Body Mass Index, Cardiac Reverse Remodeling, and Outcomes with Cardiac Resynchronization Therapy in Heart Failure: Insights from Two-Dimensional Speckle-Tracking Echocardiography

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. 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. 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. 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.