Higuchi Ryosuke, Izumo Masaki, Izumi Yuki, Saji Mike, Isobe Mitsuaki, Akashi Yoshihiro, Yamamoto Masanori, Asami Masahiko, Enta Yusuke, Nakashima Masaki, Shirai Shinichi, Mizuno Shingo, Watanabe Yusuke, Amaki Makoto, Kodama Kazuhisa, Yamaguchi Junichi, Naganuma Toru, Bota Hiroki, Ohno Yohei, Yamawaki Masahiro, Ueno Hiroshi, Mizutani Kazuki, Kubo Shunsuke, Otsuka Toshiaki, Hayashida Kentaro
Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
Division of Cardiology, St. Marianna University School of Medicine Hospital, Kawasaki, Japan.
ESC Heart Fail. 2025 Feb;12(1):408-417. doi: 10.1002/ehf2.15047. Epub 2024 Sep 23.
Mitral transcatheter edge-to-edge repair (M-TEER) is a valid treatment option for severe mitral regurgitation (MR), necessitating accurate risk stratification of M-TEER candidates for effective patient selection, optimal periprocedural care and improved long-term outcomes. The body mass index (BMI) is a simple and practical prognostic index, and the obesity paradox has been widely reported.
Between April 2018 and June 2021, 2149 patients undergoing M-TEER were registered in the prospective multicentre registry and classified into three groups: underweight (BMI < 18.5 kg/m), normal weight (18.5 ≤ BMI < 25 kg/m) and overweight and obese (25 kg/m ≦ BMI) [Correction added on 17 October 2024, after first online publication: In the preceding sentence, "18.5 ☆ BMI < 25 kg/m2" and "25 kg/m2 ☆ BMI" have been corrected to "18.5 ≤ BMI < 25 kg/m2" and "25 kg/m2 ≦ BMI" in this version.] The impact of underweight on the all-cause, cardiovascular and non-cardiovascular mortality following M-TEER was evaluated [follow-up duration: 436 (363-733) days]. The participants (median BMI: 21.1 kg/m) were categorized as underweight (n = 450, 20.9%), normal weight (n = 1409, 65.6%) and overweight and obese (n = 290, 13.5%). Compared with the other two groups, the underweight group exhibited several negative prognostic factors, including older age, frailty, no dyslipidaemia, hypoalbuminaemia, residual MR and non-home discharge. Underweight patients had the highest rate of all-cause, cardiovascular and non-cardiovascular mortality, whereas those in the other two groups were similar. As per the multivariate analysis, underweight itself was associated with all-cause mortality (hazard ratio: 1.52, 95% confidence interval: 1.17-1.97, P = 0.009) and cardiovascular mortality (hazard ratio: 1.45, 95% confidence interval: 1.04-2.01, P = 0.028).
Underweight patients had the highest mortality rate after M-TEER. Comorbidities, residual MR, discharge disposition and underweight status were correlated with postprocedural outcome.
二尖瓣经导管缘对缘修复术（M-TEER）是治疗严重二尖瓣反流（MR）的有效方法，需要对M-TEER候选者进行准确的风险分层，以实现有效的患者选择、优化围手术期护理并改善长期预后。体重指数（BMI）是一个简单实用的预后指标，肥胖悖论已被广泛报道。
2018年4月至2021年6月期间，2149例行M-TEER的患者被纳入前瞻性多中心注册研究，并分为三组：体重过轻（BMI＜18.5kg/m²）、正常体重（18.5≤BMI＜25kg/m²）和超重及肥胖（BMI≥25kg/m²）[2024年10月17日首次在线发表后更正：在上一句中，“18.5☆BMI＜25kg/m²”和“25kg/m²☆BMI”在本版本中已更正为“18.5≤BMI＜25kg/m²”和“25kg/m² ≦ BMI”]。评估体重过轻对M-TEER术后全因、心血管和非心血管死亡率的影响[随访时间：436（363 - 733）天]。参与者（BMI中位数：21.1kg/m²）被分类为体重过轻（n = 450，20.9%）、正常体重（n = 1409，65.6%）和超重及肥胖（n = 290，13.5%）。与其他两组相比，体重过轻组表现出几个不良预后因素，包括年龄较大、身体虚弱、无血脂异常、低白蛋白血症、残余MR和非家庭出院。体重过轻的患者全因、心血管和非心血管死亡率最高，而其他两组患者的死亡率相似。多因素分析显示，体重过轻本身与全因死亡率（风险比：1.52，95%置信区间：1.17 - 1.97，P = 0.009）和心血管死亡率（风险比：1.45，95%置信区间：1.04 - 2.01，P = 0.028）相关。
体重过轻的患者在M-TEER术后死亡率最高。合并症、残余MR、出院处置和体重过轻状态与术后结果相关。
