Reichl Jakob J, Poljo Adisa, Stolte Thorald, Schmitt Ramona, Boeddinghaus Jasper, Wagener Max, Leibundgut Gregor, Kaiser Christoph, Westermann Dirk, Hartikainen Tau, Mahfoud Felix, Ruile Philipp, Breitbart Philipp, Nestelberger Thomas
Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland; Department of Cardiology and Angiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Bad Krozingen, Germany.
Department of Visceral Surgery, Clarunis, University Digestive Health Care Center Basel, St. Clara Hospital and University Hospital, Basel, Switzerland.
Am J Cardiol. 2025 Aug 1;248:67-72. doi: 10.1016/j.amjcard.2025.04.012. Epub 2025 Apr 19.
Obesity is a major public health concern linked to adverse cardiovascular outcomes. Recent studies suggest an obesity paradox, showing lower mortality in obese patients after transcatheter aortic valve implantation (TAVI). This study investigates the impact of body mass index (BMI) on procedural and long-term clinical outcomes in patients undergoing TAVI. Patients undergoing TAVI at two high-volume centers were analyzed and categorized into four BMI groups: underweight (BMI <18.5 kg/m), normal (BMI 18.5-24.9 kg/m), overweight (BMI 25.0-29.9 kg/m), and obese (BMI ≥30.0 kg/m). To relax the proportional hazards assumption, restricted cubic splines were constructed. The primary outcome was procedural success and safety, including 30-day all-cause-mortality, stroke, and overall bleeding. Secondary outcomes included all-cause mortality at one and five years. In total, 6,156 patients were included: 114 (1.8%) were underweight, 2,393 (38.8%) normal weight, 2,380 (38.6%) overweight, and 1,269 (20.6%) obese. No significant differences between BMI groups were found in 30-day mortality, stroke, or bleeding. However, underweight patients had higher mortality compared to normal-weight patients at one year (23.7 vs 13.2%, p = 0.001) and five years (53.2% vs. 44.0%, p = 0.048). Obese patients had similar mortality to normal-weight patients at one year (11.4 vs 13.2%, p = 0.120) and five years (41.0 vs 44.0%, p = 0.200). Obesity showed no outcome advantage over normal weight, while underweight was an independent predictor of higher all-cause mortality after TAVI. These findings challenge the obesity paradox in the context of TAVI.
肥胖是一个与不良心血管结局相关的主要公共卫生问题。最近的研究表明存在肥胖悖论，即经导管主动脉瓣植入术（TAVI）后肥胖患者的死亡率较低。本研究调查了体重指数（BMI）对接受TAVI患者的手术及长期临床结局的影响。对在两个高容量中心接受TAVI的患者进行分析，并将其分为四个BMI组：体重过轻（BMI<18.5kg/m）、正常（BMI 18.5 - 24.9kg/m）、超重（BMI 25.0 - 29.9kg/m）和肥胖（BMI≥30.0kg/m）。为了放宽比例风险假设，构建了受限立方样条。主要结局是手术成功与安全性，包括30天全因死亡率、中风和总体出血。次要结局包括1年和5年的全因死亡率。总共纳入了6156例患者：114例（1.8%）体重过轻，2393例（38.8%）体重正常，2380例（38.6%）超重，1269例（20.6%）肥胖。BMI组之间在30天死亡率、中风或出血方面未发现显著差异。然而，体重过轻的患者在1年时的死亡率高于体重正常的患者（23.7%对13.2%，p = 0.001），在5年时也是如此（53.2%对44.0%，p = 0.048）。肥胖患者在1年时的死亡率与体重正常的患者相似（11.4%对13.2%，p = 0.120），在5年时也是如此（41.0%对44.0%，p = 0.200）。肥胖在结局方面并不优于正常体重，而体重过轻是TAVI后全因死亡率较高的独立预测因素。这些发现对TAVI背景下的肥胖悖论提出了挑战。
