mortality among young morbidly obese patients. These results have implications for active weight management in younger morbidly obese patients who are otherwise candidates for lung transplantation.

Copyright © 2018. Published by Elsevier Inc.
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