Disparate Effects of Obesity and Left Ventricular Geometry on Mortality in 8088 Elderly Patients with Preserved Systolic Function

Abstract

Background: Although left ventricular (LV) geometry has predicted cardiovascular (CV) prognosis, including in elderly cohorts, the role of obesity on CV prognosis has been more controversial. Objective: To assess the independent effects of obesity and LV geometry on all-cause mortality in a large cohort of elderly patients with preserved LV systolic function. Patients and Methods: We retrospectively assessed 8088 elderly patients (> 70 years) with an LV ejection fraction (LVEF) ≥ 50% who were referred for echocardiography at a large primary, secondary, and tertiary health care system in New Orleans. We specifically assessed clinical and echocardiographic features to determine the impact of body mass index (BMI) and LV geometric patterns, including concentric remodeling (CR) and LV hypertrophy (LVH) on all-cause mortality during an average 3.1-year follow-up. Results: Although abnormal LV geometry (P < 0.01) and LVH (P < 0.001) progressively increased with more obesity, total mortality was strongly and inversely (P < 0.0001) related with BMI. However, in each BMI subgroup, mortality progressively increased with abnormal LV geometry from normal, CR, eccentric LVH, and concentric LVH (P < 0.001 for all trends). In a multivariate analysis, abnormal LV geometry, including increased relative wall thickness (Chi-square 16; P < 0.0001) and LV mass index (Chi-square 12; P < 0.0001), and lower BMI (Chi-square 33; P < 0.0001) were independent predictors of mortality. Conclusion: Although an obesity paradox exists, in that obesity is associated with abnormal LV geometry but lower mortality, our data demonstrate that LV geometric abnormalities are prevalent in elderly patients with preserved systolic function and are associated with progressive increases in mortality.