Impact of Morbid Obesity and Obesity Phenotype on Outcomes After Transcatheter Aortic Valve Replacement

There is a paucity of outcome data on patients who are morbidly obese (MO) undergoing transcatheter aortic valve replacement. We aimed to determine their periprocedural and midterm outcomes and investigate the impact of obesity phenotype. Consecutive patients who are MO (body mass index, ≥40 kg/m 2,...

Descripción completa

Detalles Bibliográficos
Autores: McInerney, Angela|||0000-0002-1160-7735, Tirado-Conte, Gabriela|||0000-0002-7093-3936, Rodes-Cabau, Josep|||0000-0001-8237-7095, Campelo-Parada, F.|||0000-0003-1821-0658, Tafur Soto, Jose D., Barbanti, Marco, Muñoz-Garcia, Erika, Arif, Mobeena, Lopez, Diego, Toggweiler, Stefan, Veiga, Gabriela, Pylko, Anna|||0000-0002-3693-1400, Sevilla Ruiz, Teresa|||0000-0002-9450-0887, Compagnone, Miriam, Regueiro, Ander|||0000-0001-5201-447X, Serra, Viçent, Carnero-Alcázar, Manuel|||0000-0001-5045-5765, Oteo, Juan F.|||0000-0002-2641-4135, Rivero, Fernando|||0000-0002-3676-0277, Barbosa Ribeiro, Henrique, Guimaraes, Leonardo, Matta, Anthony, Giraldo Echavarria, Natalia|||0000-0001-8731-8262, Valvo, Roberto, Moccetti, Federico|||0000-0002-5794-5676, Muñoz-Garcia, Antonio J., Lopez-Pais, Javier, García del Blanco, Bruno|||0000-0002-4527-1600, Campanha Borges, Diego Carter, Dumont, Eric, Gonzalo, Nieves|||0000-0003-3827-945X, Criscione, Enrico|||0000-0002-1550-8531, Dabrowski, Maciej, Alfonso, Fernando|||0000-0002-7480-2511, Torre Hernández, Jose M. de la, Cheema, Asim N., Amat-Santos, Ignacio J.|||0000-0002-2311-4129, Saia, Francesco|||0000-0001-9969-2649, Escaned, Javier|||0000-0003-4932-0112, Nombela-Franco, Luís|||0000-0003-3438-8907
Tipo de recurso: artículo
Fecha de publicación:2021
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:255615
Acceso en línea:https://ddd.uab.cat/record/255615
https://dx.doi.org/urn:doi:10.1161/JAHA.120.019051
Access Level:acceso abierto
Palabra clave:Epicardial adipose tissue
Morbid obesity
Subcutaneous adipose tissue
Transcatheter aortic valve replacement
Visceral adipose tissue
Catheter-Based Coronary and Valvular Interventions
Obesity
Valvular Heart Disease
Descripción
Sumario:There is a paucity of outcome data on patients who are morbidly obese (MO) undergoing transcatheter aortic valve replacement. We aimed to determine their periprocedural and midterm outcomes and investigate the impact of obesity phenotype. Consecutive patients who are MO (body mass index, ≥40 kg/m 2, or ≥35 kg/m 2 with obesity-related comorbidities; n=910) with severe aortic stenosis who underwent transcatheter aortic valve replacement in 18 tertiary hospitals were compared with a nonobese cohort (body mass index, 18.5-29.9 kg/m 2, n=2264). Propensity-score matching resulted in 770 pairs. Pre-transcatheter aortic valve replacement computed tomography scans were centrally analyzed to assess adipose tissue distribution; epicardial, abdominal visceral and subcutaneous fat. Major vascular complications were more common (6.6% versus 4.3%; P =0.043) and device success was less frequent (84.4% versus 88.1%; P =0.038) in the MO group. Freedom from all-cause and cardiovascular mortality were similar at 2 years (79.4 versus 80.6%, P =0.731; and 88.7 versus 87.4%, P =0.699; MO and nonobese, respectively). Multivariable analysis identified baseline glomerular filtration rate and nontransfemoral access as independent predictors of 2-year mortality in the MO group. An adverse MO phenotype with an abdominal visceral adipose tissue:subcutaneous adipose tissue ratio ≥1 (VAT:SAT) was associated with increased 2-year all-cause (hazard ratio [HR], 3.06; 95% CI, 1.20-7.77; P =0.019) and cardiovascular (hazard ratio, 4.11; 95% CI, 1.06-15.90; P =0.041) mortality, and readmissions (HR, 1.81; 95% CI, 1.07-3.07; P =0.027). After multivariable analysis, a (VAT:SAT) ratio ≥1 remained a strong predictor of 2-year mortality (hazard ratio, 2.78; P =0.035). Transcatheter aortic valve replacement in patients who are MO has similar short- and midterm outcomes to nonobese patients, despite higher major vascular complications and lower device success. An abdominal VAT:SAT ratio ≥1 identifies an obesity phenotype at higher risk of adverse clinical outcomes.

Similares en LA Referencia