Obesity Paradox in Transcatheter Aortic Valve Replacement

Area of Science:

• Cardiology
• Clinical Outcomes
• Interventional Cardiology

Background:

• The obesity paradox, where increased body mass index (BMI) correlates with better outcomes in certain conditions, is increasingly recognized in cardiovascular disease.
• Understanding the relationship between BMI and mortality post-transcatheter aortic valve replacement (TAVR) is crucial for risk stratification.

Purpose of the Study:

• To investigate the impact of BMI on mortality rates in patients undergoing TAVR for severe aortic stenosis.
• To determine if the obesity paradox applies to outcomes following TAVR.

Main Methods:

• A multi-center retrospective analysis included 6688 patients with severe aortic stenosis undergoing TAVR.
• Patients were stratified into underweight (BMI < 18.5), normal weight (18.5–24.9), overweight (25–29.9), and obese (BMI ≥ 30) categories.
• All-cause mortality was analyzed using a multivariate Cox proportional hazard model.

Main Results:

• Obese patients (BMI ≥ 30) had lower 30-day and 3-year all-cause mortality compared to underweight, normal weight, and overweight groups.
• Multivariate analysis confirmed that obesity was associated with significantly lower long-term mortality compared to underweight and normal weight individuals.
• No significant difference in mortality was observed between overweight and obese patients.

Conclusions:

• Obesity is associated with improved short-term and long-term survival following TAVR.
• A progressive increase in mortality was observed with decreasing BMI ranges in the TAVR population.
• These findings highlight the importance of considering BMI in the context of cardiovascular risk prediction for TAVR patients.