William Beaumont University Hospital, Corewell Health East, Royal Oak, MI, USA.
Department of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA.
Curr Cardiol Rep. 2024 Sep;26(9):1005-1009. doi: 10.1007/s11886-024-02098-3. Epub 2024 Jul 29.
Obesity paradox in cardiovascular risk prediction has gained increasing attention in recent years. We aimed to investigate the impact of BMI on mortality following transcatheter aortic valve replacement (TAVR).
We performed a multi-center retrospective analysis of patients with severe aortic stenosis undergoing TAVR. Patients were categorized into: Underweight (BMI < 18.5), normal weight (18.5 ≤ BMI < 25), overweight (25 ≤ BMI < 30) and obese (BMI ≥ 30). Multivariate cox-proportional hazard model was used to compare all-cause mortality.
Total of 6688 patients included (175 underweight, 2252 normal weight, 2368 overweight and 1893 with obesity). Mean age of patients was 81 ± 8 years with 55% males. Patients with obesity had higher prevalence of comorbidities but a lower overall STS score. Mortality at 30-days post-TAVR was lower in the obese population compared to underweight, normal weight, and overweight patients (1.6% vs. 6.9%, 3.6%, and 2.8%, respectively, p < 0.001). Similarly, 3-year mortality was lowest in patients with obesity (17.1% vs. 28.9%, 24.5% and 18.6%, respectively, p < 0.001). On multivariate analysis, long term all-cause mortality at 3-years remained significantly lower in patients with obesity compared to underweight (HR 1.74, 95% CI: 1.30-2.40, p < 0.001) and normal weight (HR: 1.41, 95% CI:1.21-1.63, p < 0.001) but not in overweight patients (HR: 1.10, 95% CI:0.94-1.28, p = 0.240).
In conclusion, patients with obesity have improved short and long term mortality following TAVR with an observed progressive increase in mortality with lower BMI ranges.
近年来，心血管风险预测中的肥胖悖论引起了越来越多的关注。我们旨在研究 BMI 对经导管主动脉瓣置换术（TAVR）后死亡率的影响。
我们对接受 TAVR 的严重主动脉瓣狭窄患者进行了多中心回顾性分析。患者分为：体重不足（BMI<18.5）、正常体重（18.5≤BMI<25）、超重（25≤BMI<30）和肥胖（BMI≥30）。使用多变量 Cox 比例风险模型比较全因死亡率。
共纳入 6688 例患者（175 例体重不足，2252 例正常体重，2368 例超重，1893 例肥胖）。患者平均年龄为 81±8 岁，其中 55%为男性。肥胖患者的合并症患病率较高，但总体 STS 评分较低。TAVR 后 30 天死亡率在肥胖人群中低于体重不足、正常体重和超重患者（分别为 1.6%、3.6%和 2.8%，p<0.001）。同样，肥胖患者的 3 年死亡率最低（分别为 17.1%、24.5%和 18.6%，p<0.001）。多变量分析显示，肥胖患者的长期全因死亡率在 3 年内仍显著低于体重不足患者（HR 1.74，95%CI：1.30-2.40，p<0.001）和正常体重患者（HR：1.41，95%CI：1.21-1.63，p<0.001），但与超重患者（HR：1.10，95%CI：0.94-1.28，p=0.240）无差异。
总之，肥胖患者在接受 TAVR 后短期和长期死亡率均有所改善，随着 BMI 范围的降低，死亡率呈逐渐升高趋势。
