Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
Clin Res Cardiol. 2024 Jan;113(1):156-167. doi: 10.1007/s00392-023-02312-2. Epub 2023 Oct 4.
Obesity and underweight represent classical risk factors for outcome in patients treated for cardiovascular disease. This study describes the impact of different body mass index (BMI) categories on 1-year clinical outcome in patients with tricuspid regurgitation (TR) undergoing transcatheter-edge-to-edge repair (TEER).
We analyzed 211 consecutive patients (age 78.3 ± 7.2 years, 55.5% female, median EuroSCORE II 9.6 ± 6.7) with tricuspid regurgitation undergoing TEER from June 2015 until May 2021. Patients were prospectively enrolled in our single center registry and were retrospectively analyzed. 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), BMI 25.0 to > 30.0 kg/m (overweight) and BMI ≥ 30 kg/m (obese).
Kaplan-Meier survival curves demonstrated inferior survival for underweight and obese patients, but comparable outcomes for normal and overweight patients (global log rank test, p < 0.01). Cardiovascular death was significantly higher in underweight patients compared to the other groups (24.1% vs. 7.0% vs. 6.3% vs. 6.4%; p < 0.01). Over all, there were comparable rates of bleeding, stroke and myocardial infarction. Multivariable Cox regression analysis (adjusted for age, gender, coronary artery disease, chronic obstructive pulmonary disease, tricuspid annular plane systolic excursion, left-ventricular ejection fraction) confirmed underweight (HR 3.88; 95% CI 1.64-7.66; p < 0.01) and obesity (HR 3.24; 95% CI 1.37-9.16; p < 0.01) as independent risk factors for 1-year all-cause mortality.
Compared to normal weight and overweight patients, obesity and underweight patients undergoing TEER display significant higher 1-year all-cause mortality.
肥胖和体重不足是心血管疾病患者治疗结局的经典危险因素。本研究描述了不同体重指数（BMI）类别对行经导管缘对缘修复（TEER）的三尖瓣反流（TR）患者 1 年临床结局的影响。
我们分析了 2015 年 6 月至 2021 年 5 月期间在我们的单中心注册处接受 TEER 的 211 例连续 TR 患者（年龄 78.3±7.2 岁，55.5%为女性，中位数 EuroSCORE II 9.6±6.7）。患者前瞻性入组至我们的单中心注册处，并进行回顾性分析。根据 BMI 将患者分为 4 组：BMI<20 kg/m2（体重不足）、BMI 20.0-<25.0 kg/m2（正常体重）、BMI 25.0-<30.0 kg/m2（超重）和 BMI≥30 kg/m2（肥胖）。
Kaplan-Meier 生存曲线显示体重不足和肥胖患者的生存状况较差，但正常体重和超重患者的结局相似（全局对数秩检验，p<0.01）。与其他组相比，体重不足患者的心血管死亡明显更高（24.1%比 7.0%比 6.3%比 6.4%；p<0.01）。总体而言，各组出血、卒中和心肌梗死的发生率相似。多变量 Cox 回归分析（调整年龄、性别、冠心病、慢性阻塞性肺疾病、三尖瓣环平面收缩期位移、左心室射血分数）证实体重不足（HR 3.88；95%CI 1.64-7.66；p<0.01）和肥胖（HR 3.24；95%CI 1.37-9.16；p<0.01）是 1 年全因死亡率的独立危险因素。
与正常体重和超重患者相比，接受 TEER 的肥胖和体重不足患者 1 年全因死亡率显著更高。
