Department of Cardiology, Lehigh Valley Health Network, Allentown, PA, USA.
Universal Scientific Education and Research Network, Tehran University of Medical Sciences, Tehran, Iran.
Prog Cardiovasc Dis. 2023 May-Jun;78:58-66. doi: 10.1016/j.pcad.2022.12.006. Epub 2023 Jan 16.
The relationship of body mass index (BMI) and an "obesity paradox" with cardiovascular risk prediction is controversial. This systematic review and meta-analysis aims to compare the associations of different BMI ranges on transcatheter aortic valve implantation (TAVI) outcomes.
International databases, including PubMed, the Web of Science, and the Cochrane Library, were systematically searched for observational and randomized controlled trial studies investigating TAVI outcomes in any of the four BMI categories: underweight, normal weight, overweight, and obese with one of the predefined outcomes. Primary outcomes were in-hospital, 30-day, and long-term all-cause mortality. Random-effects meta-analysis was performed to calculate the odds ratio (OR) or standardized mean differences (SMD) with 95% confidence interval (CI) for each paired comparison between two of the BMI categories.
A total of 38 studies were included in our analysis, investigating 99,829 patients undergoing TAVI. There was a trend toward higher comorbidities such as hypertension, diabetes, and dyslipidemia in overweight patients and individuals with obesity. Compared with normal-weight, patients with obesity had a lower rate of 30-day mortality (OR 0.42, 95% CI 0.25-0.72, p < 0.01), paravalvular aortic regurgitation (OR 0.63, 95% CI 0.44-0.91, p = 0.01), 1-year mortality (OR 0.48, 95% CI 0.24-0.96, p = 0.04), and long-term mortality (OR 0.69, 95% CI 0.51-0.94, p = 0.02). However, acute kidney injury (OR 1.16, 95% CI 1.04-1.30, p = 0.01) and permanent pacemaker implantation (OR 1.25, 95% CI 1.05-1.50, p = 0.01) odds were higher in patients with obesity. Noteworthy, major vascular complications were significantly higher in underweight patients in comparison with normal weight cases (OR 1.62, 95% CI 1.07-2.46, p = 0.02). In terms of left ventricular ejection fraction (LVEF), patients with obesity had higher post-operative LVEF compared to normal-weight individuals (SMD 0.12, 95% CI 0.02-0.22, p = 0.02).
Our results suggest the presence of the "obesity paradox" in TAVI outcomes with higher BMI ranges being associated with lower short- and long-term mortality. BMI can be utilized for risk prediction of patients undergoing TAVI.
体重指数（BMI）与“肥胖悖论”与心血管风险预测的关系存在争议。本系统评价和荟萃分析旨在比较不同 BMI 范围对经导管主动脉瓣植入术（TAVI）结果的影响。
系统检索国际数据库，包括 PubMed、Web of Science 和 Cochrane Library，以查找研究任何四个 BMI 类别（体重过轻、正常体重、超重和肥胖）中 TAVI 结局的观察性和随机对照试验研究。主要结局为住院期间、30 天和长期全因死亡率。采用随机效应荟萃分析计算每个 BMI 类别之间两两比较的优势比（OR）或标准化均数差（SMD）及其 95%置信区间（CI）。
共纳入 38 项研究，涉及 99829 例接受 TAVI 的患者。超重患者和肥胖患者的合并症（如高血压、糖尿病和血脂异常）呈上升趋势。与正常体重相比，肥胖患者的 30 天死亡率（OR 0.42，95%CI 0.25-0.72，p < 0.01）、瓣周主动脉反流（OR 0.63，95%CI 0.44-0.91，p = 0.01）、1 年死亡率（OR 0.48，95%CI 0.24-0.96，p = 0.04）和长期死亡率（OR 0.69，95%CI 0.51-0.94，p = 0.02）较低。然而，肥胖患者的急性肾损伤（OR 1.16，95%CI 1.04-1.30，p = 0.01）和永久性起搏器植入（OR 1.25，95%CI 1.05-1.50，p = 0.01）的几率更高。值得注意的是，与正常体重患者相比，体重过轻患者的主要血管并发症发生率显著更高（OR 1.62，95%CI 1.07-2.46，p = 0.02）。就左心室射血分数（LVEF）而言，肥胖患者术后 LVEF 高于正常体重患者（SMD 0.12，95%CI 0.02-0.22，p = 0.02）。
我们的结果表明 TAVI 结果中存在“肥胖悖论”，较高的 BMI 范围与短期和长期死亡率降低相关。BMI 可用于预测接受 TAVI 的患者的风险。
