{"id":"6479aace6158","type":"article","url":"https://hartvaat.nl/2026/10/10/verhoogd-bmi-versnelt-myocardiale-remodellering-bij-vroege-hypertrofische-cardio/","title":"Verhoogd BMI versnelt myocardiale remodellering bij vroege hypertrofische cardiomyopathie — VANISH","title_en":"Body Mass Index, Valsartan, and Myocardial Remodeling in Early-Stage Hypertrophic Cardiomyopathy: A Secondary Analysis of the Randomized VANISH Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American Heart Association","doi":"10.1161/JAHA.126.050131","source_url":"https://doi.org/10.1161/JAHA.126.050131","authors":["John W Ostrominski","Brian L Claggett","Michael Jerosch-Herold","Anna Axelsson Raja","Sharlene M Day","Mark W Russell","Kenneth Zahka","Alexandre C Pereira","Steven D Colan","Anne M Murphy","Charles Canter","Richard G Bach","Matthew T Wheeler","Joseph W Rossano","Anjali T Owens","Luisa Mestroni","Matthew R G Taylor","Amit R Patel","Ivan Wilmot","Jonathan H Soslow","Jason R Becker","Neal K Lakdawala","Henning Bundgaard","Jose D Vargas","Carolyn Y Ho"],"significance":5,"published":"2026-10-19","source_date":"2026-10-10","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/ischemische-cardiomyopathie/","https://hartvaat.nl/kennis/hartfalen/cardiale-remodellering/"],"congress":"","summary_en":"A post hoc analysis of the randomized VANISH trial examined the impact of elevated body mass index (BMI ≥25 kg/m²) on disease progression in 171 patients with early sarcomeric hypertrophic cardiomyopathy. Over two years, higher baseline BMI and BMI gain were associated with worse exercise capacity, greater left ventricular mass expansion, and a 3.6-fold increased risk of late gadolinium enhancement, indicating accelerated fibrotic remodeling. Although valsartan modestly attenuated weight gain compared with placebo, it did not modify the drug’s effect on cardiac remodeling. These findings highlight weight management as a potential strategy to slow phenotypic progression in early HCM.","created":"2026-10-12T01:16:27Z","updated":"2026-10-12T01:16:27Z","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":"Een secundaire analyse van de gerandomiseerde VANISH-proef onderzocht bij 171 patiënten met vroege sarcomeer hypertrofische cardiomyopathie (HCM) of verhoogd BMI (≥25 kg/m²) invloed heeft op ziekteprogressie. Patiënten met een verhoogd BMI vertoonden na twee jaar een slechtere inspanningstolerantie, een grotere toename van het linkerventrikelvolume en een drie keer hogere kans op late gadoliniumenhancement, wat wijst op versnelde fibrose en remodellering. Hoewel valsartan de gewichtstoename licht remde, had dit geen invloed op de cardiologische uitkomst. De bevindingen benadrukken dat gewichtsbeheersing een belangrijke rol kan spelen in het vertragen van de progressie van HCM.","abstract_original":"BACKGROUND: Obesity is associated with adverse outcomes in overt hypertrophic cardiomyopathy, but the prevalence and impact of elevated body mass index (BMI) in early-stage hypertrophic cardiomyopathy is uncertain. METHODS: In this post hoc analysis of the randomized VANISH (Valsartan for Attenuating Disease Evolution in Early Sarcomeric Hypertrophic Cardiomyopathy) trial, participants were categorized according to baseline BMI (nonelevated or elevated [≥85th percentile if age <18 years; ≥25 kg/m2 if age ≥18 years]). Exercise capacity (peak oxygen uptake [milliliters per kilogram per minute]) and cardiac imaging parameters were evaluated by baseline BMI and 2-year change in BMI. RESULTS: Among 171 (96%) participants (mean age, 23±10 years; 39% female sex; 97% White), 82 (48%) had nonelevated BMI and 89 (52%) had an elevated BMI. After covariate adjustment, higher baseline BMI was associated with lower peak oxygen uptake; lower left ventricular systolic and diastolic function; higher left ventricular mass; and higher atrial, ventricular, and extracellular volumes. Similarly, greater 2-year increases in BMI were associated with greater declines in peak oxygen uptake and greater increases in left ventricular mass. Participants with elevated BMI were more likely to develop late gadolinium enhancement over 2 years (adjusted odds ratio, 3.6 [95% CI, 1.1-11.9]; P=0.033). Valsartan appeared to modestly attenuate 2-year increases in body weight versus placebo (adjusted mean difference, -3.1% [95% CI, -6.2 to -0.1%]; P=0.042). Baseline BMI did not appear to modify the effect of valsartan on cardiac remodeling (Pinteraction=0.96). CONCLUSIONS: Elevated BMI was common and associated with greater hypertrophic, eccentric, and fibrotic remodeling in early-stage hypertrophic cardiomyopathy. Two-year increases in BMI were associated with greater phenotypic progression. These findings suggest prevention and treatment of elevated BMI may attenuate hypertrophic cardiomyopathy progression. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01912534."}