Body Mass Index in Adult Congenital Heart Disease Patients: Distribution, Association with Exercise Capacity and Prognostic Implication. Margarita Brida MD 2,3 , Konstantinos Dimopoulos MD PhD MSc 1,2 , Alexander Kempny MD 1,2 , Emmanouil Liodakis MD 1 , Lorna Swan MD 1,2 , Anselm Uebing MD PhD 1,2 , Helmut Baumgartner MD 3 , Michael A Gatzoulis MD PhD 1,2 , Gerhard-Paul Diller MD PhD MSc 1-3 , (1) Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, NIHR Cardiovascular and Respiratory Biomedical Research Unit, Royal Brompton Hospital, London, UK (2) National Heart and Lung Institute, Imperial College London, London, UK (3) Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany. This study was supported by a research grant from the EMAH Stiftung Karla Voellm, Krefeld, Germany. G-P.D., A.K., K.D. M.G. and the Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK have received support by Actelion UK, Pfizer UK, GSK UK, the British Heart Foundation and the NIHR Cardiovascular and Respiratory Biomedical Research Units
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ACHD patients with a h · Web viewAbstract - word count: 250 The number of adults with congenital heart disease (ACHD) has markedly increased over the past few decades.1, 2 Although
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Body Mass Index in Adult Congenital Heart Disease Patients: Distribution, Association with Exercise Capacity and Prognostic Implication.
Michael A Gatzoulis MD PhD 1,2, Gerhard-Paul Diller MD PhD MSc 1-3,
(1) Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, NIHR Cardiovascular and Respiratory Biomedical Research Unit, Royal Brompton Hospital, London, UK (2) National Heart and Lung Institute, Imperial College London, London, UK (3) Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
This study was supported by a research grant from the EMAH Stiftung Karla Voellm, Krefeld, Germany. G-P.D., A.K., K.D. M.G. and the Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK have received support by Actelion UK, Pfizer UK, GSK UK, the British Heart Foundation and the NIHR Cardiovascular and Respiratory Biomedical Research Units
Correspondence to:Gerhard-Paul Diller MD PhD National Heart and Lung Institute, Imperial College London, Dovehouse StreetLondon SW3 6LY United KingdomTel: +44 207 351 8127Email: [email protected]
Table 3. Multivariable predictors of all-cause mortality.
95% CI = 95% confidence interval, NYHA = New York Heart Association functional class.
Figure 1.
A) Association between body mass index (BMI; kg/m²) and New York Heart Asssociation (NYHA) functional class. The percentage distribution for various ranges of BMI are presented. B) Quantile regression illustrating the association between BMI and peak oxygen consumption (peak VO2; ml/min). The median, 10th, 25th, 75th and 90th percentile of the regression line. The regression coefficient () and the p-value are based on non-parametric Spearman rank correlation. C) Quantile regression illustrating the association between BMI and percentage predicted peak oxygen consumption (peak VO2; %). The median, 10th, 25th, 75th and 90th percentile of the regression line. The regression coefficient () and the p-value are based on non-parametric Spearman rank correlation.
Figure 2.
A) Hazard ratio of death (all-cause mortality) for various body mass index (BMI; kg/m2) ranges illustrating the lowest hazard for BMI ranges between 30 and 40 kg/m². B) Association between hazard ratio of death and BMI as a continuous variable, illustrating excess mortality in underweight and severely obese patients. The median BMI of the population (24 kg/m²) was set as the reference value.
Figure 3.
Survival by body mass index (BMI; kg/m²) based on the results of the Cox analysis.
Compared to normal weight patients (i.e. BMI 18.5-25 kg/m²), underweight patients tended to
have worse outcome, while overweight/obese patients as a group had on average a
significantly superior prognosis.
Figure 4.
Hazard ratios of death (all-cause mortality) stratified by underlying diagnosis, the presence of cyanosis, complexity of heart disease and NYHA functional class. Hazard ratios with 95% confidence intervals are presented. Only diagnostic subgroups with at least five deaths during follow-up were included. ASD=atrial septal defects, AVSD=atrioventricular septal defect, CoA=aortic coarctation, RV=right ventricle, ToF=tetralogy of Fallot, VSD=ventricular septal defect.
Figure 5.
Survival of patient with repeated weight measurements stratified by complexity of underlying heart disease modelled based on the results of Cox proportional hazards analysis. Patients were split by those with and without weight loss between repeated measurements. Hazard ratios and 95% confidence intervals are provided.
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