부산대학교 도서관

Introduction: Right ventricular (RV) dysfunction is associated with increased mortality across a spectrum of cardiovascular diseases. Whether this association is modified by obesity is unclear. We examined the association of obesity with hemodynamic indices of RV function, and subsequent outcomes.Hypothesis: We hypothesized that obesity is associated with RV dysfunction, and that obesity modifies the association of RV dysfunction with adverse clinical outcomes.Methods: We examined patients undergoing right heart catheterization between 2005-2016 in a hospital-based cohort. Linear regression was used to examine the association of obesity with hemodynamic indices of RV dysfunction [pulmonary artery pulsatility index (PAPi), right atrial pressure: pulmonary capillary wedge pressure ratio (RAP:PCWP), RV stroke work index (RVSWI)]. Cox models examined the association with clinical outcomes.Results: We studied 8285 patients (mean age 63 years, 40% women). Higher BMI was associated with worse indices of RV dysfunction, including lower PAPi (β -0.26, SE 0.01, p <0.001) and higher RA:PCWP ratio (β 0.25, SE 0.01, p-value <0.001) but not RVSWI (p>0.05). Over 7.3 years of follow-up, we observed 3006 mortality and 2004 heart failure (HF) hospitalization events. RV dysfunction was associated with greater risk of mortality (PAPi: HR 1.11 per 1-SD increase, 95% CI 1.04-1.18; RA:PCWP ratio: HR 0.84, 95% CI 0.79-0.90), with similar associations with risk of HF hospitalization. Furthermore, BMI modified the effect of RV dysfunction on outcomes (P-interaction <=0.005 for both), and the effect of RV dysfunction was more pronounced at higher BMI.Conclusions: Patients with obesity had worse indices of RV function, including lower PAPi and higher RAP:PCWP ratio. While RV dysfunction was associated with worse clinical outcomes, this association was especially pronounced among individuals with higher BMI.