Synergistic Assessment of Mortality Risk According to Body Mass Index and Exercise Ability and Capacity in Patients Referred for Radionuclide Stress Testing |
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| Affiliation: | 1. Department of Cardiology, Mount Sinai Morningside Hospital, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY;2. Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the UQ School of Medicine, New Orleans, LA;3. Department of Imaging and Department of Medicine, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA;1. Department of Epidemiology and Health Systems (DESS), University Center for General Medicine and Public Health (UNISANTE), Lausanne, Switzerland;2. Department and Division of Primary Care Medicine, Geneva University Hospitals (HUG), Switzerland;3. Department of Nephrology and Hypertension, Geneva University Hospitals (HUG), Switzerland;4. Department of Cardiology, Geneva University Hospitals (HUG), Switzerland;5. Centre for Environment and Health, School of Public Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom;6. Department of Nephrology and Hypertension, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland;7. Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland;8. Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland;9. Unit of Pharmacogenetics and Clinical Psychopharmacology, Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Prilly, Switzerland;10. Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven, Department of Cardiovascular Sciences, University of Leuven, Belgium;11. School of Pharmaceutical Sciences, University of Geneva (UNIGE), Geneva, Switzerland;12. Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva (UNIGE), Geneva, and University of Lausanne (UNIL), Lausanne, Switzerland;13. Research Institute Alliance for Promotion of Preventive Medicine (APPREMED), Mechelen, Belgium;14. Biomedical Sciences Group, Faculty of Medicine, University of Leuven, Leuven, Belgium;1. Division of Hematology, Mayo Clinic, Rochester, MN;2. Division of Medical Oncology, Mayo Clinic, Rochester, MN;3. Center for Digital Health, Mayo Clinic, Rochester, MN;1. University of Arizona School of Medicine, Division of Integrative Medicine, Tucson, LA;2. Saint Luke’s Mid America Heart Institute, University of Missouri–Kansas City, Kansas City, LA;3. Ochsner Heart and Vascular Institute, Ochsner Clinical School–The University of Queensland School of Medicine, New Orleans, LA;4. Cincinnati Children’s Hospital, The Heart Institute, CICU, Cincinnati, OH;1. Division of Pulmonary, Allergy and Sleep Medicine, Mayo Clinic, Jacksonville, FL;2. Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL;3. Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL;4. Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN;5. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN;6. Division of Pulmonary Medicine, Mayo Clinic, Scottsdale, AZ;7. Department of Critical Care Medicine, Mayo Clinic, Scottsdale, AZ;1. University of Colorado School of Medicine, Aurora;2. ACUTE at Denver Health, Denver, Colorado;3. Eating Recovery Center, Denver, Colorado |
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| Abstract: | ObjectiveTo determine the interrelationship between body mass index (BMI), mode of stress testing (exercise or pharmacological), exercise capacity, and all-cause mortality in patients referred for stress-rest single photon emission computed tomography myocardial perfusion imaging.Patients and MethodsWe evaluated all-cause mortality in 21,638 patients undergoing stress-rest single photon emission computed tomography myocardial perfusion imaging between January 2, 1991, and December 31, 2012. Patients were divided into exercise and pharmacologically tested groups and 9 BMI categories. The median follow-up was 12.8 years (range, 5.0-26.8 years).ResultsIn exercise patients, mortality was increased with both low and high BMI vs patients with a normal referent BMI of 22.5 to 24.9 kg/m2. In pharmacologically tested patients, only low BMI, but not high BMI, was associated with increased mortality vs normal BMI. When exercise and pharmacologically tested groups were compared directly, pharmacologically tested patients manifested a marked increase in mortality risk vs exercise patients within each BMI category, ranging from an approximately 4-fold increase in mortality in those with normal or high BMI to a 12.3-fold increase in those with low BMI values. Similar findings were observed in a cohort of 4804 exercise and 4804 pharmacologically tested patients matched to have similar age and coronary artery disease risk factor profiles. In exercise patients, further risk stratification was achieved when considering both BMI and metabolic equivalent tasks of achieved exercise.ConclusionThe combined assessment of BMI and exercise ability and capacity provides synergistic and marked risk stratification of future mortality risk in patients referred for radionuclide stress testing, providing considerable insights into the “obesity paradox” that is observed in populations referred for stress testing. |
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