Association of Body Mass Index With Procedural Success and Outcomes in Patients undergoing Transcatheter Aortic Valve Implantation

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology Pub Date : 2025-04-19 DOI:10.1016/j.amjcard.2025.04.012

Jakob J. Reichl MD , Adisa Poljo MD , Thorald Stolte MD , Ramona Schmitt MD , Jasper Boeddinghaus MD , Max Wagener MD , Gregor Leibundgut MD , Christoph Kaiser MD , Dirk Westermann MD , Tau Hartikainen MD , Felix Mahfoud MD , Philipp Ruile MD , Philipp Breitbart MD , Thomas Nestelberger MD

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引用次数: 0

Abstract

Obesity is a major public health concern linked to adverse cardiovascular outcomes. Recent studies suggest an obesity paradox, showing lower mortality in obese patients after transcatheter aortic valve implantation (TAVI). This study investigates the impact of body mass index (BMI) on procedural and long-term clinical outcomes in patients undergoing TAVI. Patients undergoing TAVI at two high-volume centers were analyzed and categorized into four BMI groups: underweight (BMI <18.5 kg/m²), normal (BMI 18.5-24.9 kg/m²), overweight (BMI 25.0-29.9 kg/m²), and obese (BMI ≥30.0 kg/m²). To relax the proportional hazards assumption, restricted cubic splines were constructed. The primary outcome was procedural success and safety, including 30-day all-cause-mortality, stroke, and overall bleeding. Secondary outcomes included all-cause mortality at one and five years. In total, 6,156 patients were included: 114 (1.8%) were underweight, 2,393 (38.8%) normal weight, 2,380 (38.6%) overweight, and 1,269 (20.6%) obese. No significant differences between BMI groups were found in 30-day mortality, stroke, or bleeding. However, underweight patients had higher mortality compared to normal-weight patients at one year (23.7 vs 13.2%, p = 0.001) and five years (53.2% vs. 44.0%, p = 0.048). Obese patients had similar mortality to normal-weight patients at one year (11.4 vs 13.2%, p = 0.120) and five years (41.0 vs 44.0%, p = 0.200). Obesity showed no outcome advantage over normal weight, while underweight was an independent predictor of higher all-cause mortality after TAVI. These findings challenge the obesity paradox in the context of TAVI.

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经导管主动脉瓣植入术患者身体质量指数与手术成功率和结果的关系

肥胖是与心血管疾病相关的主要公共卫生问题。最近的研究提出了一个肥胖悖论，表明肥胖患者经导管主动脉瓣植入术（TAVI）后死亡率较低。本研究探讨身体质量指数（BMI）对TAVI患者手术和长期临床结果的影响。在两个大容量中心对接受TAVI的患者进行分析，并将其分为四个BMI组：体重过轻（BMI & 18.5 kg/m2）、正常（BMI 18.5-24.9 kg/m2）、超重（BMI 25.0-29.9 kg/m2）和肥胖（BMI≥30.0 kg/m2）。为了放宽比例风险假设，构造了受限三次样条曲线。主要结局是手术成功和安全性，包括30天全因死亡率、卒中和总体出血。次要结局包括1年和5年的全因死亡率。共纳入6156例患者：体重不足114例（1.8%），正常体重2393例（38.8%），超重2380例（38.6%），肥胖1269例（20.6%）。BMI组之间在30天死亡率、中风或出血方面没有显著差异。然而，体重过轻的患者在1年（23.7% vs 13.2%, p = 0.001）和5年（53.2% vs 44.0%, p = 0.048）的死亡率高于体重正常的患者。肥胖患者在1年（11.4% vs 13.2%, p = 0.120）和5年（41.0 vs 44.0%, p = 0.200）的死亡率与正常体重患者相似。肥胖与正常体重相比没有结果优势，而体重不足是TAVI术后全因死亡率较高的独立预测因子。这些发现挑战了TAVI背景下的肥胖悖论。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Cardiology 医学-心血管系统

CiteScore

4.00

自引率

3.60%

发文量

698

审稿时长

33 days

期刊介绍： Published 24 times a year, The American Journal of Cardiology® is an independent journal designed for cardiovascular disease specialists and internists with a subspecialty in cardiology throughout the world. AJC is an independent, scientific, peer-reviewed journal of original articles that focus on the practical, clinical approach to the diagnosis and treatment of cardiovascular disease. AJC has one of the fastest acceptance to publication times in Cardiology. Features report on systemic hypertension, methodology, drugs, pacing, arrhythmia, preventive cardiology, congestive heart failure, valvular heart disease, congenital heart disease, and cardiomyopathy. Also included are editorials, readers'' comments, and symposia.