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,...
| Autores: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Formato: | artículo |
| Fecha de publicación: | 2021 |
| País: | España |
| Recursos: | Universitat Autònoma de Barcelona |
| Repositorio: | Dipòsit Digital de Documents de la UAB |
| Idioma: | inglés |
| OAI Identifier: | oai:ddd.uab.cat:255615 |
| Acesso em linha: | https://ddd.uab.cat/record/255615 https://dx.doi.org/urn:doi:10.1161/JAHA.120.019051 |
| Access Level: | acceso abierto |
| Palavra-chave: | 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 |
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oai:ddd.uab.cat:255615 |
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| dc.title.none.fl_str_mv |
Impact of Morbid Obesity and Obesity Phenotype on Outcomes After Transcatheter Aortic Valve Replacement |
| title |
Impact of Morbid Obesity and Obesity Phenotype on Outcomes After Transcatheter Aortic Valve Replacement |
| spellingShingle |
Impact of Morbid Obesity and Obesity Phenotype on Outcomes After Transcatheter Aortic Valve Replacement McInerney, Angela|||0000-0002-1160-7735 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 |
| title_short |
Impact of Morbid Obesity and Obesity Phenotype on Outcomes After Transcatheter Aortic Valve Replacement |
| title_full |
Impact of Morbid Obesity and Obesity Phenotype on Outcomes After Transcatheter Aortic Valve Replacement |
| title_fullStr |
Impact of Morbid Obesity and Obesity Phenotype on Outcomes After Transcatheter Aortic Valve Replacement |
| title_full_unstemmed |
Impact of Morbid Obesity and Obesity Phenotype on Outcomes After Transcatheter Aortic Valve Replacement |
| title_sort |
Impact of Morbid Obesity and Obesity Phenotype on Outcomes After Transcatheter Aortic Valve Replacement |
| dc.creator.none.fl_str_mv |
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 |
| author |
McInerney, Angela|||0000-0002-1160-7735 |
| author_facet |
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 |
| author_role |
author |
| author2 |
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 |
| author2_role |
author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author |
| dc.subject.none.fl_str_mv |
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 |
| topic |
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 |
| description |
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. |
| publishDate |
2021 |
| dc.date.none.fl_str_mv |
2 2021-01-01 2021 2021-01-01 |
| dc.type.none.fl_str_mv |
Article http://purl.org/coar/resource_type/c_6501 VoR http://purl.org/coar/version/c_970fb48d4fbd8a85 |
| dc.type.openaire.fl_str_mv |
info:eu-repo/semantics/article |
| format |
article |
| dc.identifier.none.fl_str_mv |
https://ddd.uab.cat/record/255615 https://dx.doi.org/urn:doi:10.1161/JAHA.120.019051 |
| url |
https://ddd.uab.cat/record/255615 https://dx.doi.org/urn:doi:10.1161/JAHA.120.019051 |
| dc.language.none.fl_str_mv |
Inglés eng |
| language_invalid_str_mv |
Inglés |
| language |
eng |
| dc.rights.none.fl_str_mv |
open access http://purl.org/coar/access_right/c_abf2 https://creativecommons.org/licenses/by/4.0/ |
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info:eu-repo/semantics/openAccess |
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open access http://purl.org/coar/access_right/c_abf2 https://creativecommons.org/licenses/by/4.0/ |
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openAccess |
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application/pdf |
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reponame:Dipòsit Digital de Documents de la UAB instname:Universitat Autònoma de Barcelona |
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Universitat Autònoma de Barcelona |
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Dipòsit Digital de Documents de la UAB |
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Dipòsit Digital de Documents de la UAB |
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1869411488489275392 |
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Impact of Morbid Obesity and Obesity Phenotype on Outcomes After Transcatheter Aortic Valve ReplacementMcInerney, Angela|||0000-0002-1160-7735Tirado-Conte, Gabriela|||0000-0002-7093-3936Rodes-Cabau, Josep|||0000-0001-8237-7095Campelo-Parada, F.|||0000-0003-1821-0658Tafur Soto, Jose D.Barbanti, MarcoMuñoz-Garcia, ErikaArif, MobeenaLopez, DiegoToggweiler, StefanVeiga, GabrielaPylko, Anna|||0000-0002-3693-1400Sevilla Ruiz, Teresa|||0000-0002-9450-0887Compagnone, MiriamRegueiro, Ander|||0000-0001-5201-447XSerra, ViçentCarnero-Alcázar, Manuel|||0000-0001-5045-5765Oteo, Juan F.|||0000-0002-2641-4135Rivero, Fernando|||0000-0002-3676-0277Barbosa Ribeiro, HenriqueGuimaraes, LeonardoMatta, AnthonyGiraldo Echavarria, Natalia|||0000-0001-8731-8262Valvo, RobertoMoccetti, Federico|||0000-0002-5794-5676Muñoz-Garcia, Antonio J.Lopez-Pais, JavierGarcía del Blanco, Bruno|||0000-0002-4527-1600Campanha Borges, Diego CarterDumont, EricGonzalo, Nieves|||0000-0003-3827-945XCriscione, Enrico|||0000-0002-1550-8531Dabrowski, MaciejAlfonso, Fernando|||0000-0002-7480-2511Torre Hernández, Jose M. de laCheema, Asim N.Amat-Santos, Ignacio J.|||0000-0002-2311-4129Saia, Francesco|||0000-0001-9969-2649Escaned, Javier|||0000-0003-4932-0112Nombela-Franco, Luís|||0000-0003-3438-8907Epicardial adipose tissueMorbid obesitySubcutaneous adipose tissueTranscatheter aortic valve replacementVisceral adipose tissueCatheter-Based Coronary and Valvular InterventionsObesityValvular Heart DiseaseThere 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. 22021-01-0120212021-01-01Articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://ddd.uab.cat/record/255615https://dx.doi.org/urn:doi:10.1161/JAHA.120.019051reponame:Dipòsit Digital de Documents de la UABinstname:Universitat Autònoma de BarcelonaInglésengopen accesshttp://purl.org/coar/access_right/c_abf2Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.https://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:ddd.uab.cat:2556152026-06-06T12:50:31Z |
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15.301603 |