Body mass index in the context of acute heart failure and preserved left ventricular ejection fraction: a paradoxical effect of obesity?
Bibliographic record
Abstract
Abstract Introduction Obesity is a common and multifactorial disease, classified according to Body Mass Index (BMI) categories. Although previous studies suggest that higher BMI might be associated with an increased risk of cardiovascular diseases, there is limited information available for patients with a diagnosis of acute heart failure (HF) and with a preserved left ventricular ejection fraction (HFpEF). Aims To assess baseline characteristics, comorbidities, clinical presentation and outcomes according to the BMI categories in patients with HFpEF and acutely admitted due to worsening HF. Methods In this single-centre, retrospective, observational study, data on patients with HFpEF and admitted due to acute HF from 1st January 2015 to 31st December 2019 were collected. Patients were classified into the currently accepted BMI categories: 18.5-24.9 kg/m2 (normal weight), 25-29.9 kg/m2 (overweight), 30-34.9 kg/m2 (class I obesity), 35-39.9 kg/m2 (class II obesity), ≥ 40 kg/m2 (class III obesity). Baseline characteristics, clinical presentation, blood tests and echocardiographic data were analysed according to the BMI categories. Independent predictors of BMI were identified using linear regression analysis and association between BMI and outcomes was assessed using Cox proportional hazard analysis. The composite of all-cause mortality or readmission due to AHF at 90 days after discharge was our primary outcome. Results Of the 3,073 patients enrolled (aged 81 years, of whom 47 % men), 1,346 (44%) reported normal weight, 1,090 (35%) overweight, whilst 439 (14%), 121 (4%) and 77 (3%) were in the I, II and III class of obesity, respectively. Patients with higher BMI were younger, had higher prevalence of hypertension, diabetes, atrial fibrillation, coronary artery disease and kidney failure. Compared to participants with normal weight, those with greater BMI presented decreased N-terminal pro brain natriuretic peptide (NT-proBNP) measurements, whereas echocardiographic variables did not significantly differ among the BMI categories. In the multivariate analysis, participants with a higher BMI had a lower incidence of the composite outcome of all-cause mortality or HF-related readmission compared to those with normal weight (p=0.001). Conclusions BMI is often elevated in patients diagnosed with HFpEF who are acutely hospitalized for worsening HF. Greater BMI values were associated with higher prevalence of hypertension, diabetes but lower NT-proBNP concentrations. Patients with increased BMI presented a lower risk of adverse outcomes, suggesting a potential and paradoxical protective effect of obesity on the prognosis of patients with HF.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".