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Optimal Strategy for Provisional Side Branch Intervention in Coronary Bifurcation Lesions: 3-Year Outcomes of the SMART-STRATEGY Randomized Trial Identification of High-Risk Plaques Destined to Cause Acute Coronary Syndrome Using Coronary Computed Tomographic Angiography and Computational Fluid Dynamics New Volumetric Analysis Method for Stent Expansion and its Correlation With Final Fractional Flow Reserve and Clinical Outcome An ILUMIEN I Substudy Double-Kiss-Crush Bifurcation Stenting: Step-by-Step Troubleshooting Comparison of Coronary Intimal Plaques by Optical Coherence Tomography in Arteries With Versus Without Internal Running Vasa Vasorum The EBC TWO Study (European Bifurcation Coronary TWO): A Randomized Comparison of Provisional T-Stenting Versus a Systematic 2 Stent Culotte Strategy in Large Caliber True Bifurcations Chronic thromboembolic pulmonary hypertension Difference in basic concept of coronary bifurcation intervention between Korea and Japan. Insight from questionnaire in experts of Korean and Japanese bifurcation clubs Percutaneous Coronary Intervention Techniques for Bifurcation Disease: Network Meta-analysis Reveals Superiority of Double-Kissing Crush Robustness of Fractional Flow Reserve for Lesion Assessment in Non-Infarct-Related Arteries of Patients With Myocardial Infarction
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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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