González-Ferreiro Rocío, Muñoz-García Antonio J, López-Otero Diego, Avanzas Pablo, Pascual Isaac, Alonso-Briales Juan H, Trillo-Nouche Ramiro, Pun Federico, Jiménez-Navarro Manuel F, Hernández-García José M, Morís César, González Juanatey José R
Complexo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain; CIBER Cardiovascular (CIBERCV), Spain.
Hospital Clínico Universitario Virgen de la Victoria de Málaga, Spain.
Int J Cardiol. 2017 Apr 1;232:342-347. doi: 10.1016/j.ijcard.2016.12.051. Epub 2016 Dec 21.
We aimed to determine whether body mass index (BMI) is a prognostic indicator for long-term, all-cause mortality in patients undergoing transcatheter aortic valve implantation (TAVI).
Obesity in patients with established cardiovascular disease has previously been identified as an indicator of good prognosis, a phenomenon known as the "obesity paradox". The prognostic significance of BMI in patients with severe aortic stenosis (AoS) undergoing TAVI is a matter of current debate, as published studies are scarce and their results conflicting.
This is an observational, retrospective study involving 770 patients who underwent TAVI for AoS. The cohort was divided into three groups based on their BMI: normal weight (≥18.5 to <25kg/m), overweight (≥25 to <30kg/m) and obese (≥30kg/m). The predictive effect of BMI on all-cause mortality 3years following TAVI intervention was analysed using a Cox regression.
155 patients died during follow-up. The overweight group (n=302, 38.97%), experienced a lower mortality rate compared to the normal weight and obese groups (15.9% vs 25.7% and 21.0%, respectively [log-rank p-value=0.036]). After adjustment by logistic EuroSCORE, being overweight was found to be an independent protective factor against mortality (HR: 0.63 [95% CI: 0.42 to 0.94], p=0.024). This was not the case for obesity (HR: 0.92 [95% CI: 0.63 to 1.35], p=0.664). We therefore describe for the first time, a "J-shaped" regression curve describing the relationship between BMI and mortality.
BMI is a predictive factor of all-cause mortality in AoS patients undergoing TAVI. This relationship takes the form of a "J-shaped" curve in which overweight patients are associated with the lowest mortality rate at follow-up.
我们旨在确定体重指数（BMI）是否为经导管主动脉瓣植入术（TAVI）患者长期全因死亡率的预后指标。
已确诊心血管疾病患者中的肥胖此前被认定为预后良好的指标，这一现象被称为“肥胖悖论”。BMI在接受TAVI的严重主动脉瓣狭窄（AoS）患者中的预后意义目前存在争议，因为已发表的研究较少且结果相互矛盾。
这是一项观察性回顾性研究，纳入了770例因AoS接受TAVI的患者。根据BMI将队列分为三组：正常体重（≥18.5至<25kg/m）、超重（≥25至<30kg/m）和肥胖（≥30kg/m）。使用Cox回归分析BMI对TAVI干预后3年全因死亡率的预测作用。
155例患者在随访期间死亡。超重组（n = 302，38.97%）的死亡率低于正常体重组和肥胖组（分别为15.9% vs 25.7%和21.0%[对数秩p值 = 0.036]）。经逻辑EuroSCORE调整后，发现超重是死亡率的独立保护因素（HR：0.63[95%CI：0.42至0.94]，p = 0.024）。肥胖情况并非如此（HR：0.92[95%CI：0.63至1.35]，p = 0.664）。因此，我们首次描述了一条描述BMI与死亡率之间关系的“J形”回归曲线。
BMI是接受TAVI的AoS患者全因死亡率的预测因素。这种关系呈现为一条“J形”曲线，其中超重患者在随访时的死亡率最低。
