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Body mass index extremes association with worsened disease and clinical outcomes in patients with Hypertrophic Cardiomyopathy
Session:
Sessão de Posters 45 - Populações especiais, riscos especiais
Speaker:
Raquel Montalvão
Congress:
CPC 2026
Topic:
J. Preventive Cardiology
Theme:
28. Risk Factors and Prevention
Subtheme:
28.11 Nutrition, Malnutrition and Heart Disease
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Raquel Montalvão; Margarida Matias; Maria Inês Soares; Mariana Ramos; Márcia Presume; André Garcia; Rui Gomes; Débora Correia; Samuel Azevedo; Carlos Aguiar; Sérgio Maltês; Bruno Rocha
Abstract
<p><u><strong>Background:</strong></u></p> <p>Hypertrophic cardiomyopathy (HCM) is a primary myocardial disease that may be associated with worsened prognosis in the presence of other comorbidities. Body mass index (BMI) has been linked to major outcomes in heart hailure – the so-called obesity paradox. However, whether a similar pattern of association is observed in HCM remains uncertain. </p> <p><u><strong>Objective:</strong></u></p> <p>To assess whether BMI is linked to disease severity and adverse outcomes in HCM. </p> <p><u><strong>Methods:</strong></u></p> <p>Retrospective analysis of patients with HCM diagnosis followed at a tertiary center. Patients were categorized according to BMI class into 6 groups: underweight (BMI < 20 kg/m²), normal weight (BMI 20-24,9 kg/m²), pre-obesity (BMI 25-29,9 kg/m²), class I (BMI 30-34,9 kg/m²), class II (BMI 35-39,9 kg/m²) and class III obesity (BMI >40 kg/m²). Patients aged over 16 years and with at least 1 year of follow-up were included. The primary endpoint was a composite of appropriate implantable cardioverter-defibrillator shocks, heart transplantation and all-cause death. Survival analysis was assessed by Kaplan–Meier curves. </p> <p><u><strong>Results:</strong></u></p> <p>A total of 545 HCM patients were included (mean age 66 ± 15 years; 57% male; mean BMI 27.4 ± 4.7 Kg/m2). Patients were distributed across BMI categories as follows: underweight (17 [3%]); normal weight (153 [28%]); pre-obesity (235 [43%]); class I (107 [20%]); class II (22 [4%]) and class III obesity (11 [2%]). </p> <p>BMI extremes were associated with more syncope (11.8 vs 15.7 vs 6.0 vs 6.5 vs 13.6 vs 9.1%; p= 0.045); higher median NT-proBNP levels (2864 vs 1488 vs 540 vs 1371 vs 1090 vs 1691 pg/mL; p= 0.006); greater mean maximum left ventricular wall thickness (18.5 vs 17.5 vs 17.3 vs17.4 vs 18.3 vs 18 mm; p= 0.049); and more frequent apical aneurysm (0% vs 1.3% vs 4.3% vs 1.9% vs 13.6% vs 27.3%; p<0.001), respectively (central figure). No significant differences on other clinical or ecocardiographic markers were noted. </p> <p>Over a median follow-up of 4 (2-8) years, 91 (17%) patients reached the primary composite endpoint. Underweight and severe obesity were significantly associated with a higher risk of the composite outcome (41.2 vs 20.3 vs 14.0 vs 13.1 vs 18.2 vs 18.2%; p=0.031; respectively), mainly due a higher risk of death (29.4 vs. 13.7 vs. 11.1 vs. 10.3 vs. 9.1 vs. 18.2%, p=0.031). </p> <p><u><strong>Conclusions:</strong></u> </p> <p>In a contemporary HCM cohort, BMI extremes were associated with a worsened clinical profile and a higher risk of major cardiovascular outcomes. We observed a “U-shaped” risk pattern across BMI categories, suggesting that targeted weight management interventions in underweight and moderate-to-severe obese patients could confer HCM-related benefits. </p>
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