TY - JOUR
T1 - Low body mass index and risk of mortality after mitral transcatheter edge-to-edge repair procedure
T2 - The “obesity paradox”
AU - Carter-Storch, Rasmus
AU - Veien, Karsten T.
AU - Mogensen, Nils Sofus Borg
AU - Banke, Ann
AU - Tofte-Hansen, Emil Ulrikkaholm
AU - Ali, Mulham
AU - Laursen, Kristian
AU - Dahl, Jordi Sanchez
PY - 2024/8
Y1 - 2024/8
N2 - Background: Most patients undergoing the mitral transcatheter edge-to-edge repair (TEER) technique are elderly comorbid patients. Low body mass index (BMI) < 23 kg/m2 has been identified in other elderly populations as a risk factor, but has not been studied sufficiently in mitral TEER. Aims: We aimed to study the impact of low BMI (23 kg/m2) on the outcome after mitral TEER. Methods: Patients undergoing first-time TEER for mitral regurgitation at a single tertiary center were included, with the exclusion of patients with preprocedural hemodynamic instability or missing BMI. The primary endpoint was all-cause mortality. Secondary endpoints were long-term major bleeding or admission with heart failure. Results: A total of 120 patients (mean age 76 ± 10 years, 76% men) were included in the study. Thirty-nine (31%) had low BMI. Patients with low BMI had a similar symptomatic benefit as patients with BMI ≥ 23 kg/m2 at 1 year regarding decrease in diuretics dose and decrease in New York Heart Association (NYHA) class (p > 0.05). In a multivariable Cox regression analysis, BMI as a continuous variable (hazard ratio [HR]: 0.93 [95% confidence interval, CI: 0.87–0.99], p = 0.03) and low BMI (HR: 1.99 [95% CI: 1.12–3.52], p = 0.02) were associated with the primary outcome. Low BMI was not significantly associated with major bleeding (subdistribution hazard ratio [SHR]: 2.39 [95% CI: 0.96–5.97], p = 0.06) or admission with heart failure (SHR: 1.06 [95% CI: 0.61–1.88], p = 0.83) during follow-up with univariable competing risk regression analysis. Conclusion: Low BMI is a risk factor for mortality after mitral valve TEER, confirming the presence of an “obesity paradox” in this population and should receive attention in patient selection.
AB - Background: Most patients undergoing the mitral transcatheter edge-to-edge repair (TEER) technique are elderly comorbid patients. Low body mass index (BMI) < 23 kg/m2 has been identified in other elderly populations as a risk factor, but has not been studied sufficiently in mitral TEER. Aims: We aimed to study the impact of low BMI (23 kg/m2) on the outcome after mitral TEER. Methods: Patients undergoing first-time TEER for mitral regurgitation at a single tertiary center were included, with the exclusion of patients with preprocedural hemodynamic instability or missing BMI. The primary endpoint was all-cause mortality. Secondary endpoints were long-term major bleeding or admission with heart failure. Results: A total of 120 patients (mean age 76 ± 10 years, 76% men) were included in the study. Thirty-nine (31%) had low BMI. Patients with low BMI had a similar symptomatic benefit as patients with BMI ≥ 23 kg/m2 at 1 year regarding decrease in diuretics dose and decrease in New York Heart Association (NYHA) class (p > 0.05). In a multivariable Cox regression analysis, BMI as a continuous variable (hazard ratio [HR]: 0.93 [95% confidence interval, CI: 0.87–0.99], p = 0.03) and low BMI (HR: 1.99 [95% CI: 1.12–3.52], p = 0.02) were associated with the primary outcome. Low BMI was not significantly associated with major bleeding (subdistribution hazard ratio [SHR]: 2.39 [95% CI: 0.96–5.97], p = 0.06) or admission with heart failure (SHR: 1.06 [95% CI: 0.61–1.88], p = 0.83) during follow-up with univariable competing risk regression analysis. Conclusion: Low BMI is a risk factor for mortality after mitral valve TEER, confirming the presence of an “obesity paradox” in this population and should receive attention in patient selection.
KW - echocardiography
KW - interventional cardiology
KW - risk factors
KW - valvular disease
KW - Body Mass Index
KW - Hemorrhage/mortality
KW - Risk Assessment
KW - Humans
KW - Risk Factors
KW - Thinness/mortality
KW - Male
KW - Treatment Outcome
KW - Heart Failure/mortality
KW - Obesity/mortality
KW - Mitral Valve/surgery
KW - Heart Valve Prosthesis Implantation/adverse effects
KW - Mitral Valve Insufficiency/mortality
KW - Time Factors
KW - Cardiac Catheterization/adverse effects
KW - Aged, 80 and over
KW - Female
KW - Aged
KW - Retrospective Studies
U2 - 10.1002/ccd.31114
DO - 10.1002/ccd.31114
M3 - Journal article
C2 - 38819910
AN - SCOPUS:85195110943
SN - 1522-1946
VL - 104
SP - 401
EP - 407
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 2
ER -