Universitäres Herzzentrum Eppendorf, Hamburg, Germany.
Klinikum Siegburg (Kardiologie und Angiologie), Germany.
Am Heart J. 2020 Apr;222:73-82. doi: 10.1016/j.ahj.2019.12.022. Epub 2020 Jan 10.
Underweight and obesity represent classical risk factors for adverse outcome in patients treated for cardiovascular disease.
The current analysis examines the impact of underweight, overweight and obesity on intra-hospital, short and long-term outcomes in patients treated by MitraClip therapy.
From August 2010 until July 2013, 799 patients (age 75.3 ± 8.6 years, male gender 60.7%, median logistic EuroSCORE 20% [12; 31], functional mitral regurgitation (MR): 69.3%) were prospectively enrolled into the multicenter German Transcatheter Mitral Valve Interventions registry. Patients were stratified according to body mass index (BMI) into 4 groups: BMI <20 kg/m (underweight), BMI 20.0 to <25.0 kg/m (normal weight, reference group), BMI 25.0 to <30.0 kg/m (overweight) and BMI ≥30 kg/m (obese). Significant increased rates of procedural failure, transfusion/bleeding, sepsis or multiorgan failure and low cardiac output failure were found for underweight patients only. Kaplan-Meier survival curves demonstrated inferior survival for underweight patients, but comparable outcomes for all other patients (global log rank test, P < .01). Multivariable Cox-regression analysis (adjusted for age, gender, creatinine ≥1.5 mg/dL, diabetes, left ventricular ejection fraction <30% and chronic obstructive pulmonary disease) confirmed underweight (as compared to normal weight) as an independent risk factor of death (hazard ratio [HR]: 1.58, 95% confidence interval (CI): 1.01-2.46, P = .044) and overweight as protective against death (HR: 0.71; 95%-CI: 0.55-0.93; P = .011).
Compared to other weight groups, underweight patients undergoing MitraClip implantation are exposed to increased rates of procedural failure, bleeding and low cardiac output as well as increased short- and long-term mortality rates and should therefore be carefully discussed in the heart-team.
体重过轻和肥胖是心血管疾病患者治疗后出现不良结局的经典危险因素。
本分析研究了体重过轻、超重和肥胖对行经导管二尖瓣夹合术治疗的患者院内、短期和长期结局的影响。
2010 年 8 月至 2013 年 7 月，前瞻性纳入了 799 名（年龄 75.3±8.6 岁，男性 60.7%，中位数 logistic EuroSCORE 20%[12;31]，功能性二尖瓣反流（MR）：69.3%）患者至德国经导管二尖瓣瓣环成形术多中心注册研究。根据体重指数（BMI）将患者分为 4 组：BMI＜20kg/m²（体重过轻）、BMI 20.0-＜25.0kg/m²（正常体重，参考组）、BMI 25.0-＜30.0kg/m²（超重）和 BMI≥30kg/m²（肥胖）。仅体重过轻的患者术中失败率、输血/出血、败血症或多器官衰竭和低心输出量衰竭率显著升高。Kaplan-Meier 生存曲线显示体重过轻患者的生存率较低，但所有其他患者的结果相似（全局对数秩检验，P＜.01）。多变量 Cox 回归分析（调整年龄、性别、肌酐≥1.5mg/dL、糖尿病、左心室射血分数＜30%和慢性阻塞性肺疾病）证实，与正常体重相比，体重过轻是死亡的独立危险因素（危险比[HR]：1.58，95%置信区间[CI]：1.01-2.46，P=0.044），超重则对死亡有保护作用（HR：0.71；95%CI：0.55-0.93；P=0.011）。
与其他体重组相比，行经导管二尖瓣夹合术治疗的体重过轻患者术中失败、出血和低心输出量的发生率更高，且短期和长期死亡率更高，因此应在心衰团队中仔细讨论。
