Impact of Preoperative Body Mass Index on Long-term Survival, Quality of Life, and Functional Outcomes after Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension: Results from the UK National Cohort.
Body Mass Index
Chronic thromboembolic pulmonary hypertension
Patient-Reported Outcomes
obesity
pulmonary endarterectomy
Journal
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
ISSN: 1557-3117
Titre abrégé: J Heart Lung Transplant
Pays: United States
ID NLM: 9102703
Informations de publication
Date de publication:
10 Sep 2024
10 Sep 2024
Historique:
received:
01
02
2024
revised:
26
06
2024
accepted:
04
09
2024
medline:
13
9
2024
pubmed:
13
9
2024
entrez:
12
9
2024
Statut:
aheadofprint
Résumé
Previous studies have demonstrated the safety of pulmonary endarterectomy (PEA) in all body mass index (BMI) strata. However, long-term survival and patient-reported quality of life outcome measures by BMI strata remain unknown. We sought to examine the impact of preoperative BMI on long-term survival, quality of life, and functional outcomes for patients undergoing PEA for chronic thromboembolic pulmonary hypertension (CTEPH). Retrospective review of 2004 patients from the UK National Cohort between 2007 and 2021 undergoing PEA for CTEPH (mPAP>20 mmHg and PVR>160 dynes). Patients were stratified into BMI<20, 20-29, 30-39, 40-49, and 50+. All-cause mortality was the primary outcome measure. Secondary outcome measures were 3-6 month postoperative hemodynamics, 6-minute walk distance (6MWD), New York Heart Association (NYHA) class, and Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) scores. Kruskal-Wallis, ANOVA, and Kaplan Meier Estimate were used for comparisons. Postoperative hemodynamics and 6MWD at 3-6 months were similar across BMI strata. However, patients with BMI 50+ reported the highest incidence of post-operative NYHA III/IV limitation (53.3%, p<0.001) and the highest residual symptom burden by CAMPHOR (p<0.001). Overall 5-year survival was lowest in patients with BMI 50+ (70.2%) and BMI<20 (73.4%), whilst highest in BMI 30-39 (88.2%, p=0.008). 10-year Kaplan-Meier Estimates predicted lowest survival in BMI 50+ and BMI<20. PEA remains safe and effective for all patients regardless of BMI. Despite similar hemodynamic outcomes, patients with BMI 50+ are at greatest risk of long-term all-cause mortality and patients with BMI 50+ experience residual symptomatic limitation.
Sections du résumé
BACKGROUND
BACKGROUND
Previous studies have demonstrated the safety of pulmonary endarterectomy (PEA) in all body mass index (BMI) strata. However, long-term survival and patient-reported quality of life outcome measures by BMI strata remain unknown. We sought to examine the impact of preoperative BMI on long-term survival, quality of life, and functional outcomes for patients undergoing PEA for chronic thromboembolic pulmonary hypertension (CTEPH).
METHODS
METHODS
Retrospective review of 2004 patients from the UK National Cohort between 2007 and 2021 undergoing PEA for CTEPH (mPAP>20 mmHg and PVR>160 dynes). Patients were stratified into BMI<20, 20-29, 30-39, 40-49, and 50+. All-cause mortality was the primary outcome measure. Secondary outcome measures were 3-6 month postoperative hemodynamics, 6-minute walk distance (6MWD), New York Heart Association (NYHA) class, and Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) scores. Kruskal-Wallis, ANOVA, and Kaplan Meier Estimate were used for comparisons.
RESULTS
RESULTS
Postoperative hemodynamics and 6MWD at 3-6 months were similar across BMI strata. However, patients with BMI 50+ reported the highest incidence of post-operative NYHA III/IV limitation (53.3%, p<0.001) and the highest residual symptom burden by CAMPHOR (p<0.001). Overall 5-year survival was lowest in patients with BMI 50+ (70.2%) and BMI<20 (73.4%), whilst highest in BMI 30-39 (88.2%, p=0.008). 10-year Kaplan-Meier Estimates predicted lowest survival in BMI 50+ and BMI<20.
CONCLUSION
CONCLUSIONS
PEA remains safe and effective for all patients regardless of BMI. Despite similar hemodynamic outcomes, patients with BMI 50+ are at greatest risk of long-term all-cause mortality and patients with BMI 50+ experience residual symptomatic limitation.
Identifiants
pubmed: 39265669
pii: S1053-2498(24)01835-7
doi: 10.1016/j.healun.2024.09.005
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024. Published by Elsevier Inc.