Ting-Yu Lan, Xin Sun, Hao Wang

Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China

Correspondence: Hao Wang, Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, People’s Republic of China, Tel +86 18611323100, Email haowangdrwh@163.com

Objective: This study aimed to evaluate the effects of cardiac resynchronization therapy (CRT) on cardiac reverse remodeling and long-term clinical outcomes in individuals with advanced heart failure, stratified by body mass index (BMI), using two-dimensional speckle-tracking echocardiography.
Methods: In this retrospective, single-center study, a cohort of 141 patients with heart failure who underwent CRT implantation between 2008 and 2014 was categorized into 4 BMI groups. Clinical and echocardiographic parameters were assessed at baseline and six months post-therapy. Strain analyses of the left atrium and left ventricle were performed using EchoPAC, and long-term clinical outcomes were recorded.
Results: Participants classified as overweight (BMI 24– 28 kg/m²) or obese (BMI ≥ 28 kg/m²) demonstrated greater improvements in clinical status and echocardiographic strain measures (p < 0.05), along with higher CRT response rates compared to those classified as underweight (BMI < 18.5 kg/m²) or normal weight (BMI 18.5– 24 kg/m²). Additionally, patients who were overweight and obese exhibited more favorable long-term outcomes. Left atrial conduit strain (LAScd) emerged as an independent predictor of CRT response and prognosis.
Conclusion: CRT was associated with greater clinical and echocardiographic benefits in patients with higher BMI, and LAScd was identified as a key predictor of therapeutic response and long-term prognosis.

Keywords: body mass indices, cardiac resynchronization therapy, left atrial conduit strain, obese, obesity paradox, overweight, two-dimensional speckle-tracking echocardiography