Abstract
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.