Obesity Paradox in Transcatheter Aortic Valve Replacement.

All-cause mortality BMI Obesity paradox TAVR

Journal

Current cardiology reports
ISSN: 1534-3170
Titre abrégé: Curr Cardiol Rep
Pays: United States
ID NLM: 100888969

Informations de publication

Date de publication:
29 Jul 2024
Historique:
accepted: 08 07 2024
medline: 29 7 2024
pubmed: 29 7 2024
entrez: 29 7 2024
Statut: aheadofprint

Résumé

Obesity paradox in cardiovascular risk prediction has gained increasing attention in recent years. We aimed to investigate the impact of BMI on mortality following transcatheter aortic valve replacement (TAVR). We performed a multi-center retrospective analysis of patients with severe aortic stenosis undergoing TAVR. Patients were categorized into: Underweight (BMI < 18.5), normal weight (18.5 ≤ BMI < 25), overweight (25 ≤ BMI < 30) and obese (BMI ≥ 30). Multivariate cox-proportional hazard model was used to compare all-cause mortality. Total of 6688 patients included (175 underweight, 2252 normal weight, 2368 overweight and 1893 with obesity). Mean age of patients was 81 ± 8 years with 55% males. Patients with obesity had higher prevalence of comorbidities but a lower overall STS score. Mortality at 30-days post-TAVR was lower in the obese population compared to underweight, normal weight, and overweight patients (1.6% vs. 6.9%, 3.6%, and 2.8%, respectively, p < 0.001). Similarly, 3-year mortality was lowest in patients with obesity (17.1% vs. 28.9%, 24.5% and 18.6%, respectively, p < 0.001). On multivariate analysis, long term all-cause mortality at 3-years remained significantly lower in patients with obesity compared to underweight (HR 1.74, 95% CI: 1.30-2.40, p < 0.001) and normal weight (HR: 1.41, 95% CI:1.21-1.63, p < 0.001) but not in overweight patients (HR: 1.10, 95% CI:0.94-1.28, p = 0.240). In conclusion, patients with obesity have improved short and long term mortality following TAVR with an observed progressive increase in mortality with lower BMI ranges.

Sections du résumé

BACKGROUND BACKGROUND
Obesity paradox in cardiovascular risk prediction has gained increasing attention in recent years. We aimed to investigate the impact of BMI on mortality following transcatheter aortic valve replacement (TAVR).
METHODS METHODS
We performed a multi-center retrospective analysis of patients with severe aortic stenosis undergoing TAVR. Patients were categorized into: Underweight (BMI < 18.5), normal weight (18.5 ≤ BMI < 25), overweight (25 ≤ BMI < 30) and obese (BMI ≥ 30). Multivariate cox-proportional hazard model was used to compare all-cause mortality.
RESULTS RESULTS
Total of 6688 patients included (175 underweight, 2252 normal weight, 2368 overweight and 1893 with obesity). Mean age of patients was 81 ± 8 years with 55% males. Patients with obesity had higher prevalence of comorbidities but a lower overall STS score. Mortality at 30-days post-TAVR was lower in the obese population compared to underweight, normal weight, and overweight patients (1.6% vs. 6.9%, 3.6%, and 2.8%, respectively, p < 0.001). Similarly, 3-year mortality was lowest in patients with obesity (17.1% vs. 28.9%, 24.5% and 18.6%, respectively, p < 0.001). On multivariate analysis, long term all-cause mortality at 3-years remained significantly lower in patients with obesity compared to underweight (HR 1.74, 95% CI: 1.30-2.40, p < 0.001) and normal weight (HR: 1.41, 95% CI:1.21-1.63, p < 0.001) but not in overweight patients (HR: 1.10, 95% CI:0.94-1.28, p = 0.240).
CONCLUSION CONCLUSIONS
In conclusion, patients with obesity have improved short and long term mortality following TAVR with an observed progressive increase in mortality with lower BMI ranges.

Identifiants

DOI: 10.1007/s11886-024-02098-3 PMID: 39073506
pubmed: 39073506
doi: 10.1007/s11886-024-02098-3
pii: 10.1007/s11886-024-02098-3
doi:

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Références

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Auteurs

Luai Madanat (L)

William Beaumont University Hospital, Corewell Health East, Royal Oak, MI, USA.

Ahmad Jabri (A)

Department of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA.

Ivan D Hanson (ID)

William Beaumont University Hospital, Corewell Health East, Royal Oak, MI, USA.

Houman Khalili (H)

Florida Atlantic University and Memorial Cardiovascular Institute, Hollywood, FL, USA.

Josep Rodés-Cabau (J)

Université Laval/Québec Heart and Lung Institute, Laval, Québec, Canada.

Thomas Pilgrim (T)

Bern University Hospital, Bern, Switzerland.

Taishi Okuno (T)

Bern University Hospital, Bern, Switzerland.

Sammy Elmariah (S)

University of San Francisco, San Francisco, CA, USA.

Philippe Pibarot (P)

Université Laval/Québec Heart and Lung Institute, Laval, Québec, Canada.

Pedro Villablanca (P)

Department of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA.

Amr E Abbas (AE)

William Beaumont University Hospital, Corewell Health East, Royal Oak, MI, USA. Amr.Abbas@corewellhealth.org.
Department of Cardiovascular Medicine, William Beaumont University Hospital, Corewell Health East, 3601 W 13 Mile Rd, Royal Oak, MI, 48073, USA. Amr.Abbas@corewellhealth.org.

Classifications MeSH