Department of Medicine, National University Health System, Singapore.
These authors contributed equally as first authors in this work.
Singapore Med J. 2022 Jun;63(6):330-334. doi: 10.11622/smedj.2020169. Epub 2020 Dec 2.
The obesity paradox, where obesity is associated with improved survival, has been described in patients undergoing haemodialysis and in those with heart failure. It was also demonstrated in patients undergoing valve replacement for aortic stenosis (AS). We explored this phenomenon in medically managed severe AS.
154 patients with medically managed severe AS (aortic valve area index [AVAi] < 0.6 cm/m; mean pressure gradient > 40 mmHg and peak velocity > 400 cm/s) and preserved left ventricular ejection fraction (> 50%) were categorised into the obese (body mass index [BMI] Asian cut-off ≥ 27.5 kg/m) and non-obese groups. Their clinical and echocardiographic profiles were compared.
24 (15.6%) patients were obese. Obese patients were similar to non-obese patients in age (68.5 ± 11.6 years vs. 68.9 ± 13.1 years) but had higher prevalence of cardiovascular risk factors. Left atrial diameter (43.7 ± 6.7 mm vs. 38.5 ± 10.2 mm) was larger in obese patients, while left ventricular outflow tract diameter (19.5 ± 1.7 mm vs. 20.4 ± 2.1 mm) was smaller. Despite lower AVAi in obese patients (0.36 ± 0.10 cm/m vs. 0.43 ± 0.11 cm/m), there was lower mortality (37.5% vs. 41.0%, log-rank 4.06, p = 0.045) on follow-up (8.0 ± 5.7 years). After adjusting for age and AVAi, higher BMI ≥ 27.5 kg/m remained protective for mortality (hazard ratio 0.38, 95% confidence interval 0.15 to 0.98, p = 0.046).
We demonstrated that obesity was associated with improved survival in severe AS despite lower AVAi and increased prevalence of cardiovascular risk factors.
肥胖悖论是指肥胖与生存改善相关，这一现象在接受血液透析的患者和心力衰竭患者中已有描述。在接受主动脉瓣狭窄（AS）置换术的患者中也有类似的表现。我们在接受药物治疗的严重 AS 患者中探讨了这一现象。
154 例接受药物治疗的严重 AS 患者（主动脉瓣面积指数[AVAi]＜0.6cm/m；平均压力梯度＞40mmHg，峰值速度＞400cm/s）和保留左心室射血分数（＞50%）被分为肥胖组（BMI 亚洲切点≥27.5kg/m）和非肥胖组。比较两组患者的临床和超声心动图特征。
24 例（15.6%）患者肥胖。肥胖患者与非肥胖患者在年龄（68.5±11.6 岁比 68.9±13.1 岁）方面相似，但心血管危险因素的发生率更高。肥胖患者的左心房直径更大（43.7±6.7mm 比 38.5±10.2mm），而左心室流出道直径更小（19.5±1.7mm 比 20.4±2.1mm）。尽管肥胖患者的 AVAi 较低（0.36±0.10cm/m 比 0.43±0.11cm/m），但死亡率较低（37.5%比 41.0%，log-rank 4.06，p=0.045）。随访 8.0±5.7 年后，肥胖患者的死亡率更低。在校正年龄和 AVAi 后，较高的 BMI≥27.5kg/m 仍然与死亡率降低相关（风险比 0.38，95%置信区间 0.15 至 0.98，p=0.046）。
尽管肥胖患者的 AVAi 较低且心血管危险因素的发生率较高，但我们发现肥胖与严重 AS 患者的生存改善相关。
