Boukhris Marouane, Forcillo Jessica, Potvin Jeannot, Noiseux Nicolas, Stevens Louis-Mathieu, Badreddine Malek, Gobeil Jean-François, Masson Jean-Bernard
Division of Cardiology and Cardiac Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada; Department of Cardiology, Dupuytren University Hospital, Limoges, France.
Division of Cardiology and Cardiac Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
Cardiovasc Revasc Med. 2022 May;38:1-8. doi: 10.1016/j.carrev.2021.08.011. Epub 2021 Aug 14.
Data is controversial regarding the existence of an "obesity paradox" in patients undergoing Transcatheter Aortic Valve Replacement (TAVR). We sought to investigate the prognostic value of the body mass index (BMI) on outcomes following TAVR.
This is an observational, single-center study involving all patients who underwent TAVR from 2009 to 2019. BMI was calculated in all patients before TAVR. The cohort was subdivided into four groups: underweight (<20 kg/m), normal weight (≥20 to <25 kg/m), overweight (≥25 to <30 kg/m) and obese (≥30 kg/m). The main endpoint was all-cause 30-day and one-year mortality.
A total of 412 patients (mean age 79.6 ± 7.8 years, mean STS score 5.3 ± 3.6) were included. Patients were grouped as follows: underweight (n = 35, 8.5%), normal weight (n = 121, 29.4%), overweight (n = 140, 34%) and obese (n = 116, 28.1%). Obese patients were younger, included more females and had lower STS score than the rest of the cohort whereas underweight patients were older, had higher STS score, more chronic kidney disease, more left ventricular dysfunction and more often underwent non-transfemoral TAVR. BMI predicted 30-day survival (AUC:0.692 [95%CI 0.522-0.862]; p = 0.030) with an optimal cut-off of 24.4 (sensitivity = 66.6%, specificity = 63.6%). On multivariate analysis, higher BMI trended toward lower 30-day mortality (HR = 0.87 [95%CI 0.75-1.01]; p = 0.071). Thirty-day mortality was higher in the underweight group (8.3%) in comparison with other BMI subgroups (normal weight 2.5%, overweight 1.4%, obese 0.9%; p = 0.045). However, no significant difference was found after adjustment of confounders (all p = NS). BMI did not predict one-year mortality. No significant difference in one-year survival was observed between the four BMI subgroups (log rank p = 0.925).
BMI could represent an interesting prognostic tool for short-term mortality in patients undergoing TAVR. BMI < 20 kg/m was associated with higher 30-day mortality. Symptoms improved similarly in obese patients compared to lower BMI patients. For 30-day survivors, no evidence of the existence of an obesity paradox was observed in this cohort.
关于经导管主动脉瓣置换术（TAVR）患者中“肥胖悖论”的存在，数据存在争议。我们试图研究体重指数（BMI）对TAVR术后结局的预后价值。
这是一项观察性单中心研究，纳入了2009年至2019年期间所有接受TAVR的患者。所有患者在TAVR术前均计算BMI。队列被分为四组：体重过轻（<20kg/m²）、正常体重（≥20至<25kg/m²）、超重（≥25至<30kg/m²）和肥胖（≥30kg/m²）。主要终点是全因30天和1年死亡率。
共纳入412例患者（平均年龄79.6±7.8岁，平均STS评分5.3±3.6）。患者分组如下：体重过轻（n = 35，8.5%）、正常体重（n = 121，29.4%）、超重（n = 140，34%）和肥胖（n = 116，28.1%）。肥胖患者比队列中的其他患者更年轻，女性更多，STS评分更低，而体重过轻的患者年龄更大，STS评分更高，慢性肾病更多，左心室功能障碍更多，且更常接受非经股动脉TAVR。BMI可预测30天生存率（AUC：0.692[95%CI 0.522 - 0.862]；p = 0.030），最佳截断值为24.4（敏感性 = 66.6%，特异性 = 63.6%）。多因素分析显示，较高的BMI有降低30天死亡率的趋势（HR = 0.87[95%CI 0.75 - 1.01]；p = 0.071）。体重过轻组的30天死亡率（8.3%）高于其他BMI亚组（正常体重2.5%、超重1.4%、肥胖0.9%；p = 0.045）。然而，调整混杂因素后未发现显著差异（所有p = 无统计学意义）。BMI不能预测1年死亡率。四个BMI亚组之间的1年生存率无显著差异（对数秩检验p = 0.925）。
BMI可能是TAVR患者短期死亡率的一个有意义的预后工具。BMI < 20kg/m²与较高的30天死亡率相关。与BMI较低的患者相比，肥胖患者的症状改善情况相似。对于30天幸存者，该队列中未观察到“肥胖悖论”存在的证据。
