Impacto da obesidade no prognóstico de pacientes com insuficiência cardíaca de fração de ejeção reduzida de etiologia isquêmica

Abstract

Introduction: The prevalence of obesity has reached epidemic proportions worldwide and is associated with widespread changes in cardiovascular structure and function. It is also known that a high body mass index (BMI) is a risk factor for the development of heart failure (HF). In contrast, several studies show a paradoxical association between obesity and the prognosis of patients with coronary artery disease (CAD) and HF, called the “obesity paradox”. According to this theory, contrary to expectations, individuals with established heart disease and overweight or obesity would have a better prognosis than individuals with low or normal weight. Objective: To evaluate the relationship between obesity and the prognosis of patients with heart failure with reduced ejection fraction (HFREF) of ischemic etiology, using overall mortality as a variable. Methods: observational, retrospective and single-center study, carried out through the analysis of medical records, in addition to telephone contacts of patients followed at the HF outpatient clinic of a quaternary hospital. Records from November 1997 to August 2019 were analyzed, with a maximum follow-up period of 10 years and a minimum of 6 months being determined. Inclusion criteria: age between 18 and 90 years, patients with HFREF of ischemic etiology, with the presence of anthropometric data in their first assessment and at least one consultation between 2010 and 2019. Demographic, clinical, laboratory, echocardiographic, therapeutic and prognostics. Results: Among the 1556 medical records of the clinic, 242 met the inclusion criteria. They were 71% male, median age 62.6 (56-70), low BMI 1%, eutrophic 35%, overweight 37%, grade I obesity 18%, grade II obesity 7% and grade III obesity 1%. Underweight and grade III obesity groups were excluded from the main analysis due to insufficient sampling. In the grade II obesity group, there was a higher incidence of alcoholism, atrial fibrillation, diabetes, and patients in NYHA functional class (FC) III, while in the other groups in FC II. In the 4 groups analyzed, there was a predominance of severe left ventricular (LV) dysfunction. Of the 242 patients, 50% died. Based on the survival curves: the obesity grade I and eutrophic groups had the best prognosis, the overweight group had an intermediate performance, and the grade II obesity group the worst curve (p=0.123). In the subgroup analysis, the grade I obesity group had a better prognosis than the grade II obesity group (p=0.033). In the multivariate analysis or MAGGIC was not able to predict mortality in different nutritional status groups, possibly due to the long follow-up time and/or due to small sample size. Conclusion: Obesity did not affect the prognosis of outpatients with HFrEF of ischemic etiology. Conclusion: Obesity did not affect the prognosis of outpatients with HFREF of ischemic etiology.