Studies assessing BMI and cardiorespiratory fitness: Effect on heart failure prognosis
| Study | Na | Average LVEF of target groups | Designb | End point | Main findings |
|---|---|---|---|---|---|
| Lavie et al24 | 2,066 | High fit = 30.1% Low fit = 26.0% | Patients stratified by BMI and peak VO2 | Overall mortality | In patients with low cardiorespiratory fitness, BMI ≥ 30 kg/m2 was a significant predictor of better survival. No obesity paradox seen at the high fitness level. |
| Clark et al7 1,675 | High fit = 23.4% Low fit = 23.2% | Patients stratified by BMI and peak VO2 | Death, urgent status 1A heart transplant, or VAD placement. | BMI of obesity class was associated with a significantly lower risk of death, urgent transplant, or device placement than with normal BMI in the group with low peak VO2. In the high peak VO2 group, no difference was seen for BMI and survival. | |
| Piepoli et al27 MECKI Score Research Group | 4,623 | BMI (kg/m2) < 25 = 31% 25 to 30 = 33% > 30 to ≤ 35 = 33% > 35 = 33% | Patients stratified by BMI and peak VO2 | All-cause mortality and CV death | Higher BMI and peak VO2 were significant positive predictors of longer survival. When patients in a BMI category were matched according to age, sex, LVEF, and peak VO2, the protective role of BMI disappeared. |
| McAuley et al26 FIT Project | 774 | High fit = 41% Low fit = 40% | Patients stratified by BMI and peak METs | Overall mortality | Significant positive association between BMI category and survival for exercise capacity < 4 METs, but not ≥ 4 METs. |
↵a All patients had established heart failure.
↵b All studies were retrospective.
BMI = body mass index; CV = cardiovascular; FIT = Henry Ford Exercise Testing; LVEF = left ventricular ejection fraction; MECKI = Metabolic Exercise test data combined with Cardiac and Kidney Indexes; METs = metabolic equivalents; VAD = ventricular assist device; VO2 = exercise oxygen uptake