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Long-term safety and effectiveness of unprotected left main coronary stenting with drug-eluting stents compared with bare-metal stents Left main coronary angioplasty: early and late results of 127 acute and elective procedures Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms. Results from the prospective multicenter DISCOVER-FLOW Unprotected Left Main Disease: Indications and Optimal Strategies for Percutaneous Intervention Real-world clinical utility and impact on clinical decision-making of coronary computed tomography angiography-derived fractional flow reserve: lessons from the ADVANCE Registry Angiographic versus functional severity of coronary artery stenoses in the FAME study fractional flow reserve versus angiography in multivessel evaluation Influence of Heart Rate on FFR Measurements: An Experimental and Clinical Validation Study Impact of myocardial supply area on the transstenotic hemodynamics as determined by fractional flow reserve Validation of bifurcation DEFINITION criteria and comparison of stenting strategies in true left main bifurcation lesions A prediction model of simple echocardiographic variables to screen for potentially correctable shunts in adult patients with pulmonary arterial hypertension associated with atrial septal defects: a cross-sectional study
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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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