{"id":"db4fe9e46bbe","type":"article","url":"https://hartvaat.nl/2026/03/25/bmi-en-prognose-bij-acuut-hartfalen-verschillen-per-fenotype-en-geslacht/","title":"BMI en prognose bij acuut hartfalen verschillen per fenotype en geslacht","title_en":"Sex- and Phenotype-Specific Prognostic Implications of Body Mass Index in Acute Heart Failure","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","nt-probnp","step-hfpef","summit-trial","vrouwen"],"journal":"ESC heart failure","doi":"10.1093/eschf/xvag050","source_url":"https://doi.org/10.1093/eschf/xvag050","authors":["Yoonsun Won","Mi-Seung Shin","Eunji Kim","Wook-Jin Chung","Eung Ju Kim","Seong Woo Han","Seong-Mi Park","Hyung-Seop Kim","Ju-Hee Lee","Hyo-Suk Ahn","Hyun-Jai Cho","Seok-Jae Hwang","Jin-Ok Jeong","Dong Heon Yang","Junho Hyun","Jin Oh Choi","Byung-Su Yoo","Seok-Min Kang","Dong-Ju Choi"],"significance":6,"published":"2026-03-25","source_date":"2026-03-25","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfmref-hartfalen-met-matig-verminderde-ejectie/","https://hartvaat.nl/kennis/hartfalen/wat-is-hartfalen/"],"congress":"","summary_en":"Whether the prognostic value of BMI differs by heart-failure phenotype and sex was examined in the Korean HF III registry (5,271 patients hospitalised for acute heart failure). The primary outcome was 2-year all-cause mortality or heart transplantation. In HFrEF, lower BMI was consistently associated with worse outcomes in both men and women (in women with HFrEF higher BMI was favourable, HR 0.66). In HFpEF, BMI was prognostic only in women (lower BMI borderline unfavourable, HR 1.56), not in men. The findings underscore the importance of sex- and phenotype-specific interpretation of BMI in risk assessment.","created":"2026-07-03T10:32:18Z","updated":"2026-07-03T18:39:21Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Of de prognostische betekenis van de BMI verschilt per hartfalenfenotype en geslacht, werd onderzocht in het Koreaanse HF III-register (5.271 patiënten opgenomen met acuut hartfalen). Het primaire eindpunt was tweejaars totale sterfte of harttransplantatie. Bij HFrEF was een lagere BMI bij zowel mannen als vrouwen consistent geassocieerd met slechtere uitkomsten (bij vrouwen met HFrEF was een hogere BMI gunstig, HR 0,66). Bij HFpEF was de BMI alleen prognostisch bij vrouwen (een lagere BMI grensgevallend ongunstig, HR 1,56), niet bij mannen. De bevindingen onderstrepen het belang van een sekse- en fenotype-specifieke interpretatie van de BMI bij risico-inschatting.","abstract_original":"AIMS: This study aimed to determine whether the prognostic implications of body mass index (BMI) differ according to heart failure (HF) phenotype and sex. METHODS: From the Korean HF III registry (n = 7,351), we analyzed 5,271 patients hospitalized for acute heart failure (AHF) with available data. BMI was categorized as low (<18.5 kg/m²), normal (18.5-24.9), or high (≥25.0) using cut-off values consistent with Asia-Pacific criteria. The primary outcome was a composite of 2-year all-cause mortality or heart transplantation. Kaplan-Meier analyses and multivariable Cox proportional hazards models, including interaction terms for BMI, sex, and HF phenotype, were performed. RESULTS: In HF with reduced ejection fraction (HFrEF), lower BMI was consistently associated with worse outcomes in both men and women. In contrast, in HF with preserved ejection fraction (HFpEF), BMI was prognostic in women but not in men: survival differed by BMI category in Kaplan-Meier analyses for all subgroups except men with HFpEF. In multivariable analyses, higher BMI was independently associated with lower risk in women with HFrEF (hazard ratio [HR] 0.66, 95% confidence interval [CI] 0.45-0.96, p = 0.032), whereas lower BMI in women with HFpEF showed a borderline association with higher risk (HR 1.56, 95% CI 0.99-2.47, p = 0.057). CONCLUSION: The prognostic implications of BMI in AHF differ according to HF phenotype and sex. Lower BMI is a consistent adverse marker in HFrEF in both sexes and shows a borderline adverse association in women with HFpEF, whereas BMI is not prognostic in men with HFpEF. These findings highlight the importance of sex- and phenotype-specific interpretation of BMI in risk assessment."}