Effect of Body Mass Index in Patients With Cardiogenic Shock Requiring Microaxial Flow Pump

Figures

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  Figure 1. Study Flowchart BMI = body mass index; J-PAVD = Japanese Registry for Percutaneous Ventricular Assist Device; mAFP = microaxial flow pump.

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  Figure 2. Histogram of BMI Distribution The body mass index (BMI) categories were defined as underweight (<18.5 kg/m2), normal weight (18.5-22.9 kg/m2), overweight (23.0-24.9 kg/m2), obesity (25.0-29.9 kg/m2), and severe obesity (≥30.0 kg/m2).15

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  Figure 3. Kaplan-Meier Estimates of 30-Day Mortality According to Body Mass Index Categories The Kaplan-Meier curve demonstrated a significant increase in 30-day mortality with higher body mass index categories. Percentages indicate estimated mortality at 30 days after the first microaxial flow pump insertion.

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  Central Illustration. Mortality and Adverse Events According to Body Mass Index Categories in J-PVAD From the J-PVAD (Japanese Registry for Percutaneous Ventricular Assist Device), patients with cardiogenic shock treated with microaxial flow pumps were stratified into 5 body mass index categories: underweight (<18.5 kg/m2), normal weight (18.5-22.9 kg/m2), overweight (23.0-24.9 kg/m2), obesity (25.0-29.9 kg/m2), and severe obesity (≥30.0 kg/m2).15 (A) Kaplan-Meier estimates and (B) adjusted HR for mortality. Severe obesity and obesity were associated with a higher risk of mortality, whereas underweight was associated with a lower risk of mortality, compared with normal weight. ∗Overall P < 0.001. (C) The incidence of bleeding and hemolysis. Bleeding was numerically more frequent in underweight and severely obese groups (P = 0.205), whereas hemolysis increased with higher body mass index (P = 0.022). † indicates association with subsequent mortality. NA = not applicable.

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  Figure 4. Restricted Cubic Spline Curve Analysis of BMI Predicting Mortality The restricted cubic spline curve plotting adjusted HR of mortality on the y-axis and body mass index (BMI) on the x-axis, constructed with knots at the borderline of the BMI categories. The center of the normal weight range was set as a reference. The gray area represents the 95% CI.

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  Figure 5. Heatmap of aHR According to BMI Categories in Various Subgroups The heatmap illustrates adjusted hazard ratio (aHR) for 30-day mortality across body mass index (BMI) categories within different subgroups. In the color code, white represents the reference of aHR = 1.0 in normal weight, blue indicates lower aHR, and red indicates higher aHR than reference. ∗P for trend ≥0.05. All other subgroups without ∗ indicate P for trend <0.05. #P for interaction <0.05 (marked only if either subgroup has P for trend ≥0.05). AMI = acute myocardial infarction; ECMO = extracorporeal membrane oxygenation; IABP = intra-aortic balloon pump; LVEF = left ventricular ejection fraction; mAFP = microaxial flow pump; PCI = percutaneous coronary intervention; STEMI = ST-segment elevation myocardial infarction; TIA = transient ischemic attack.