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Midterm Outcomes of Underweight Patients Undergoing Transcatheter Aortic Valve Implantation: Insight From the LAPLACE-TAVR Registry
BACKGROUND: Obesity is a major risk factor for cardiovascular disease; however, a paradoxical effect of obesity has been reported in patients with heart failure or myocardial infarction. Although several studies have suggested the same obesity paradox in patients undergoing transcatheter aortic valv...
Autores principales: | , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9982279/ https://www.ncbi.nlm.nih.gov/pubmed/36873767 http://dx.doi.org/10.1016/j.jacasi.2022.08.014 |
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author | Tezuka, Taiyo Higuchi, Ryosuke Hagiya, Kenichi Saji, Mike Takamisawa, Itaru Nanasato, Mamoru Iguchi, Nobuo Shimizu, Atsushi Shimizu, Jun Doi, Shinichiro Okazaki, Shinya Sato, Kei Tamura, Harutoshi Yokoyama, Hiroaki Onishi, Takayuki Tobaru, Tetsuya Takanashi, Shuichiro Takayama, Morimasa |
author_facet | Tezuka, Taiyo Higuchi, Ryosuke Hagiya, Kenichi Saji, Mike Takamisawa, Itaru Nanasato, Mamoru Iguchi, Nobuo Shimizu, Atsushi Shimizu, Jun Doi, Shinichiro Okazaki, Shinya Sato, Kei Tamura, Harutoshi Yokoyama, Hiroaki Onishi, Takayuki Tobaru, Tetsuya Takanashi, Shuichiro Takayama, Morimasa |
author_sort | Tezuka, Taiyo |
collection | PubMed |
description | BACKGROUND: Obesity is a major risk factor for cardiovascular disease; however, a paradoxical effect of obesity has been reported in patients with heart failure or myocardial infarction. Although several studies have suggested the same obesity paradox in patients undergoing transcatheter aortic valve replacement (TAVR), they included a limited number of underweight patients. OBJECTIVES: This study aimed to clarify the effect of being underweight on TAVR outcomes. METHODS: We retrospectively analyzed 1,693 consecutive patients undergoing TAVR between 2010 and 2020. The patients were categorized according to body mass index: underweight (<18.5 kg/m(2); n = 242), normal weight (18.5 to 25 kg/m(2); n = 1,055), and overweight (>25 kg/m(2); n = 396). We compared midterm outcomes after TAVR among the 3 groups; all clinical events were in accordance with the Valve Academic Research Consortium-2 criteria. RESULTS: Underweight patients were more likely to be women and have severe heart failure symptoms, peripheral artery disease, anemia, hypoalbuminemia, and pulmonary dysfunction. They also had lower ejection fractions, smaller aortic valve areas, and higher surgical risk scores. Device failure, life-threatening bleeding, major vascular complications, and 30-day mortality occurred more frequently in underweight patients. The midterm survival rate of the underweight group was inferior to those of the other 2 groups (P < 0.0001; average follow-up, 717 days). In the multivariate analysis, underweight was associated with noncardiovascular mortality (HR: 1.78; 95% CI: 1.16-2.75) but not cardiovascular mortality (HR: 1.28; 95% CI: 0.58-1.88) after TAVR. CONCLUSIONS: Underweight patients had a worse midterm prognosis, demonstrating the obesity paradox in this TAVR population. (Outcomes of transcatheter aortic valve implantation in Japanese patients with aortic stenosis: multi-center registry; UMIN000031133) |
format | Online Article Text |
id | pubmed-9982279 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-99822792023-03-04 Midterm Outcomes of Underweight Patients Undergoing Transcatheter Aortic Valve Implantation: Insight From the LAPLACE-TAVR Registry Tezuka, Taiyo Higuchi, Ryosuke Hagiya, Kenichi Saji, Mike Takamisawa, Itaru Nanasato, Mamoru Iguchi, Nobuo Shimizu, Atsushi Shimizu, Jun Doi, Shinichiro Okazaki, Shinya Sato, Kei Tamura, Harutoshi Yokoyama, Hiroaki Onishi, Takayuki Tobaru, Tetsuya Takanashi, Shuichiro Takayama, Morimasa JACC Asia Original Research BACKGROUND: Obesity is a major risk factor for cardiovascular disease; however, a paradoxical effect of obesity has been reported in patients with heart failure or myocardial infarction. Although several studies have suggested the same obesity paradox in patients undergoing transcatheter aortic valve replacement (TAVR), they included a limited number of underweight patients. OBJECTIVES: This study aimed to clarify the effect of being underweight on TAVR outcomes. METHODS: We retrospectively analyzed 1,693 consecutive patients undergoing TAVR between 2010 and 2020. The patients were categorized according to body mass index: underweight (<18.5 kg/m(2); n = 242), normal weight (18.5 to 25 kg/m(2); n = 1,055), and overweight (>25 kg/m(2); n = 396). We compared midterm outcomes after TAVR among the 3 groups; all clinical events were in accordance with the Valve Academic Research Consortium-2 criteria. RESULTS: Underweight patients were more likely to be women and have severe heart failure symptoms, peripheral artery disease, anemia, hypoalbuminemia, and pulmonary dysfunction. They also had lower ejection fractions, smaller aortic valve areas, and higher surgical risk scores. Device failure, life-threatening bleeding, major vascular complications, and 30-day mortality occurred more frequently in underweight patients. The midterm survival rate of the underweight group was inferior to those of the other 2 groups (P < 0.0001; average follow-up, 717 days). In the multivariate analysis, underweight was associated with noncardiovascular mortality (HR: 1.78; 95% CI: 1.16-2.75) but not cardiovascular mortality (HR: 1.28; 95% CI: 0.58-1.88) after TAVR. CONCLUSIONS: Underweight patients had a worse midterm prognosis, demonstrating the obesity paradox in this TAVR population. (Outcomes of transcatheter aortic valve implantation in Japanese patients with aortic stenosis: multi-center registry; UMIN000031133) Elsevier 2022-12-13 /pmc/articles/PMC9982279/ /pubmed/36873767 http://dx.doi.org/10.1016/j.jacasi.2022.08.014 Text en © 2023 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Original Research Tezuka, Taiyo Higuchi, Ryosuke Hagiya, Kenichi Saji, Mike Takamisawa, Itaru Nanasato, Mamoru Iguchi, Nobuo Shimizu, Atsushi Shimizu, Jun Doi, Shinichiro Okazaki, Shinya Sato, Kei Tamura, Harutoshi Yokoyama, Hiroaki Onishi, Takayuki Tobaru, Tetsuya Takanashi, Shuichiro Takayama, Morimasa Midterm Outcomes of Underweight Patients Undergoing Transcatheter Aortic Valve Implantation: Insight From the LAPLACE-TAVR Registry |
title | Midterm Outcomes of Underweight Patients Undergoing Transcatheter Aortic Valve Implantation: Insight From the LAPLACE-TAVR Registry |
title_full | Midterm Outcomes of Underweight Patients Undergoing Transcatheter Aortic Valve Implantation: Insight From the LAPLACE-TAVR Registry |
title_fullStr | Midterm Outcomes of Underweight Patients Undergoing Transcatheter Aortic Valve Implantation: Insight From the LAPLACE-TAVR Registry |
title_full_unstemmed | Midterm Outcomes of Underweight Patients Undergoing Transcatheter Aortic Valve Implantation: Insight From the LAPLACE-TAVR Registry |
title_short | Midterm Outcomes of Underweight Patients Undergoing Transcatheter Aortic Valve Implantation: Insight From the LAPLACE-TAVR Registry |
title_sort | midterm outcomes of underweight patients undergoing transcatheter aortic valve implantation: insight from the laplace-tavr registry |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9982279/ https://www.ncbi.nlm.nih.gov/pubmed/36873767 http://dx.doi.org/10.1016/j.jacasi.2022.08.014 |
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