Prognostic Effect of Body Mass Index in Patients With an Implantable Cardioverter-defibrillator for Primary Prevention of Sudden Death

González-Cambeiro, María Cristina; Rodríguez‐Mañero, Moisés; Abellas-Sequeiros, Alba; Moreno‐Arribas, José; Filgueira-Rama, David; González-Juanàtey, José Ramón

doi:10.1016/j.rec.2016.04.055

Cited by 6 publications

(14 citation statements)

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“…For patients with an implantable cardioverter defibrillator (ICD) who lived with a potentially fatal arrhythmia or a high risk of sudden cardiac death (SCD) due to underlying heart disease, whether the "obesity paradox" exists is controversial because the relevant research results are inconsistent. [12][13][14][15][16][17] Additionally, no research has focused on ICD patients with nonischemic cardiomyopathy (NICM). Our study intended to explore the impact of BMI on clinical outcomes in NICM patients with an ICD.…”

Section: Introductionmentioning

confidence: 99%

“…The 'obesity paradox' occurs when a higher body mass index (BMI) leads to better clinical outcomes. For patients with an implantable cardioverter defibrillator (ICD) who lived with a potentially fatal arrhythmia or a high risk of sudden cardiac death (SCD) due to underlying heart disease, whether the “obesity paradox” exists is controversial because the relevant research results are inconsistent 12‐17 . Additionally, no research has focused on ICD patients with nonischemic cardiomyopathy (NICM).…”

Section: Introductionmentioning

confidence: 99%

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Overweight and obesity as protective factors against mortality in nonischemic cardiomyopathy patients with an implantable cardioverter defibrillator

Zhou

Zhao

Tang

et al. 2020

Clinical Cardiology

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Background: Previous studies have reported inconsistent results on the relationship between body mass index (BMI) and clinical outcomes in implantable cardioverter defibrillator (ICD) patients. Additionally, research on ICD patients with nonischemic cardiomyopathy (NICM) is lacking. Hypothesis: This study aimed to investigate the impact of BMI on mortality and ventricular arrhythmias (VAs) in NICM patients with an ICD. Methods: This study retrospectively analyzed the data from the Study of Home Monitoring System Safety and Efficacy in Cardiac Implantable Electronic Deviceimplanted patients (SUMMIT) in China. Four hundred and eighty NICM patients with an ICD having BMI data were enrolled. Patients were divided into two groups: underweight and normal range group (BMI < 24 kg/m 2), overweight and obese group (BMI≥24 kg/m 2). The primary endpoint was all-cause mortality. The secondary endpoint was the first occurrence of VAs requiring appropriate ICD therapy or shock. Results: During a median follow-up of 61 (1-95) months, 70 patients (14.6%) died, 173 patients (36%) experienced VAs requiring appropriate ICD therapy, and 112 patients (23.3%) were treated with ICD shock. Multivariate Cox regression modeling indicated a decreased mortality risk in the overweight and obese group compared with the underweight and normal range group (hazard ratio = 0.44, 95% confidence interval 0.26-0.77, P = .003). However, the risk of VAs was similar in both groups in univariate and multivariate Cox models. Conclusions: Compared with underweight and normal weight, overweight and obesity are protective against mortality but have only a neutral impact on VAs risk in NICM patients with an ICD.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Overweight and obesity as protective factors against mortality in nonischemic cardiomyopathy patients with an implantable cardioverter defibrillator

Zhou

Zhao

Tang

et al. 2020

Clinical Cardiology

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“…However, a post-hoc analysis of the ICD/CRT-D patients from the Multicenter Automatic Defibrillator Implantation trial with Cardiac Resynchronization Therapy (MADIT-CRT) showed that BMI had no impact on VT/VF ( 9 ). Another study from Spain also found that BMI was not associated with VT/VF in ICD patients for the purpose of primary prevention ( 10 ). These contradictory results may be the result of differences in the population characteristics, sample sizes, racial groups, and the adjustment of confounders.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have illustrated the effect of BMI on the risk of VT/VF in ICD/CRT-D patients, but the results have been inconsistent ( 6 , 8 – 10 ). Pietrasik et al conducted a retrospective analysis of non-diabetic patients with ischemic left ventricular dysfunction using data from the Multicenter Automatic Defibrillator Implantation Trial-II (MADIT II) and demonstrated that a higher rate of VT/VF was detected in obese patients (BMI ≥30 kg/m 2 ) compared with the rate in non-obese patients ( 8 ).…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, as a global health problem, obesity, which is usually assessed by body mass index (BMI) in clinical practice, has been recognized as a risk factor for SCD in the general population ( 7 ). However, the results from the few studies on the effects of obesity on SCD or VT/VF in patients who had received an ICD/CRT-D due to their high risk of SCD have been controversial ( 6 , 8 – 10 ).…”

Section: Introductionmentioning

confidence: 99%

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Non-linear Association Between Body Mass Index and Ventricular Tachycardia/Ventricular Fibrillation in Patients With an Implantable Cardioverter-Defibrillator or Cardiac Resynchronization Therapy Defibrillator: A Multicenter Cohort Study

Zhou

Zhao

Tang

et al. 2020

Front. Cardiovasc. Med.

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Background: Results from studies on the effects of obesity on sudden cardiac death (SCD) or ventricular tachycardia/ventricular fibrillation (VT/VF) in patients with an implantable cardioverter-defibrillator/cardiac resynchronization therapy defibrillator (ICD/CRT-D) are inconsistent. Our study aimed to explore the impact of BMI on VT/VF in patients with an ICD/CRT-D.Methods: We retrospectively analyzed the data from the Study of Home Monitoring System Safety and Efficacy in Cardiac Implantable Electronic Device–implanted Patients in China. Nine hundred and seventy ICD/CRT-D patients were enrolled. The outcome was the first occurrence of VT/VF requiring appropriate ICD/CRT-D therapy. A general linear model and general additive model were used to assess the relationship between BMI and VT/VF.Results: After a median follow-up of 5.17 years, 352 (36.3%) patients experienced VT/VF requiring appropriate ICD/CRT-D therapy. BMI, whether as a continuous variable or a categorical variable classified by various BMI classification criteria, had no significant effect on VT/VF according to a multivariable Cox proportional hazards model with adjustment for potential confounders. However, a non-linear association between BMI and VT/VF was identified using a cubic spline function model and smooth curve fitting. The inflection point for the curve was found at a BMI level of 23 kg/m2. The hazard ratios (95% confidence intervals) for VT/VF were 1.12 (1.01–1.24) and 0.96 (0.90–1.02) to the left and right of the inflection point, respectively.Conclusions: BMI is related to VT/VF in a non-linear manner in patients with an ICD/CRT-D. Our research suggests a complicated role of BMI in VT/VF with different impacts at different ranges.

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Effects of obesity on arrhythmic events and survival in patients with an implantable cardioverter defibrillator

et al. 2022

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Background Studies have shown that increased body weight and obesity may be associated with an increased risk of arrhythmic events. The aim of this study was to evaluate the effect of obesity on the risk of arrhythmic events, hospitalization, and death in patients who received implantable cardioverter defibrillator (ICD) therapy for primary or secondary prevention.Material and Methods A single-center, prospective, observational study was conducted. Patients with body mass index (BMI) <30 kg / m2 were classified as non-obese, and patients with BMI ≥30 kg / m2 were classified as obese. The primary endpoints were arrhythmic events and device interventions. The secondary endpoints were all-cause mortality, cardiac mortality, cardiac rehospitalization, and a composite endpoint of mortality and hospitalization.Results Among a total of 340 patients, 78.2 % were male, and 22.1 % were obese. The mean age was 60.9 yrs. Ventricular tachycardia (VT) was more frequent in non-obese patients (HR 0.57, [CI] 0.38–0.87, p=0.009). All-cause mortality and cardiac mortality in all patients tended to be more frequent in non-obese (HR 2.71, [CI] 0.93–7.93, p= 0.069 for all-cause mortality; HR 3.29, [CI] 0.97–11.17, p=0.056 for cardiac mortality). In the subgroup analysis, VT, all-cause mortality, and cardiac mortality were more common for non-obese patients in primary prevention and ischemic heart failure (HF) groups.Conclusion While VT was more frequent in non-obese patients, VF, ICD appropriate shock, inappropriate shock, and antitachycardia pacing were similar in obese and non-obese patients. All-cause mortality and cardiac mortality were more frequent in non-obese patients.

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Prognostic Effect of Body Mass Index in Patients With an Implantable Cardioverter-defibrillator for Primary Prevention of Sudden Death

Cited by 6 publications

References 6 publications

Overweight and obesity as protective factors against mortality in nonischemic cardiomyopathy patients with an implantable cardioverter defibrillator

Overweight and obesity as protective factors against mortality in nonischemic cardiomyopathy patients with an implantable cardioverter defibrillator

Non-linear Association Between Body Mass Index and Ventricular Tachycardia/Ventricular Fibrillation in Patients With an Implantable Cardioverter-Defibrillator or Cardiac Resynchronization Therapy Defibrillator: A Multicenter Cohort Study

Effects of obesity on arrhythmic events and survival in patients with an implantable cardioverter defibrillator

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