Relationship Between Myocardial Function, Body Mass Index, and Outcome After ST-Segment–Elevation Myocardial Infarction

Abstract

Background-Better survival for overweight and obese patients after ST-segment-elevation myocardial infarction (STEMI) has been demonstrated. The association between body mass index (BMI), outcome, and left ventricular (LV) structure and function after STEMI, including LV longitudinal strain (global longitudinal strain), was evaluated. . LV global longitudinal strain was measured using speckle-tracking analysis. Primary outcome measure was all-cause mortality. Compared with normal/underweight patients, obese patients were younger and more likely to have diabetes mellitus, hypertension, and hyperlipidemia and have higher discharge blood pressures. Despite no significant differences in infarct size, obese patients had significantly more impaired LV global longitudinal strain (−13.7±3.8 versus −15.0±4.2% and −15.0±4.1%; P<0.001) compared with normal/underweight and overweight patients, respectively. Although normal/underweight patients had the worst overall survival (log-rank P=0.04) after STEMI during a median follow-up of 5.2 (3.6, 6.9) years on Kaplan-Meier analysis, a significant nonlinear association between BMI and all-cause mortality across the range of BMI was seen, persisting after adjustment for age and sex.Conclusions-Obese patients demonstrate greater adverse LV remodeling and more impaired LV deformation after STEMI compared with those with normal BMI, amid similar infarct characteristics. Normal weight patients continue to demonstrate the worst survival, suggesting that the potential nonadverse effect of higher BMI in this population is independent of LV function. (Circ Cardiovasc Imaging. 2017;10:e005670.

Takotsubo syndrome – fatal prognosis of patients with low body mass index in 5-year follow-up

“…Moscarella et al [27] stated that after a 5-year follow-up period 9.5% of overweight patients were dead, slightly more patients with BMI < 25 -13.7% and the smallest number of obese patients with STEMI -6.3%. Joyce et al [29] noted similar results obtained during a 5-year follow-up of patients after STEMI, as 13.6% of patients who were underweight or had normal body weight, and 9.1% of overweight and obese patients died.…”

“…In the present study overweight patients constitute the biggest group (45%), people with normal body weight represent 35%, 12.5% of patients from the tested group were obese, while 7.5% of patients were underweight. Joyce et al [29] reported that 51% of patients were overweight, 30% had normal body weight, and 19% people were obese. Similarly, in the study by Moscarella et al [27], overweight patients amounted to nearly half (49.4%) of the group with NSTEMI, obese patients -22.4% and people with normal BMI -28.2%.…”

Does body mass index truly affect mortality and cardiovascular outcomes in patients after coronary revascularization with percutaneous coronary intervention or coronary artery bypass graft? A systematic review and network meta‐analysis

“…Among them, 2,040 records were excluded as a result of irrelevant content. Finally, a total of 65 records met the eligibility criteria and provided sufficient data to be included in the current NMA . A flow diagram of the literature selection process is listed in Fig.…”

Effect of Low Body Mass Index on the Clinical Outcomes of Japanese Patients With Acute Myocardial Infarction ― Results From the Prospective Japan Acute Myocardial Infarction Registry (JAMIR) ―

“…Fifth, the present Japanese AMI cohort included a limited number of patients with extremely high BMI (≥40 kg/m 2 ), although a previous AMI study in a Western country demonstrated higher mortality not only in underweight patients but also in patients with extremely high BMI (U-shaped relationship between BMI and mortality). 33 Sixth, we only collected the BMI data at the time of study registration; any change in the BMI was not evaluated, therefore, we could not discuss the effect of BMI change on the clinical outcomes. Finally, these results were derived from only Japanese populations, and therefore might not be generalizable to other populations.…”