Yamashita Yoshiyuki, Baudo Massimo, Sicouri Serge, Zafar Mujtaba, Rodriguez Roberto, Gnall Eric M, Coady Paul M, Goldman Scott M, Gray William A, Ramlawi Basel
Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Pennsylvania, USA.
Department of Interventional Cardiology, Lankenau Heart Institute, Main Line Health Wynnewood, Pennsylvania, USA.
Anatol J Cardiol. 2024 Oct 7;28(12):565-74. doi: 10.14744/AnatolJCardiol.2024.4637.
The association of body mass index (BMI) and an "obesity paradox" with cardiovascular risk prediction is controversial. This study aimed to evaluate the impact of elevated BMI on the outcome of transcatheter aortic valve replacement (TAVR) for aortic stenosis.
This retrospective study included 1019 patients with a BMI of ≥18.5 kg/m2 divided into 3 groups: 1) normal BMI (18.5-24.9 kg/m2), 2) overweight (25-29.9 kg/m2), and 3) obese (≥30 kg/m2). Propensity score matching was used to compare normal BMI with overweight and normal BMI with obese.
The median age of the cohort was 82 years, and 348 patients had a normal BMI, while 319 and 352 patients were overweight and obese, respectively. After 1 : 1 propensity score matching, 258 and 192 pairs between normal BMI and overweight, and normal BMI and obese patients, respectively, were analyzed. Both overweight and obese patients had higher post-transaortic mean gradients and lower indexed effective orifice areas compared to normal BMI patients. During a median follow-up of 25 (range: 0.1-72) months, all-cause mortality was similar between overweight or obese patients and patients with a normal BMI. However, in a subgroup analysis of patients with moderate/severe chronic lung disease, all-cause mortality was significantly higher in obese patients compared with normal BMI patients (hazard ratio = 3.49, 95% confidence interval, 1.21-10.0, P = .021).
In this study, the "obesity paradox" was not observed in patients undergoing TAVR; rather, in patients with significant lung disease, obesity may be associated with worse midterm outcomes after TAVR.
体重指数（BMI）以及“肥胖悖论”与心血管风险预测之间的关联存在争议。本研究旨在评估BMI升高对经导管主动脉瓣置换术（TAVR）治疗主动脉瓣狭窄结局的影响。
这项回顾性研究纳入了1019名BMI≥18.5kg/m²的患者，分为3组：1）正常BMI（18.5 - 24.9kg/m²），2）超重（25 - 29.9kg/m²），3）肥胖（≥30kg/m²）。采用倾向评分匹配法比较正常BMI与超重以及正常BMI与肥胖患者。
该队列的中位年龄为82岁，348例患者BMI正常，319例和352例患者分别为超重和肥胖。在1:1倾向评分匹配后，分别分析了正常BMI与超重、正常BMI与肥胖患者之间的258对和192对。与正常BMI患者相比，超重和肥胖患者的经主动脉平均压差更高，而指数化有效瓣口面积更低。在中位随访25（范围：0.1 - 72）个月期间，超重或肥胖患者与正常BMI患者的全因死亡率相似。然而，在中度/重度慢性肺病患者的亚组分析中，肥胖患者的全因死亡率显著高于正常BMI患者（风险比 = 3.49，95%置信区间，1.21 - 10.0，P = 0.021）。
在本研究中，接受TAVR的患者未观察到“肥胖悖论”；相反，在患有严重肺部疾病的患者中，肥胖可能与TAVR术后中期结局较差有关。
