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Data are scarce in candidates for cardiac resynchronization therapy (CRT). We aimed to investigate the association between body mass index (BMI) and all-cause mortality in patients eligible for CRT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Altogether 1,585 patients underwent cardiac resynchronization therapy between 2000\u20132020 and were categorized based on their BMI, 459 (29%) patients with normal weight (BMI &amp;lt; 25 kg\/m2), 641 (40%) patients with overweight (BMI 25- &amp;lt; 30 kg\/m2) and 485 (31%) with obesity (BMI \u2265 30 kg\/m2). The primary endpoint was all-cause mortality, heart transplantation, and left ventricular assist device implantation. We assessed periprocedural complications and 6-month echocardiographic response.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Normal-weight patients were older compared to patients with overweight or obesity (70 years vs. 69 years vs. 68 years; P \u20390.001), respectively. Sex distribution, ischaemic aetiology, and CRT-D implantation rates were similar in the three patient groups. Diabetes mellitus (BMI &amp;lt; 25 kg\/m2 26% vs. BMI 25- &amp;lt; 30 kg\/m2 37% vs. BMI \u2265 30 kg\/m2 48%; P \u20390.001) and hypertension (BMI &amp;lt; 25 kg\/m2 71% vs. BMI 25- &amp;lt; 30 kg\/m2 74% vs. BMI \u2265 30 kg\/m2 82%; P \u20390.001) were more frequent in patients with overweight and obesity.<\/jats:p>\n                    <jats:p>During the mean follow-up time of 5.1 years, 973 (61%) reached the primary endpoint, 66% in the BMI &amp;lt; 25 kg\/m2 group, 61% in the BMI 25- &amp;lt; 30 kg\/m2 group and 58% in the BMI \u2265 30 kg\/m2 group (log-rank P\u20390.05). Patients with obesity showed mortality benefit over normal-weight patients (HR 0.78; 95%CI 0.66\u20130.92; P = 0.003). The obesity paradox was present in patients free from diabetes, atrial fibrillation, and ischemic events. Periprocedural complication rates did not differ in the three groups (BMI &amp;lt; 25 kg\/m2 25% vs. BMI 25- &amp;lt; 30 kg\/m2 28% vs. BMI \u2265 30 kg\/m2 26%; P = 0.48). Left ventricular ejection fraction improved significantly in all patient groups (BMI &amp;lt; 25 kg\/m2 median \u2206-LVEF 7% vs. BMI 25- &amp;lt; 30 kg\/m2 median \u2206-LVEF 7.5% vs. BMI \u2265 30 kg\/m2 median \u2206-LVEF 6%; P &amp;lt; 0.0001) with a similar proportion of developing reverse remodeling (BMI &amp;lt; 25 kg\/m2 58% vs. BMI 25- &amp;lt; 30 kg\/m2 61% vs. BMI \u2265 30 kg\/m2 57%; P = 0.48); P = 0.75).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The obesity paradox was present in our HF cohort at long-term, patients underwent CRT implantation with obesity and free of comorbidities showed mortality benefit compared to normal weight patients. Patients with obesity showed similar echocardiographic response and safety outcomes compared to normal weight patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.14961","type":"journal-article","created":{"date-parts":[[2024,7,19]],"date-time":"2024-07-19T06:53:48Z","timestamp":1721372028000},"page":"3616-3625","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Obesity Paradox in Patients with Reduced Ejection Fraction Eligible for Device Implantation \u2013 An Observational Study"],"prefix":"10.1093","volume":"11","author":[{"given":"Eperke D.","family":"Merkel","sequence":"first","affiliation":[{"name":"Heart and Vascular Center, Semmelweis University , Budapest ,","place":["Hungary"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anett","family":"Behon","sequence":"additional","affiliation":[{"name":"Heart and Vascular Center, Semmelweis University , Budapest 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