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Domondon IAA, Jeyakumar D, Raake M, Halaharvi SP, Zafar F, Contreras Vazquez SA, Abarca YA, Goli SR, Rohra D, Shah F, Sikander M, Al-Tawil M. Outcomes of Surgical Versus Transcatheter Aortic Valve Replacement in Obese Patients: A Systematic Review and Meta-Analysis. Cardiol Rev 2024:00045415-990000000-00321. [PMID: 39254505 DOI: 10.1097/crd.0000000000000767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
Transcatheter aortic valve implantation (TAVI) has been increasingly preferred over surgical aortic valve replacement (SAVR) for treating patients with severe aortic stenosis and intermediate to high surgical risk. Recent studies have indicated that obesity may confer protective benefits in cardiac surgery, known as the obesity paradox. We conducted a systematic review and meta-analysis to explore how obesity influences outcomes of TAVI versus SAVR. We searched and reviewed relevant studies comparing TAVI and SAVR in obese patients with aortic stenosis indexed in PubMed, Embase, and Scopus databases. Data from 5 studies with 16,161 patients (TAVI, n = 2951; SAVR, n = 13,210) were included. There was a lower incidence of postprocedural in-hospital mortality [risk ratio (RR), 0.64; 95% confidence interval (CI), 0.41-0.98; P = 0.04], acute kidney injury (RR, 0.53; 95% CI, 0.38-0.73; P = 0.0001), and shorter duration of in-hospital stay (mean difference: -3.35; 95% CI, -4.93 to -1.76; P = 0.0001) in TAVI versus SAVR. There was no significant difference in the risk of postoperative stroke (RR, 0.93; 95% CI, 0.29-3.02; P = 0.91), major bleeding (RR, 0.71; 95% CI, 0.47-1.07; P = 0.10), and myocardial infarction (RR, 0.64; 95% CI, 0.39-1.06; P = 0.08) between TAVI and SAVR. Higher incidences of PPM implantation (RR, 2.0; 95% CI, 1.38-2.90; P = 0.0003) and major vascular complications (RR, 1.51; 95% CI, 1.01-2.27; P = 0.05) were observed with TAVI. In obese patients, TAVI offers similar results as in the general population when compared with SAVR, except for increased vascular complications. An individualized approach can lead to optimal outcomes in this subpopulation.
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Affiliation(s)
- Ileana Anika A Domondon
- From the Emergency Medicine Department, Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
| | - Deepapriya Jeyakumar
- Internal Medicine Department, Government Sivagangai Medical College, Tamil Nadu Dr. M.G.R Medical University, Sivagangai, India
| | - Mohammed Raake
- Faculty of Medicine, Annamalai University, Chidambaram, Cuddalore, India
| | - Savitri Poornima Halaharvi
- Department of Cardiology, JSS Medical College, Rajiv Gandhi University of Health Sciences, Mysore, India
| | - Fabeha Zafar
- Department of Cardiology, Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Yozahandy A Abarca
- Department of Cardiology, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico City, Mexico
| | - Snehitha Reddy Goli
- Department of Cardiology, College of Medicine, Zhengzhou University, Henan Province, Henan, China
| | - Divya Rohra
- Department of Cardiology, Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, India
| | - Farah Shah
- Internal Medicine Department, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - Mohammed Sikander
- Department of Cardiology, School of Medicine, University of Texas Rio Grande Valley, TX; and
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Rohrbach S, Uluocak O, Junge M, Knapp F, Schulz R, Böning A, Nef HM, Krombach GA, Niemann B. Epicardial adipose tissue and muscle distribution affect outcomes in very old patients after transcatheter aortic valve replacement. EUROPEAN HEART JOURNAL OPEN 2024; 4:oeae073. [PMID: 39310722 PMCID: PMC11414403 DOI: 10.1093/ehjopen/oeae073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 07/15/2024] [Accepted: 08/06/2024] [Indexed: 09/25/2024]
Abstract
Aims To analyse the relevance of body composition and blood markers for long-term outcomes in very old patients after transcatheter aortic valve replacement (TAVR). Methods and results A total of 403 very old patients were characterized with regard to subcutaneous, visceral, and epicardial fat, psoas muscle area, plasma growth differentiation factor 15 (GDF-15), and leptin. Cohorts grouped by body mass index (BMI) were analysed for long-term outcomes. Patients underwent transapical and transfemoral TAVR (similar 30-day/1-year survival). Body mass index >35 kg/m2 showed increased 2- and 3-year mortality compared with BMI 25-34.9 kg/m2 but not compared with BMI <25 kg/m2. Fat areas correlated positively to BMI (epicardial: R 2 = 0.05, P < 0.01; visceral: R 2 = 0.20, P < 0.001; subcutaneous: R 2 = 0.13, P < 0.001). Increased epicardial or visceral but not subcutaneous fat area resulted in higher long-term mortality. Patients with high BMI (1781.3 mm2 ± 75.8, P < 0.05) and lean patients (1729.4 ± 52.8, P < 0.01) showed lower psoas muscle area compared with those with mildly elevated BMI (2055.2 ± 91.7). Reduced psoas muscle area and increased visceral fat and epicardial fat areas were independent predictors of long-term mortality. The levels of serum GDF-15 were the highest in BMI >40 kg/m2 (2793.5 pg/mL ± 123.2) vs. BMI <25 kg/m2 (2017.6 pg/mL ±130.8), BMI 25-30 kg/m2 (1881.8 pg/mL ±127.4), or BMI 30-35 kg/m2 (2054.2 pg/mL ±124.1, all P < 0.05). Increased GDF-15 level predicted mortality (2587 pg/mL, area under the receiver operating characteristic curve 0.94). Serum leptin level increased with BMI without predictive value for long-term mortality. Conclusion Morbidly visceral and epicardial fat accumulation, reduction in muscle area, and GDF-15 increase are strong predictors of adverse outcomes in very old patients post-TAVR.
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Affiliation(s)
- Susanne Rohrbach
- Institute of Physiology, Justus Liebig University Giessen, Aulweg 129, 35392 Giessen, Germany
| | - Oezge Uluocak
- Department of Cardiac and Vascular Surgery, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Rudolph-Buchheim-Strasse 7, 35392 Giessen, Germany
| | - Marieke Junge
- Department of Cardiac and Vascular Surgery, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Rudolph-Buchheim-Strasse 7, 35392 Giessen, Germany
| | - Fabienne Knapp
- Institute of Physiology, Justus Liebig University Giessen, Aulweg 129, 35392 Giessen, Germany
| | - Rainer Schulz
- Institute of Physiology, Justus Liebig University Giessen, Aulweg 129, 35392 Giessen, Germany
| | - Andreas Böning
- Department of Cardiac and Vascular Surgery, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Rudolph-Buchheim-Strasse 7, 35392 Giessen, Germany
| | - Holger M Nef
- Department of Cardiology, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Klinikstrasse 33, 35392 Giessen, Germany
| | - Gabriele A Krombach
- Department of Radiology, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Klinikstrasse 33, 35392 Giessen, Germany
| | - Bernd Niemann
- Department of Cardiac and Vascular Surgery, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Rudolph-Buchheim-Strasse 7, 35392 Giessen, Germany
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Carter-Storch R, Veien KT, Mogensen NSB, Banke A, Tofte-Hansen EU, Ali M, Laursen K, Dahl JS. Low body mass index and risk of mortality after mitral transcatheter edge-to-edge repair procedure: The "obesity paradox". Catheter Cardiovasc Interv 2024; 104:401-407. [PMID: 38819910 DOI: 10.1002/ccd.31114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/16/2024] [Accepted: 05/21/2024] [Indexed: 06/01/2024]
Abstract
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.
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Affiliation(s)
| | - Karsten T Veien
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Ann Banke
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Mulham Ali
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Kristian Laursen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
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Brahier MS, Kochi S, Huang J, Piliponis E, Smith A, Johnson A, Poian S, Abdulkareem M, Ma X, Wu C, Piccini JP, Petersen S, Vargas JD. Machine Learning of Cardiac Anatomy and the Risk of New-Onset Atrial Fibrillation After TAVR. JACC Clin Electrophysiol 2024; 10:1873-1884. [PMID: 38842977 DOI: 10.1016/j.jacep.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 03/01/2024] [Accepted: 04/09/2024] [Indexed: 08/30/2024]
Abstract
BACKGROUND New-onset atrial fibrillation (NOAF) occurs in 5% to 15% of patients who undergo transfemoral transcatheter aortic valve replacement (TAVR). Cardiac imaging has been underutilized to predict NOAF following TAVR. OBJECTIVES The objective of this analysis was to compare and assess standard, manual echocardiographic and cardiac computed tomography (cCT) measurements as well as machine learning-derived cCT measurements of left atrial volume index and epicardial adipose tissue as risk factors for NOAF following TAVR. METHODS The study included 1,385 patients undergoing elective, transfemoral TAVR for severe, symptomatic aortic stenosis. Each patient had standard and machine learning-derived measurements of left atrial volume and epicardial adipose tissue from cardiac computed tomography. The outcome of interest was NOAF within 30 days following TAVR. We used a 2-step statistical model including random forest for variable importance ranking, followed by multivariable logistic regression for predictors of highest importance. Model discrimination was assessed by using the C-statistic to compare the performance of the models with and without imaging. RESULTS Forty-seven (5.0%) of 935 patients without pre-existing atrial fibrillation (AF) experienced NOAF. Patients with pre-existing AF had the largest left atrial volume index at 76.3 ± 28.6 cm3/m2 followed by NOAF at 68.1 ± 26.6 cm3/m2 and then no AF at 57.0 ± 21.7 cm3/m2 (P < 0.001). Multivariable regression identified the following risk factors in association with NOAF: left atrial volume index ≥76 cm2 (OR: 2.538 [95% CI: 1.165-5.531]; P = 0.0191), body mass index <22 kg/m2 (OR: 4.064 [95% CI: 1.500-11.008]; P = 0.0058), EATv (OR: 1.007 [95% CI: 1.000-1.014]; P = 0.043), aortic annulus area ≥659 mm2 (OR: 6.621 [95% CI: 1.849-23.708]; P = 0.004), and sinotubular junction diameter ≥35 mm (OR: 3.891 [95% CI: 1.040-14.552]; P = 0.0435). The C-statistic of the model was 0.737, compared with 0.646 in a model that excluded imaging variables. CONCLUSIONS Underlying cardiac structural differences derived from cardiac imaging may be useful in predicting NOAF following transfemoral TAVR, independent of other clinical risk factors.
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Affiliation(s)
- Mark S Brahier
- Duke University Hospital, Durham North Carolina, USA; Georgetown University Medical Center, Washington, DC, USA; Electrophysiology Section, Duke Heart Center, Duke University Hospital & Duke Clinical Research Institute, Durham, North Carolina, USA.
| | - Shwetha Kochi
- Georgetown University Medical Center, Washington, DC, USA
| | - Julia Huang
- Georgetown University Medical Center, Washington, DC, USA
| | - Emma Piliponis
- Georgetown University Medical Center, Washington, DC, USA
| | - Andrew Smith
- Georgetown University Medical Center, Washington, DC, USA
| | - Adam Johnson
- Georgetown University Medical Center, Washington, DC, USA
| | - Suraya Poian
- Georgetown University Medical Center, Washington, DC, USA
| | - Musa Abdulkareem
- Barts Heart Centre, Barts Health National Health Service (NHS) Trust, London, United Kingdom; National Institute for Health Research (NIHR) Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom; Health Data Research UK, London, United Kingdom
| | - Xiaoyang Ma
- Georgetown University Medical Center, Washington, DC, USA
| | - Colin Wu
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Jonathan P Piccini
- Electrophysiology Section, Duke Heart Center, Duke University Hospital & Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Steffen Petersen
- Barts Heart Centre, Barts Health National Health Service (NHS) Trust, London, United Kingdom; National Institute for Health Research (NIHR) Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom; Health Data Research UK, London, United Kingdom; The Alan Turing Institute, London, United Kingdom
| | - Jose D Vargas
- Veterans Affairs Medical Center, Washington, DC, USA
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Pfeiffer P, Wittemann K, Mattern L, Buchholz V, El Beyrouti H, Ghazy A, Oezkur M, Duerr GD, Probst C, Treede H, Dohle DS. The Effect of Obesity on Short- and Long-Term Outcome after Surgical Treatment for Acute Type A Aortic Dissection. Life (Basel) 2024; 14:955. [PMID: 39202697 PMCID: PMC11355667 DOI: 10.3390/life14080955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/24/2024] [Accepted: 07/28/2024] [Indexed: 09/03/2024] Open
Abstract
BACKGROUND A paradox of lower morbidity and mortality in overweight or obese patients undergoing cardiac surgery has been described; however, knowledge about the influence of obesity in patients with acute Type A aortic dissection (AAD) is limited. This study aimed to evaluate the effect of obesity on short- and long-term outcomes after surgical treatment for AAD. METHODS Between 01/2004 and 12/2022, 912 patients with a BMI of 18.5 or greater were operated on for AAD. Patients were grouped according to their BMI (normal weight: BMI 18.5-24.9, n = 332; overweight: BMI 25-29.9, n = 367; obesity class I: BMI 30-34.9, n = 133; obesity class II+: BMI ≥ 35, n = 67), and the obtained clinical and surgical data were compared. RESULTS Obese patients were younger at the time of AAD (p = 0.001) and demonstrated higher rates of typical cardiovascular comorbidities (arterial hypertension, p = 0.005; diabetes mellitus, p < 0.001). The most important preoperative parameters, as well as the surgical approach, were similar between all four groups. The occurrence of renal failure requiring dialysis was higher in patients with BMI ≥ 35 (p = 0.010), but the in-hospital (p = 0.461) and long-term survival (p = 0.894) showed no significant differences. CONCLUSIONS There are no indications that the obesity paradox is applicable in the setting of AAD. Since obese patients are affected by AAD at a younger age, obesity might constitute a risk factor for AAD. However, obesity does not influence short- or long-term survival. Regardless of body weight, immediate surgical therapy remains the treatment of choice for AAD.
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Affiliation(s)
- Philipp Pfeiffer
- Department of Cardiovascular Surgery, University Medical Center Mainz, 55131 Mainz, Germany; (K.W.); (L.M.); (V.B.); (H.E.B.); (A.G.); (M.O.); (G.D.D.); (C.P.); (H.T.); (D.-S.D.)
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Chang KC, Ho LT, Huang KC, Hsu JC, Kuan DTW, Lin TT, Lee JK, Yang YY, Chuang SL, Lin LY. Effect of body mass index on mortality for diabetic patients with aortic stenosis. Aging (Albany NY) 2024; 16:11359-11372. [PMID: 39058301 PMCID: PMC11315379 DOI: 10.18632/aging.206018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/07/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Several studies suggest an "obesity paradox," associating obesity with better cardiovascular outcomes in patients with type 2 diabetes mellitus (DM) or aortic stenosis (AS) compared to normal or underweight individuals. This study explores the impact of body mass index (BMI) on diabetic patients with AS. METHODS Between 2014 and 2019, patients with DM who underwent echocardiography were analyzed. Outcomes included all-cause mortality, cardiovascular, and non-cardiovascular death. Patients were categorized as underweight, normal weight, or obese based on BMI (<18.5, 18.5 to 27, and >27 kg/m2, respectively). RESULTS Among 74,835 DM patients, 734 had AS. Normal weight comprised 65.5% (n=481), underweight 4.1% (N=30), and 30.4% were obese. Over a 6-year follow-up, underweight patients had significantly higher all-cause mortality (HR 1.96, 95% CI 1.22 - 3.14, p = 0.005), while obese patients had significantly lower mortality (HR 0.79, 95% CI 0.68 - 0.91, p=0.001) compared to the normal group. Regarding etiologies, underweight patients had a higher risk of non-cardiovascular death (HR 2.47, 95% CI 1.44-4.25, p = 0.001), while obese patients had a lower risk of cardiovascular death (HR 0.66, 95% CI 0.50-0.86, p=0.003). Subgroup analysis showed a consistent trend without significant interaction. CONCLUSIONS BMI significantly impacts mortality in DM patients with AS. Being underweight is associated with worse non-cardiovascular death, while obesity is linked to improved cardiovascular death outcomes.
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Affiliation(s)
- Kai-Chun Chang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Ting Ho
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kuan-Chih Huang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Jung-Chi Hsu
- Department of Internal Medicine, National Taiwan University Hospital Jinshan Branch, New Taipei City, Taiwan
| | - David Te-Wei Kuan
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ting-Tse Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jen-Kuang Lee
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yen-Yun Yang
- Integrative Medical Database Center, Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Shu-Lin Chuang
- Integrative Medical Database Center, Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Lian-Yu Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
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Kang JJ, Bozso SJ, El-Andari R, Alam AS, Boe DE, Hong Y, Gill RS, Moon MC, Freed DH, Nagendran J, Nagendran J. Relation of body mass index to long-term survival and cardiac remodelling for patients undergoing mitral valve replacement surgery. Nutr Metab Cardiovasc Dis 2024; 34:1371-1380. [PMID: 38503618 DOI: 10.1016/j.numecd.2024.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND AND AIMS Studies have demonstrated that obesity is paradoxically associated with reduced mortality following cardiac surgery. However, these studies have treated various types of cardiac surgery as a single entity. With mitral valve (MV) surgeries being the fastest-growing cardiac surgical interventions in North America, the purpose of this study was to identify the impact of body mass index (BMI) on long-term survival and cardiac remodelling of patients undergoing MV replacement (MVR). METHODS AND RESULTS In this retrospective, single-center study, 1071 adult patients who underwent an MVR between 2004 and 2018 were stratified into five BMI groups (<20, 20-24.9, 25-29.9, 30-34.9, >35). Cox proportional hazard regression models were used to determine the association between BMI and all-cause mortality. Patients who were underweight had significantly higher all-cause mortality rates at the longest follow-up (median 8.2 years) than patients with normal weight (p = 0.01). Patients who were in the obese group had significantly higher readmission rates due to myocardial infarction (MI) at the longest follow-up (p = 0.017). Subgroup analysis revealed a significant increase in long-term all-cause mortality for female patients who were underweight. Significant changes in left atrial size, mitral valve peak and mean gradients were seen in all BMI groups. CONCLUSIONS For patients undergoing mitral valve replacement, BMI is unrelated to operative outcomes except for patients who are underweight.
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Affiliation(s)
- Jimmy Jh Kang
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Sabin J Bozso
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Ryaan El-Andari
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Abrar S Alam
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Dana E Boe
- Department of Anesthesiology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Yongzhe Hong
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Richdeep S Gill
- Division of General Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Michael C Moon
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Darren H Freed
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jayan Nagendran
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jeevan Nagendran
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
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Pekař M, Jiravský O, Novák J, Branny P, Balušík J, Daniš D, Hečko J, Kantor M, Prosecky R, Blaha L, Neuwirth R. Sarcopenia and adipose tissue evaluation by artificial intelligence predicts the overall survival after TAVI. Sci Rep 2024; 14:8842. [PMID: 38632317 PMCID: PMC11024085 DOI: 10.1038/s41598-024-59134-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/08/2024] [Indexed: 04/19/2024] Open
Abstract
Sarcopenia is a serious systemic disease that reduces overall survival. TAVI is selectively performed in patients with severe aortic stenosis who are not indicated for open cardiac surgery due to severe polymorbidity. Artificial intelligence-assisted body composition assessment from available CT scans appears to be a simple tool to stratify these patients into low and high risk based on future estimates of all-cause mortality. Within our study, the segmentation of preprocedural CT scans at the level of the lumbar third vertebra in patients undergoing TAVI was performed using a neural network (AutoMATiCA). The obtained parameters (area and density of skeletal muscles and intramuscular, visceral, and subcutaneous adipose tissue) were analyzed using Cox univariate and multivariable models for continuous and categorical variables to assess the relation of selected variables with all-cause mortality. 866 patients were included (median(interquartile range)): age 79.7 (74.9-83.3) years; BMI 28.9 (25.9-32.6) kg/m2. Survival analysis was performed on all automatically obtained parameters of muscle and fat density and area. Skeletal muscle index (SMI in cm2/m2), visceral (VAT in HU) and subcutaneous adipose tissue (SAT in HU) density predicted the all-cause mortality in patients after TAVI expressed as hazard ratio (HR) with 95% confidence interval (CI): SMI HR 0.986, 95% CI (0.975-0.996); VAT 1.015 (1.002-1.028) and SAT 1.014 (1.004-1.023), all p < 0.05. Automatic body composition assessment can estimate higher all-cause mortality risk in patients after TAVI, which may be useful in preoperative clinical reasoning and stratification of patients.
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Affiliation(s)
- Matej Pekař
- Hospital AGEL Třinec-Podlesí, Konská 453, 739 61, Třinec, Czech Republic
- Department of Physiology, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic
| | - Otakar Jiravský
- Hospital AGEL Třinec-Podlesí, Konská 453, 739 61, Třinec, Czech Republic
| | - Jan Novák
- Department of Physiology, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic.
- 2nd Department of Internal Medicine, St. Anne's University Hospital in Brno, Pekařská 53, 656 91, Brno, Czech Republic.
- Faculty of Medicine, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic.
| | - Piotr Branny
- Hospital AGEL Třinec-Podlesí, Konská 453, 739 61, Třinec, Czech Republic
- Faculty of Medicine, Palacky University, Krizkovskeho 511/8, 779 00, Olomouc, Czech Republic
| | - Jakub Balušík
- Hospital AGEL Třinec-Podlesí, Konská 453, 739 61, Třinec, Czech Republic
| | - Daniel Daniš
- The Jackson Laboratory for Genomic Medicine, 10 Discovery Drive, Farmington, CT, 06032, USA
| | - Jan Hečko
- Hospital AGEL Třinec-Podlesí, Konská 453, 739 61, Třinec, Czech Republic
- Faculty of Electrical Engineering and Computer Science, VSB - Technical University of Ostrava, 17. Listopadu Street 2172/15, 708 00, Ostrava, Czech Republic
| | - Marek Kantor
- Hospital AGEL Třinec-Podlesí, Konská 453, 739 61, Třinec, Czech Republic
| | - Robert Prosecky
- 2nd Department of Internal Medicine, St. Anne's University Hospital in Brno, Pekařská 53, 656 91, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic
| | - Lubomir Blaha
- Hospital AGEL Třinec-Podlesí, Konská 453, 739 61, Třinec, Czech Republic
| | - Radek Neuwirth
- Hospital AGEL Třinec-Podlesí, Konská 453, 739 61, Třinec, Czech Republic
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9
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Bimal T, Bhuiyan MR, Fishbein J, Ukrani J, Gandotra P, Selim S, Ong L, Gruberg L. The impact of sex, body mass index and chronic kidney disease on outcomes following percutaneous coronary intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 59:37-45. [PMID: 37604707 DOI: 10.1016/j.carrev.2023.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVE This study sought to evaluate 1) the relationship between body mass index (BMI), chronic kidney disease (CKD) and bleeding complications in patients undergoing percutaneous coronary intervention (PCI); and 2) whether CKD modified the effect of BMI on major bleeding and major adverse cardiac and cerebrovascular events (MACCE). BACKGROUND The interaction of CKD, sex and BMI in patients undergoing PCI is unclear. METHODS Between 2010 and 2018, a total of 31,116 patients underwent PCI at six New York metropolitan area hospitals. Bleeding complications were classified by the Bleeding Academic Research Consortium (BARC). Major bleeding was defined as BARC≥3. MACCE was the composite of in-hospital death; myocardial infarction; cerebrovascular events and major bleeding complications. Interaction on multiplicative scales was assessed adjusting for other factors. A three-way multiplicative interaction between BMI, CKD and sex were considered and evaluated for both endpoints of primary interest (BARC≥3 and MACCE). RESULTS Patients with BARC≥3 bleeding were older (p < 0.0001) and more likely female (p < 0.0001). A 3-way interaction existed between sex, BMI, and CKD on BARC≥3 (p = 0.02). Specifically, the effect of CKD status on odds of BARC≥3 depended on BMI group among males, whereas BMI did modify the relationship between CKD and BARC≥3 among females; after stratification by sex, a significant interaction between BMI and CKD was present in females (p = 0.03) but not in males (p = 0.43). Among females without CKD, normal BMI patients had the greatest odds of BARC≥3 compared to obese or overweight females. Contrasted to females without CKD, among females with CKD there was no significant increased odds of BARC≥3 in normal BMI patients compared to obese or overweight females. However, overweight females with CKD had a significantly increased odds of BARC≥3 compared to obese females with CKD. Furthermore, obese females with CKD had significantly greater BARC≥3 odds compared to obese females without CKD. Similarly, overweight females with CKD had an increased odds of BARC≥3 compared to overweight females without CKD. No significant interactions were found for the odds of MACCE. CONCLUSION In patients undergoing PCI, there was evidence of a significant and complex 3-way interaction between BMI, CKD and sex for major bleeding events. The predicted probability of major bleeding was greater for females than for male patients, and for both sexes, greater among those with CKD, but BMI group influences these probabilities. Obese females with kidney disease had the lowest incidence of bleeding complications when compared with overweight or normal weight female patients undergoing PCI. This interaction was not seen in the male group or for MACCE. Furthermore, age, cardiogenic shock, STEMI and use of IABP/Impella were each independently associated with odds of major bleeding (among both males and females) and MACCE.
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Affiliation(s)
- Tia Bimal
- Mather Hospital, Port Jefferson, NY, United States of America
| | | | - Joanna Fishbein
- Office of Academic Affairs, New Hyde Park, NY, United States of America
| | - Janta Ukrani
- Mather Hospital, Port Jefferson, NY, United States of America
| | - Puneet Gandotra
- Division of Cardiology, South Shore University Hospital, Bay Shore, NY, United States of America
| | - Samy Selim
- Division of Cardiology, South Shore University Hospital, Bay Shore, NY, United States of America
| | - Lawrence Ong
- Division of Cardiology, South Shore University Hospital, Bay Shore, NY, United States of America
| | - Luis Gruberg
- Mather Hospital, Port Jefferson, NY, United States of America.
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10
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Al-Atta A, Farag M, Jeyalan V, Gazzal Asswad A, Thompson A, Irvine T, Edwards R, Das R, Zaman A, Alkhalil M. Low Transvalvular Flow Rate in Patients Undergoing Transcatheter Aortic Valve Implantation (TAVI) Is a Predictor of Mortality: The TFR-TAVI Study. Heart Lung Circ 2023; 32:1489-1499. [PMID: 37993343 DOI: 10.1016/j.hlc.2023.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 07/12/2023] [Accepted: 09/21/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Transvalvular flow rate (TFR) represents a better reflection of transvalvular flow than the stroke volume index (SVi), and has recently emerged as a useful prognostic tool in patients undergoing surgical aortic valve replacement. There is a paucity of data investigating the role of TFR and its relationship with other clinical or echocardiographic factors in patients undergoing transcatheter aortic valve implantation (TAVI). METHOD This was a retrospective single-centre study of 629 consecutive patients who underwent TAVI between March 2009 and September 2020. Pre-TAVI low TFR was defined as <200 c/s. The primary study end point was all-cause mortality. RESULTS Low TFR was observed in 41.8% (263/629) of included patients and was associated with increasing age, low body surface area, hypertension, diabetes, atrial fibrillation, left ventricular (LV) dysfunction, and significant mitral regurgitation. LV function status and severity of aortic valve disease were independent predictors of low TFR. Low TFR was significantly associated with long-term all-cause mortality even after adjustment for other risk factors (adjusted hazard ratio [aHR] 1.44; 95% confidence interval [CI] 1.02-2.03; p=0.038). When data were stratified according to SVi, low TFR was an independent predictor of long-term all-cause mortality in patients with normal SVi (aHR 1.98; 95% CI 1.06-3.69; p=0.032) but not in patients with low SVi (HR 1.23; 95% CI 0.71-2.11; p=0.46; p=0.016 for interaction). CONCLUSIONS Low TFR is common in patients undergoing TAVI and is an independent predictor of all-cause mortality, particularly in patients with normal SVi.
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Affiliation(s)
- Ayman Al-Atta
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK
| | - Mohamed Farag
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK
| | - Visvech Jeyalan
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK
| | | | | | - Tim Irvine
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK
| | - Richard Edwards
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK
| | - Rajiv Das
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK
| | - Azfar Zaman
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Mohammed Alkhalil
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
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11
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Movahed MR, Timmerman B, Hashemzadeh M. Independent association of aortic stenosis with many known cardiovascular risk factors and many inflammatory diseases. Arch Cardiovasc Dis 2023; 116:467-473. [PMID: 37749002 DOI: 10.1016/j.acvd.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/20/2023] [Accepted: 07/31/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Aortic valve stenosis is associated with age, rheumatic fever and bicuspid aortic valve, but its association with other co-morbidities, such as inflammatory disease and race/ethnicity, is less known. AIM To investigate any association between aortic stenosis and many co-morbidities. METHODS We used the large Nationwide Inpatient Sample database to evaluate any association between aortic stenosis and risk factors. We performed univariate and multivariable analyses, adjusting for co-morbid conditions. RESULTS Data were extracted from the first available database that used the International Classification of Diseases, Tenth Revision codes specifically coding for aortic stenosis alone, spanning from 2016 to 2020 (n=112,982,565). A total of 2,322,649 patients had aortic stenosis; the remaining 110,659,916 served as controls. We found a strong and independent significant association between aortic stenosis and coronary artery disease (odds ratio [OR]: 2.11, 95% confidence interval [CI]: 2.09-2.13), smoking (OR: 1.08, 95% CI: 1.07-1.08), diabetes mellitus (OR: 1.15, 95% CI: 1.14-1.16), hypertension (OR: 1.41, 95% CI: 1.4-1.42), hyperlipidaemia (OR: 1.31, 95% CI: 1.3-1.32), renal disease (OR: 1.3, 95% CI: 1.29-1.31), chronic obstructive pulmonary disease (OR: 1.05, 95% CI: 1.04-1.05), obesity (OR: 1.3, 95% CI: 1.29-1.32), white race/ethnicity (OR: 1.47, 95% CI: 1.42-1.52), rheumatoid arthritis (OR: 1.13, 95% CI: 1.11-1.15), scleroderma (OR: 1.93, 95% CI: 1.79-2.09), systemic connective tissue disease (OR: 1.24, 95% CI: 1.2-1.27), polyarteritis nodosa (OR: 1.5, CI: 1.24-1.81) and Raynaud's syndrome (OR: 1.16, 95% CI: 1.09-1.24) (all P<0.001), in addition to known factors, such as age, male sex and bicuspid aortic valve. CONCLUSION Using a very large database, we found many new associations with aortic valve stenosis, including race/ethnicity, renal disease, several inflammatory diseases, chronic obstructive pulmonary disease and obesity, in addition to many other known cardiovascular risk factors.
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Affiliation(s)
- Mohammad Reza Movahed
- University of Arizona College of Medicine, Phoenix, AZ 85724, USA; Sarver Heart Center, University of Arizona College of Medicine, Tucson, AZ 85724, USA.
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12
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Wiebe N, Lloyd A, Crumley ET, Tonelli M. Associations between body mass index and all-cause mortality: A systematic review and meta-analysis. Obes Rev 2023; 24:e13588. [PMID: 37309266 DOI: 10.1111/obr.13588] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/12/2023] [Accepted: 05/22/2023] [Indexed: 06/14/2023]
Abstract
Fasting insulin and c-reactive protein confound the association between mortality and body mass index. An increase in fat mass may mediate the associations between hyperinsulinemia, hyperinflammation, and mortality. The objective of this study was to describe the "average" associations between body mass index and the risk of mortality and to explore how adjusting for fasting insulin and markers of inflammation might modify the association of BMI with mortality. MEDLINE and EMBASE were searched for studies published in 2020. Studies with adult participants where BMI and vital status was assessed were included. BMI was required to be categorized into groups or parametrized as non-first order polynomials or splines. All-cause mortality was regressed against mean BMI squared within seven broad clinical populations. Study was modeled as a random intercept. β coefficients and 95% confidence intervals are reported along with estimates of mortality risk by BMIs of 20, 30, and 40 kg/m2 . Bubble plots with regression lines are drawn, showing the associations between mortality and BMI. Splines results were summarized. There were 154 included studies with 6,685,979 participants. Only five (3.2%) studies adjusted for a marker of inflammation, and no studies adjusted for fasting insulin. There were significant associations between higher BMIs and lower mortality risk in cardiovascular (unadjusted β -0.829 [95% CI -1.313, -0.345] and adjusted β -0.746 [95% CI -1.471, -0.021]), Covid-19 (unadjusted β -0.333 [95% CI -0.650, -0.015]), critically ill (adjusted β -0.550 [95% CI -1.091, -0.010]), and surgical (unadjusted β -0.415 [95% CI -0.824, -0.006]) populations. The associations for general, cancer, and non-communicable disease populations were not significant. Heterogeneity was very large (I2 ≥ 97%). The role of obesity as a driver of excess mortality should be critically re-examined, in parallel with increased efforts to determine the harms of hyperinsulinemia and chronic inflammation.
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Affiliation(s)
- Natasha Wiebe
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Anita Lloyd
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Ellen T Crumley
- Rowe School of Business, Dalhousie University, Halifax, Nova Scotia, Canada
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13
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Patel E, Varghese JJ, Garg M, Yacob O, Sánchez JS, Garcia-Garcia HM. Comparison of Body Mass Index (Four Categories) to In-Hospital Outcomes in Patients Who Underwent Transcatheter Aortic Valve Implantation. Am J Cardiol 2023; 192:190-195. [PMID: 36812703 DOI: 10.1016/j.amjcard.2023.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 12/16/2022] [Accepted: 01/15/2023] [Indexed: 02/23/2023]
Abstract
Although obesity is often associated with adverse outcomes in cardiovascular diseases, studies have demonstrated a beneficial effect on patients who underwent transcatheter aortic valve implantation (TAVI), coining the term "obesity paradox." We sought to determine if the obesity paradox is valid when patients are studied in body mass index (BMI) groups versus simplified classification of obese and nonobese. We examined the National Inpatient Sample database from 2016 to 2019 for all patients who underwent TAVI >18 years of age using the International Classification of Diseases, 10th edition procedure codes. Patients were grouped by BMI categories of underweight, overweight, obese, and morbidly obese. They were compared with normal-weight patients to assess the relative risk of in-hospital mortality, cardiogenic shock, ST-elevation myocardial infarction, bleeding complications requiring transfusions, and complete heart blocks requiring permanent pacemaker. A logistic regression model was constructed to account for potential confounders. Of the 221,000 patients who underwent TAVI, 42,315 patients with appropriate BMI designation were stratified into BMI groups. Compared to the normal-weight group, overweight, obese, and morbid-obese TAVI patients were associated with a lower risk of in-hospital mortality (relative risk [RR] 0.48, confidence interval [CI] 0.29 to 0.77, p <0.001), (RR 0.42, CI 0.28 to 0.63, p <0.001), (RR 0.49, CI 0.33 to 0.71, p <0.001 respectively), cardiogenic shock (RR 0.27, CI 0.20 to 0.38, p <0.001), (RR 0.21, CI 0.16 to 0.27, p <0.001), (RR 0.21, CI 0.16 to 0.26, p <0.001), and blood transfusions (RR 0.63, CI 0.50 to 0.79, p <0.001), (RR 0.47, CI 0.39 to 0.58, p <0.001), (RR 0.61, CI 0.51 to 0.74, p <0.001). This study indicated that obese patients were at a significantly lower risk of in-hospital mortality, cardiogenic shock, and bleeding complications requiring transfusions. In conclusion, our study supported the existence of the obesity paradox in TAVI patients.
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Affiliation(s)
- Etee Patel
- Department of Medicine, HCA Florida Oak Hill Hospital, Brooksville, Florida
| | - Jobin Joseph Varghese
- Departments of Medicine, Medstar Cardiovascular Research Network, Medstar Washington Hospital Center, Washington, District of Columbia
| | - Mohil Garg
- Departments of Medicine, Medstar Cardiovascular Research Network, Medstar Washington Hospital Center, Washington, District of Columbia
| | - Omar Yacob
- Department of Cardiology, MercyOne Heart and Vascular Institute, Mason City, Iowa
| | - Jorge Sanz Sánchez
- Hospital Universitari i Politecnic La Fe, Valencia, Spain; Centro de Investigación Biomedica en Red (CIBERCV), Madrid, Spain
| | - Hector M Garcia-Garcia
- Departments of Cardiology, Medstar Cardiovascular Research Network, Medstar Washington Hospital Center, Washington, District of Columbia.
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14
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Gupta R, Mahmoudi E, Behnoush AH, Khalaji A, Malik AH, Sood A, Bandyopadhyay D, Zaid S, Goel A, Sreenivasan J, Patel C, Vyas AV, Lavie CJ, Patel NC. Effect of BMI on patients undergoing transcatheter aortic valve implantation: A systematic review and meta-analysis. Prog Cardiovasc Dis 2023:S0033-0620(22)00158-X. [PMID: 36657654 DOI: 10.1016/j.pcad.2022.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 12/26/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND The relationship of body mass index (BMI) and an "obesity paradox" with cardiovascular risk prediction is controversial. This systematic review and meta-analysis aims to compare the associations of different BMI ranges on transcatheter aortic valve implantation (TAVI) outcomes. METHODS International databases, including PubMed, the Web of Science, and the Cochrane Library, were systematically searched for observational and randomized controlled trial studies investigating TAVI outcomes in any of the four BMI categories: underweight, normal weight, overweight, and obese with one of the predefined outcomes. Primary outcomes were in-hospital, 30-day, and long-term all-cause mortality. Random-effects meta-analysis was performed to calculate the odds ratio (OR) or standardized mean differences (SMD) with 95% confidence interval (CI) for each paired comparison between two of the BMI categories. RESULTS A total of 38 studies were included in our analysis, investigating 99,829 patients undergoing TAVI. There was a trend toward higher comorbidities such as hypertension, diabetes, and dyslipidemia in overweight patients and individuals with obesity. Compared with normal-weight, patients with obesity had a lower rate of 30-day mortality (OR 0.42, 95% CI 0.25-0.72, p < 0.01), paravalvular aortic regurgitation (OR 0.63, 95% CI 0.44-0.91, p = 0.01), 1-year mortality (OR 0.48, 95% CI 0.24-0.96, p = 0.04), and long-term mortality (OR 0.69, 95% CI 0.51-0.94, p = 0.02). However, acute kidney injury (OR 1.16, 95% CI 1.04-1.30, p = 0.01) and permanent pacemaker implantation (OR 1.25, 95% CI 1.05-1.50, p = 0.01) odds were higher in patients with obesity. Noteworthy, major vascular complications were significantly higher in underweight patients in comparison with normal weight cases (OR 1.62, 95% CI 1.07-2.46, p = 0.02). In terms of left ventricular ejection fraction (LVEF), patients with obesity had higher post-operative LVEF compared to normal-weight individuals (SMD 0.12, 95% CI 0.02-0.22, p = 0.02). CONCLUSION Our results suggest the presence of the "obesity paradox" in TAVI outcomes with higher BMI ranges being associated with lower short- and long-term mortality. BMI can be utilized for risk prediction of patients undergoing TAVI.
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Affiliation(s)
- Rahul Gupta
- Department of Cardiology, Lehigh Valley Health Network, Allentown, PA, USA.
| | - Elham Mahmoudi
- Universal Scientific Education and Research Network, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Behnoush
- Universal Scientific Education and Research Network, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirmohammad Khalaji
- Universal Scientific Education and Research Network, Tehran University of Medical Sciences, Tehran, Iran
| | - Aaqib H Malik
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Aayushi Sood
- Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, PA, USA
| | - Dhrubajyoti Bandyopadhyay
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Syed Zaid
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Institute, Houston, TX, USA
| | - Akshay Goel
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Institute, Houston, TX, USA
| | - Jayakumar Sreenivasan
- Department of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Chirdeep Patel
- Department of Cardiology, Lehigh Valley Health Network, Allentown, PA, USA
| | - Apurva V Vyas
- Department of Cardiology, Lehigh Valley Health Network, Allentown, PA, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Nainesh C Patel
- Department of Cardiology, Lehigh Valley Health Network, Allentown, PA, USA
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15
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Gupta R, Maitz T, Behnoush AH, Khalaji A, Mahmoudi E, Goel A, Malik A, Sreenivasan J, Bandyopadhyay D, Vyas AV, Patel NC. Obesity paradox in transcatheter aortic valve implantation? Effect of body-mass index on clinical outcomes in patients undergoing transcatheter aortic valve implantation. Eur J Prev Cardiol 2022; 29:e362-e364. [PMID: 36130181 DOI: 10.1093/eurjpc/zwac215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Rahul Gupta
- Lehigh Valley Heart Institute, Lehigh Valley Health Network, 1200 S Cedar Crest Blvd, Allentown, PA 18103, USA
| | - Theresa Maitz
- Department of Internal Medicine, Lehigh Valley Health Network, 1200 S Cedar Crest Blvd, Allentown, PA 18103, USA
| | - Amir Hossein Behnoush
- Universal Scientific Education and Research Network, Tehran University of Medical Sciences, Poorsina Street, Keshavarz Boulevard, Tehran 1417653955, Iran
| | - Amirmohammad Khalaji
- Universal Scientific Education and Research Network, Tehran University of Medical Sciences, Poorsina Street, Keshavarz Boulevard, Tehran 1417653955, Iran
| | - Elham Mahmoudi
- Universal Scientific Education and Research Network, Tehran University of Medical Sciences, Poorsina Street, Keshavarz Boulevard, Tehran 1417653955, Iran
| | - Akshay Goel
- Department of Cardiology, Westchester Medical Center and New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA
| | - Aaqib Malik
- Department of Cardiology, Westchester Medical Center and New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA
| | - Jayakumar Sreenivasan
- Department of Cardiology, Westchester Medical Center and New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA
| | - Dhrubajyoti Bandyopadhyay
- Department of Cardiology, Westchester Medical Center and New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA
| | - Apurva V Vyas
- Lehigh Valley Heart Institute, Lehigh Valley Health Network, 1200 S Cedar Crest Blvd, Allentown, PA 18103, USA
| | - Nainesh C Patel
- Lehigh Valley Heart Institute, Lehigh Valley Health Network, 1200 S Cedar Crest Blvd, Allentown, PA 18103, USA
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16
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Keller K, Geyer M, Hobohm L, Tamm AR, Kreidel F, Ruf TF, Hell M, Schmitt VH, Bachmann K, Born S, Schulz E, Münzel T, von Bardeleben RS. Survival benefit of overweight patients undergoing MitraClip® procedure in comparison to normal-weight patients. Clin Cardiol 2022; 45:1236-1245. [PMID: 36070481 DOI: 10.1002/clc.23897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 07/06/2022] [Accepted: 08/01/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The number of MitraClip® implantations increased significantly in recent years. Data regarding the impact of weight class on survival are sparse. HYPOTHESIS We hypothesized that weight class influences survival of patients treated with MitraClip® implantation. METHODS We investigated in-hospital, 1-year, 3-year, and long-term survival of patients successfully treated with isolated MitraClip® implantation for mitral valve regurgitation (MR) (June 2010-March 2018). Patients were categorized by weight classes, and the impact of weight classes on survival was analyzed. RESULTS Of 617 patients (aged 79.2 years; 47.3% females) treated with MitraClip® implantation (June 2010-March 2018), 12 patients were underweight (2.2%), 220 normal weight (40.1%), 237 overweight (43.2%), and 64 obesity class I (11.7%), 12 class II (2.2%), and 4 class III (0.7%). Preprocedural Logistic EuroScore (21.1 points [IQR 14.0-37.1]; 26.0 [18.5-38.5]; 26.0 [18.4-39.9]; 24.8 [16.8-33.8]; 33.0 [25.9-49.2]; 31.6 [13.1-47.6]; p = .291) was comparable between groups. Weight class had no impact on in-hospital death (0.0%; 4.1%; 1.5%; 0.0%; 7.7%; 0.0%; p = .189), 1-year survival (75.0%; 72.0%; 76.9%; 75.0%; 75.0%; 33.3%; p = .542), and 3-year survival (40.0%; 36.8%; 38.2%; 48.6%; 20.0%; 33.3%; p = .661). Compared to normal weight, underweight (hazard ratio [HR]: 1.35 [95% confidence interval [CI]: 0.65-2.79], p = .419), obesity-class I (HR: 0.93 [95% CI: 0.65-1.34], p = .705), class II (HR: 0.39 [95% CI: 0.12-1.24], p = .112), and class III (HR: 1.28 [95% CI: 0.32-5.21], p = .726) did not affect long-term survival. In contrast, overweight was associated with better survival (HR: 1.32 [95% CI: 1.04-1.68], p = .023). CONCLUSION Overweight affected the long-term survival of patients undergoing MitraClip® implantation beneficially compared to normal weight.
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Affiliation(s)
- Karsten Keller
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany.,Medical Clinic VII: Department of Sports Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Martin Geyer
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Lukas Hobohm
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Alexander R Tamm
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Felix Kreidel
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Tobias F Ruf
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Michaela Hell
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Volker H Schmitt
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhein Main, Mainz, Germany
| | - Kevin Bachmann
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Sonja Born
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Eberhard Schulz
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhein Main, Mainz, Germany
| | - Ralph S von Bardeleben
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhein Main, Mainz, Germany
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17
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Seo J, Li W, Safiriyu I, Kharawala A, Nagraj S, Tahir A, Doundoulakis I, Koliastasis L, Rios S, Palaiodimos L, Kokkinidis DG. A Meta-Analysis on the Impact of High BMI in Patients Undergoing Transcatheter Aortic Valve Replacement. J Cardiovasc Dev Dis 2022; 9:386. [PMID: 36354785 PMCID: PMC9695436 DOI: 10.3390/jcdd9110386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/22/2022] [Accepted: 11/01/2022] [Indexed: 06/24/2024] Open
Abstract
BACKGROUND A paradoxical association of obesity with lower risk of transcatheter aortic valve replacement (TAVR) outcomes has been reported. We aimed to systematically review the literature and compare TAVR-related morbidity and mortality among individuals with overweight or obesity and their peers with normal body mass index (BMI). METHODS PubMed and Embase databases were systematically searched for studies reporting TAVR outcomes in different BMI groups. Separate meta-analyses were conducted for studies reporting hazard ratios (HR) and odds ratios/relative risks. Short- and mid-/long-term outcomes were examined. RESULTS 26 studies with a total of 74,163 patients were included in our study. Overweight was associated with lower risk of short-term mortality (HR: 0.77; 95% CI: 0.60-0.98) and mid-/long-term mortality (HR: 0.79; 95% CI: 0.70-0.89). Obesity was associated with lower risk for mid-/long-term mortality (HR: 0.79; 95% CI: 0.73-0.86), but no difference was observed in short-term mortality, although a trend was noted (HR: 0.87l 95% CI: 0.74-1.01). Individuals with obesity demonstrated an association with higher odds of major vascular complications (OR: 1.33; 95% CI: 1.05-1.68). Both overweight (OR: 1.16; 95% CI: 1.03-1.30) and obesity (OR: 1.26; 95% CI: 1.06-1.50) were associated with higher likelihood for receiving permanent pacemakers after TAVR. CONCLUSION Individuals with overweight and obesity were associated with lower mortality risk compared to those with normal BMI but with higher likelihood of major vascular complications and permanent pacemaker implantation after TAVR.
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Affiliation(s)
- Jiyoung Seo
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | - Weijia Li
- AdventHealth Orlando, Orlando, FL 32803, USA
| | - Israel Safiriyu
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | - Amrin Kharawala
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | - Sanjana Nagraj
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | - Arooj Tahir
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | - Ioannis Doundoulakis
- Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, 10679 Athens, Greece
| | - Leonidas Koliastasis
- Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, 10679 Athens, Greece
| | - Saul Rios
- Montefiore Einstein Center for Heart & Vascular Care, Albert Einstein College of Medicine, Montefiore Medical Center, The Bronx, NY 10467, USA
| | - Leonidas Palaiodimos
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | - Damianos G. Kokkinidis
- Section of Cardiovascular Medicine, Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT 06510, USA
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18
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Biancari F. Transcatheter or surgical aortic valve replacement in severely obese patients? EUROINTERVENTION 2022; 18:e360-e361. [PMID: 35929070 PMCID: PMC10241287 DOI: 10.4244/eij-e-22-00021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Fausto Biancari
- Clinica Montevergine, GVM Care & Research, Mercogliano, Italy.,Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
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19
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Shibata K, Yamamoto M, Kameshima M, Fujiyama H, Sano T, Kagase A, Tokuda T, Adachi Y, Yamaguchi R, Shimura T, Iritani N, Murase K, Koyama Y. Impact of arm circumference on clinical outcomes in patients undergoing transcatheter aortic valve replacement. IJC HEART & VASCULATURE 2022; 40:101049. [PMID: 35601527 PMCID: PMC9118512 DOI: 10.1016/j.ijcha.2022.101049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 04/25/2022] [Accepted: 05/04/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Kenichi Shibata
- Department of Cardiac Rehabilitation, Nagoya Heart Center, Nagoya, Japan
| | - Masanori Yamamoto
- Department of Cardiology, Nagoya Heart Canter, Nagoya, Japan
- Department of Cardiology, Toyohashi Heart Canter, Toyohashi, Japan
- Department of Cardiology, Gifu Heart Center, Gifu, Japan
- Corresponding author at: Department of cardiology, Toyohashi Heart Canter, 21-1 Gobudori, Oyamachyo, Toyohashi, Aichi 441-8530, Japan.
| | - Masataka Kameshima
- Department of Cardiac Rehabilitation, Nagoya Heart Center, Nagoya, Japan
| | - Hiroaki Fujiyama
- Department of Cardiac Rehabilitation, Nagoya Heart Center, Nagoya, Japan
| | - Taisei Sano
- Department of Cardiac Rehabilitation, Nagoya Heart Center, Nagoya, Japan
| | - Ai Kagase
- Department of Cardiology, Nagoya Heart Canter, Nagoya, Japan
| | - Takahiro Tokuda
- Department of Cardiology, Nagoya Heart Canter, Nagoya, Japan
| | - Yuya Adachi
- Department of Cardiology, Toyohashi Heart Canter, Toyohashi, Japan
| | - Ryo Yamaguchi
- Department of Cardiology, Toyohashi Heart Canter, Toyohashi, Japan
| | | | - Naoki Iritani
- Department of Cardiac Rehabilitation, Toyohashi Heart Canter, Toyohashi, Japan
| | - Kazuma Murase
- Department of Cardiac Rehabilitation, Toyohashi Heart Canter, Toyohashi, Japan
| | - Yutaka Koyama
- Department of Cardiovascular Surgery, Gifu Heart Center, Gifu, Japan
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20
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Ngiam JN, Chew NWS, Tan BYQ, Sim HW, Sia CH, Kong WKF, Yeo TC, Poh KK. The obesity paradox: association of obesity with improved survival in medically managed severe aortic stenosis. Singapore Med J 2022; 63:330-334. [PMID: 36043300 PMCID: PMC9329552 DOI: 10.11622/smedj.2020169] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The obesity paradox, where obesity is associated with improved survival, has been described in patients undergoing haemodialysis and in those with heart failure. It was also demonstrated in patients undergoing valve replacement for aortic stenosis (AS). We explored this phenomenon in medically managed severe AS. METHODS 154 patients with medically managed severe AS (aortic valve area index [AVAi] < 0.6 cm2/m2; mean pressure gradient > 40 mmHg and peak velocity > 400 cm/s) and preserved left ventricular ejection fraction (> 50%) were categorised into the obese (body mass index [BMI] Asian cut-off ≥ 27.5 kg/m2) and non-obese groups. Their clinical and echocardiographic profiles were compared. RESULTS 24 (15.6%) patients were obese. Obese patients were similar to non-obese patients in age (68.5 ± 11.6 years vs. 68.9 ± 13.1 years) but had higher prevalence of cardiovascular risk factors. Left atrial diameter (43.7 ± 6.7 mm vs. 38.5 ± 10.2 mm) was larger in obese patients, while left ventricular outflow tract diameter (19.5 ± 1.7 mm vs. 20.4 ± 2.1 mm) was smaller. Despite lower AVAi in obese patients (0.36 ± 0.10 cm2/m2 vs. 0.43 ± 0.11 cm2/m2), there was lower mortality (37.5% vs. 41.0%, log-rank 4.06, p = 0.045) on follow-up (8.0 ± 5.7 years). After adjusting for age and AVAi, higher BMI ≥ 27.5 kg/m2 remained protective for mortality (hazard ratio 0.38, 95% confidence interval 0.15 to 0.98, p = 0.046). CONCLUSION We demonstrated that obesity was associated with improved survival in severe AS despite lower AVAi and increased prevalence of cardiovascular risk factors.
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Affiliation(s)
- Jinghao Nicholas Ngiam
- Department of Medicine, National University Health System, Singapore
- These authors contributed equally as first authors in this work
| | - Nicholas WS Chew
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore
- These authors contributed equally as first authors in this work
| | | | - Hui Wen Sim
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore
| | - William KF Kong
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore
| | - Tiong-Cheng Yeo
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kian-Keong Poh
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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21
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El-Andari R, Bozso SJ, Kang JJH, Bedard AMA, Adams C, Wang W, Nagendran J. Heart valve surgery and the obesity paradox: A systematic review. Clin Obes 2022; 12:e12506. [PMID: 34962353 DOI: 10.1111/cob.12506] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/24/2021] [Accepted: 12/11/2021] [Indexed: 12/22/2022]
Abstract
Obesity has been associated with increased incidence of comorbidities and shorter life expectancy, and it has generally been assumed that patients with obesity should have inferior outcomes after surgery. Previous literature has often demonstrated equivalent or even improved rates of mortality after cardiac surgery when compared to their lower-weight counterparts, coined the obesity paradox. Herein, we aim to review the literature investigating the impact of obesity on surgical valve interventions. PubMed and Embase were systematically searched for articles published from 1 January 2000 to 15 October 2021. A total of 1315 articles comparing differences in outcomes between patients of varying body mass index (BMI) undergoing valve interventions were reviewed and 25 were included in this study. Patients with higher BMI demonstrated equivalent or reduced rates of postoperative myocardial infarction, stroke, reoperation rates, acute kidney injury, dialysis and bleeding. Two studies identified increased rates of deep sternal wound infection in patients with higher BMI, although the majority of studies found no significant difference in deep sternal wound infection rates. The obesity paradox has described counterintuitive outcomes predominantly in coronary artery bypass grafting and transcatheter aortic valve replacement. Recent literature has identified similar trends in other heart valve interventions. While the obesity paradox has been well characterized, its causes are yet to be identified. Further study is essential in order to identify the causes of the obesity paradox so patients of all body sizes can receive optimal care.
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Affiliation(s)
- Ryaan El-Andari
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Sabin J Bozso
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jimmy J H Kang
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Alexandre M A Bedard
- Department of Biological Sciences, Faculty of Science, University of Alberta, Edmonton, Alberta, Canada
| | - Corey Adams
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Wei Wang
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jeevan Nagendran
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
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22
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Koifman E, Arow Z. Obesity paradox – Truth or misconception? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 38:9-10. [DOI: 10.1016/j.carrev.2022.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 02/18/2022] [Indexed: 11/25/2022]
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23
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Ravaux JM, Van Kuijk SMJ, Di Mauro M, Vernooy K, Bidar E, Van’t Hof AW, Veenstra L, Kats S, Houterman S, Maessen JG, Lorusso R. Incidence and Predictors of Permanent Pacemaker Implantation after Transcatheter Aortic Valve Procedures: Data of The Netherlands Heart Registration (NHR). J Clin Med 2022; 11:jcm11030560. [PMID: 35160012 PMCID: PMC8836997 DOI: 10.3390/jcm11030560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 12/30/2022] Open
Abstract
Atrioventricular conduction disturbance leading to permanent pacemaker (PM) implantation is a frequent and relevant complication after transcatheter aortic valve implantation (TAVI). We aimed to evaluate the rate of post-TAVI permanent PM implantation over time and to identify the predictive factors for post-TAVI PM. The data were retrospectively collected by the Netherlands Heart Registration (NHR). In total, 7489 isolated TAVI patients between 2013 and 2019 were included in the final analysis. The primary endpoint was a permanent PM implantation within 30 days following TAVI. The incidence of the primary endpoint was 12%. Post-TAVI PM showed a stable rate over time. Using multivariable logistic regression analysis, age (OR 1.01, 95% CI 1.00–1.02), weight (OR 1.00, 95% CI 1.00–1.01), creatinine serum level (OR 1.15, 95% CI 1.01–1.31), transfemoral TAVI approach (OR 1.34, 95% CI 1.11–1.61), and TAVI post-dilatation (OR 1.58, 95% CI 1.33–1.89) were shown to be independent predictors of PM. Male sex (OR 0.80, 95% CI 0.68–0.93) and previous aortic valve surgery (OR 0.42, 95% CI 0.26–0.69) had a protective effect on post-TAVI PM. From a large national TAVI registry, some clinical and procedural factors have been identified as promoting or preventing post-TAVI PM. Further efforts are required to identify high-risk patients for post-TAVI PM and to reduce the incidence of this important issue.
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Affiliation(s)
- Justine M. Ravaux
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), 6202 AZ Maastricht, The Netherlands; (S.M.J.V.K.); (M.D.M.); (E.B.); (S.K.); (J.G.M.); (R.L.)
- Correspondence:
| | - Sander M. J. Van Kuijk
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), 6202 AZ Maastricht, The Netherlands; (S.M.J.V.K.); (M.D.M.); (E.B.); (S.K.); (J.G.M.); (R.L.)
| | - Michele Di Mauro
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), 6202 AZ Maastricht, The Netherlands; (S.M.J.V.K.); (M.D.M.); (E.B.); (S.K.); (J.G.M.); (R.L.)
| | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Centre (MUMC), 6202 AZ Maastricht, The Netherlands; (K.V.); (A.W.V.H.); (L.V.)
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands
- Department of Cardiology, Radboud University Medical Centre (Radboudumc), 6525 GA Nijmegen, The Netherlands
| | - Elham Bidar
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), 6202 AZ Maastricht, The Netherlands; (S.M.J.V.K.); (M.D.M.); (E.B.); (S.K.); (J.G.M.); (R.L.)
| | - Arnoud W. Van’t Hof
- Department of Cardiology, Maastricht University Medical Centre (MUMC), 6202 AZ Maastricht, The Netherlands; (K.V.); (A.W.V.H.); (L.V.)
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands
- Department of Cardiology, Zuyderland Medical Center, 6419 PC Heerlen, The Netherlands
| | - Leo Veenstra
- Department of Cardiology, Maastricht University Medical Centre (MUMC), 6202 AZ Maastricht, The Netherlands; (K.V.); (A.W.V.H.); (L.V.)
| | - Suzanne Kats
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), 6202 AZ Maastricht, The Netherlands; (S.M.J.V.K.); (M.D.M.); (E.B.); (S.K.); (J.G.M.); (R.L.)
| | - Saskia Houterman
- Netherlands Heart Registration (NHR), 1105 AZ Amsterdam, The Netherlands;
| | - Jos G. Maessen
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), 6202 AZ Maastricht, The Netherlands; (S.M.J.V.K.); (M.D.M.); (E.B.); (S.K.); (J.G.M.); (R.L.)
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands
| | - Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), 6202 AZ Maastricht, The Netherlands; (S.M.J.V.K.); (M.D.M.); (E.B.); (S.K.); (J.G.M.); (R.L.)
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands
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24
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Kjønås D, Schirmer H, Aakhus S, Eidet J, Malm S, Aaberge L, Busund R, Rösner A. Clinical and Echocardiographic Parameters Predicting 1- and 2-Year Mortality After Transcatheter Aortic Valve Implantation. Front Cardiovasc Med 2021; 8:739710. [PMID: 34938779 PMCID: PMC8685271 DOI: 10.3389/fcvm.2021.739710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 11/02/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has become a standard treatment option for patients with symptomatic aortic stenosis. Elderly high-risk patients treated with TAVI have a high residual mortality due to preexisting comorbidities. Knowledge of factors predicting futility after TAVI is sparse and clinical tools to aid the preoperative evaluation are lacking. The aim of this study was to evaluate if echocardiographic measures, including speckle-tracking analysis, in addition to clinical parameters, could aid in the prediction of mortality beyond 30 days after TAVI. Methods: This prospective observational cohort study included 227 patients treated with TAVI at the University Hospital of North Norway, Tromsø and Oslo University Hospital, Rikshospitalet from February 2010 to June 2013. All the patients underwent preoperative echocardiographic evaluation with retrospective speckle-tracking analysis. Primary endpoints were 1- and 2-year mortality beyond 30 days after TAVI. Results: All-cause 1- and 2-year mortality beyond 30 days after TAVI was 12.1 and 19.5%, respectively. Predictors of 1-year mortality beyond 30 days were body mass index [hazard ratio (HR): 0.88, 95% CI: 0.80-0.98, p = 0.018], previous myocardial infarction (HR: 2.69, 95% CI: 1.14-6.32, p = 0.023), and systolic pulmonary artery pressure ≥ 60 mm Hg (HR: 5.93, 95% CI: 1.67-21.1, p = 0.006). Moderate-to-severe mitral regurgitation (HR: 2.93, 95% CI: 1.53-5.63, p = 0.001), estimated glomerular filtration rate (HR: 0.98, 95% CI: 0.96-0.99, p = 0.002), and chronic obstructive pulmonary disease (HR: 1.9, 95% CI: 1.01-3.58, p = 0.046) were predictors of 2-year mortality. Conclusion: Both the clinical and echocardiographic parameters should be considered when evaluating high-risk patients for TAVI, as both are predictive of 1-and 2-year mortality. Our results support the importance of individual risk assessment using a multidisciplinary, multimodal, and individual approach.
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Affiliation(s)
- Didrik Kjønås
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
| | - Henrik Schirmer
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Svend Aakhus
- Department of Circulation and Imaging, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway
| | - Jo Eidet
- Department of Anesthesiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Siri Malm
- Department of Cardiology, University Hospital of North Norway, Harstad, Norway
| | - Lars Aaberge
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Rolf Busund
- Institute of Clinical Medicine, The Arctic University of Norway (UiT), Tromsø, Norway
- Department of Cardiothoracic and Vascular Surgery, University Hospital of North Norway, Tromsø, Norway
| | - Assami Rösner
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
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25
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Berti S, Bartorelli AL, Koni E, Giordano A, Petronio AS, Iadanza A, Bedogni F, Reimers B, Spaccarotella C, Trani C, Attisano T, Sardella G, Bonmassari R, Medda M, Sherwood MW, Tomai F, Navarese EP. Impact of High Body Mass Index on Vascular and Bleeding Complications After Transcatheter Aortic Valve Implantation. Am J Cardiol 2021; 155:86-95. [PMID: 34284861 DOI: 10.1016/j.amjcard.2021.06.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/09/2021] [Accepted: 06/14/2021] [Indexed: 12/20/2022]
Abstract
Increased body mass index (BMI) is an established cardiovascular risk factor. The impact of high BMI on vascular and bleeding complications in patients undergoing transcatheter aortic valve implantation (TAVI) is not clarified. RISPEVA, a multicenter prospective database of patients undergoing TAVI stratified by BMI was used for this analysis. Patients were classified as normal or high BMI (obese and overweight) according to the World Health Organization criteria. A comparison of 30-day vascular and bleeding outcomes between groups was performed using propensity scores methods. A total of 3776 matched subjects for their baseline characteristics were included. Compared with normal BMI, high BMI patients had significantly 30-day greater risk of the composite of vascular or bleeding complications (11.1% vs 8.8%, OR: 1.28, 95% CI [1.02 to 1.61]; p = 0.03). Complications rates were higher in both obese (11.3%) and overweight (10.5%), as compared with normal weight patients (8.8%). By a landmark event analysis, the effect of high versus normal BMI on these complications appeared more pronounced within 7 days after the TAVI procedure. A significant linear association between increased BMI and vascular complications was observed at this time frame (p = 0.03). In conclusion, compared with normal BMI, both obese and overweight patients undergoing TAVI, experience increased rates of 30-day vascular and bleeding complications. These findings indicate that high BMI is an independent risk predictor of vascular and bleeding complications after TAVI.
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Affiliation(s)
- Sergio Berti
- Department of Diagnostic and Interventional Cardiology, Gabriele Monasterio Tuscany Foundation, G. Pasquinucci Heart Hospital, Massa, Italy
| | - Antonio L Bartorelli
- Centro Monzino, IRCCS and Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Endrin Koni
- Department of Diagnostic and Interventional Cardiology, Gabriele Monasterio Tuscany Foundation, G. Pasquinucci Heart Hospital, Massa, Italy; Department of Interventional Cardiology, Santa Corona Hospital, Pietra Ligure, Italy
| | - Arturo Giordano
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
| | - Anna S Petronio
- Department of Cardiology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Alessandro Iadanza
- Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Siena, Italy
| | - Francesco Bedogni
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Bernard Reimers
- Cardio Center, Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy
| | - Carmen Spaccarotella
- Division of Cardiology, CCU and Interventional, Cardiology, Cardiovascular Research Center, University Magna Graecia, Catanzaro, Italy
| | - Carlo Trani
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Tiziana Attisano
- Department of Cardiology, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Gennaro Sardella
- Department of Cardiology, Policlinico "Umberto I," Sapienza University of Rome, Rome, Italy
| | | | - Massimo Medda
- Istituto Clinico Sant'Ambrogio, Gruppo San Donato, Milano, Italy
| | | | | | - Eliano P Navarese
- Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland; Faculty of Medicine, University of Alberta, Edmonton, Canada.
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26
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Moscarelli M, Gallo F, Gallone G, Kim WK, Reifart J, Veulemans V, Zeus T, Toggweiler S, De Backer O, Søndergaard L, Mangieri A, De Marco F, Regazzoli D, Reimers B, Muntané-Carol G, Lauriero RE, Armario X, Mylotte D, Bhadra OD, Conradi L, Donday LAM, Nombela-Franco L, Barbanti M, Reddavid C, Brugaletta S, Nicolini E, Tzanis G, Rodes-Cabau J, Colombo A, Giannini F. Aortic angle distribution and predictors of horizontal aorta in patients undergoing transcatheter aortic valve replacement. Int J Cardiol 2021; 338:58-62. [PMID: 34090956 DOI: 10.1016/j.ijcard.2021.05.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/25/2021] [Accepted: 05/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Horizontal aorta (HA) is an anatomical feature that can pose significant technical challenges for the successful positioning of the bioprosthetic valve during transcatheter aortic valve replacement (TAVR). Physiological range of aortic angle (AA) is unknown; hence there is no cutoff AA for classifying HA. Moreover, patient characteristics predicting HA are under-investigated. METHODS This was a retrospective analysis of prospective collected data from 16 heart valve centers in Europe. The study utilized a common dataset with a priori agreed-upon definitions and variables. Eligible patients underwent TAVR between 2014 and 2020 and had multidetector computed tomographic imaging data available for determining the AA. The analysis described the distribution of AA and potential predictors of HA. Inter-center variability was also explored. RESULTS For 4022 patients analyzed, the mean AA ± standard deviation was 49.4° ± 9.4° (median 49°, inter-quartile range [IQR] 12°, range 18-90°). There was no significant difference in mean AA between men and women (49.4° ± 9.1° vs. 49.6° ± 9.3°, respectively; p = 0.53); therefore, 49.4° was accepted as the cutoff value for HA in subsequent analyses. Covariates significantly associated with HA included age (odds ratio [OR]: 1.02, 95% confidence interval [CI]: 1.01-1.04, p < 0.001), body mass index (OR: 1.06, 95% CI: 1.05-1.08, p < 0.01), previous cardiac surgery (OR: 0.58, 95% CI: 0.45-0.75, p < 0.001), and porcelain aorta (OR: 0.66, 95% CI: 0.52-0.85, p = 0.001). Some inter-center variability was observed. CONCLUSIONS We defined 49.4° as the mean AA, and also associated predictors of HA in a large case series of patients with severe aortic stenosis candidates for TAVR.
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Affiliation(s)
- Marco Moscarelli
- Department of Cardiovascular Surgery, GVM Care & Research, Bari, Italy.
| | - Francesco Gallo
- Interventional Cardiology Unit, Maria Cecilia Hospital, GVM Care and Research, Italy
| | - Guglielmo Gallone
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
| | - Jörg Reifart
- Department of Cardiology, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
| | - Verena Veulemans
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Düsseldorf, Germany
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Düsseldorf, Germany
| | | | - Ole De Backer
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Søndergaard
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Antonio Mangieri
- Interventional Cardiology Unit, Maria Cecilia Hospital, GVM Care and Research, Italy
| | - Federico De Marco
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Damiano Regazzoli
- Department of Clinical and Interventional Cardiology, Cardio Center, Humanitas Research Hospital, Rozzano-Milano, Italy
| | - Bernhard Reimers
- Department of Clinical and Interventional Cardiology, Cardio Center, Humanitas Research Hospital, Rozzano-Milano, Italy
| | | | | | - Xavier Armario
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Darren Mylotte
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Oliver Daniel Bhadra
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | | | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Claudia Reddavid
- Division of Cardiology, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Salvatore Brugaletta
- Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Elisa Nicolini
- Interventional Cardiology, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Giorgos Tzanis
- Department of Interventional Cardiology, Henry Dunant Hospital Center, Athens, Greece
| | - Josep Rodes-Cabau
- Department of Clinical and Interventional Cardiology, Cardio Center, Humanitas Research Hospital, Rozzano-Milano, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, Maria Cecilia Hospital, GVM Care and Research, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, Maria Cecilia Hospital, GVM Care and Research, Italy
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Cone JT, Benjamin ER, Alfson DB, Demetriades D. Isolated severe blunt traumatic brain injury: effect of obesity on outcomes. J Neurosurg 2021; 134:1667-1674. [PMID: 32534488 DOI: 10.3171/2020.3.jns193458] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/09/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Obesity has been widely reported to confer significant morbidity and mortality in both medical and surgical patients. However, contemporary data indicate that obesity may confer protection after both critical illness and certain types of major surgery. The authors hypothesized that this "obesity paradox" may apply to patients with isolated severe blunt traumatic brain injuries (TBIs). METHODS The Trauma Quality Improvement Program (TQIP) database was queried for patients with isolated severe blunt TBI (head Abbreviated Injury Scale [AIS] score 3-5, all other body areas AIS < 3). Patient data were divided based on WHO classification levels for BMI: underweight (< 18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), obesity class 1 (30.0-34.9 kg/m2), obesity class 2 (35.0-39.9 kg/m2), and obesity class 3 (≥ 40.0 kg/m2). The role of BMI in patient outcomes was assessed using regression models. RESULTS In total, 103,280 patients were identified with isolated severe blunt TBI. Data were excluded for patients aged < 20 or > 89 years or with BMI < 10 or > 55 kg/m2 and for patients who were transferred from another treatment center or who showed no signs of life upon presentation, leaving data from 38,446 patients for analysis. Obesity was not found to confer a survival advantage on univariate analysis. On multivariate analysis, underweight patients as well as obesity class 1 and 3 patients had a higher rate of mortality (OR 1.86, 95% CI 1.48-2.34; OR 1.18, 95% CI 1.01-1.37; and OR 1.41, 95% CI 1.03-1.93, respectively). Increased obesity class was associated with an increased risk of respiratory complications (obesity class 1: OR 1.19, 95% CI 1.03-1.37; obesity class 2: OR 1.30, 95% CI 1.05-1.62; obesity class 3: OR 1.55, 95% CI 1.18-2.05) and thromboembolic complications (overweight: OR 1.43, 95% CI 1.16-1.76; obesity class 1: OR 1.45, 95% CI 1.11-1.88; obesity class 2: OR 1.55, 95% CI 1.05-2.29) despite a decreased risk of overall complications (obesity class 2: OR 0.82, 95% CI 0.73-0.92; obesity class 3: OR 0.83, 95% CI 0.72-0.97). Underweight patients had a significantly increased risk of overall complications (OR 1.39, 95% CI 1.24-1.57). CONCLUSIONS Although there was an obesity-associated decrease in overall complications, the study data did not demonstrate a paradoxical protective effect of obesity on mortality after isolated severe blunt TBI. Obese patients with isolated severe blunt TBI are at increased risk of respiratory and venous thromboembolic complications. However, underweight patients appear to be at highest risk after severe blunt TBI, with significantly increased risks of morbidity and mortality.
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Affiliation(s)
- Jennifer T Cone
- 1Department of Surgery, Section of Trauma and Acute Care Surgery, University of Chicago, Illinois; and
| | - Elizabeth R Benjamin
- 2Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California
| | - Daniel B Alfson
- 2Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California
| | - Demetrios Demetriades
- 2Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California
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Shibata K, Yamamoto M, Yamada S, Kobayashi T, Morita S, Kagase A, Tokuda T, Shimura T, Tsunaki T, Tada N, Naganuma T, Araki M, Yamanaka F, Shirai S, Mizutani K, Tabata M, Ueno H, Takagi K, Higashimori A, Watanabe Y, Hayashida K. Clinical Outcomes of Subcutaneous and Visceral Adipose Tissue Characteristics Assessed in Patients Underwent Transcatheter Aortic Valve Replacement. CJC Open 2021; 3:142-151. [PMID: 33644728 PMCID: PMC7893200 DOI: 10.1016/j.cjco.2020.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/25/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Adipose tissue (AT) characteristics are considered to be a marker for predicting clinical outcomes. This study aimed to investigate the prognostic value of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) computed tomography (CT) assessment in patients who underwent transcatheter aortic valve replacement (TAVR). METHODS We used the Japanese multicentre registry data of 1372 patients (age: 84.5 ± 5.0 years, women: 70.6%) who underwent TAVR. The SAT and VAT were assessed according to the preprocedural CT area and density. Baseline characteristics and clinical outcomes were compared based on the differences in AT characteristics. The independent associations with all-cause mortality after TAVR were evaluated according to the CT area and density of AT. RESULTS Low-volume area of SAT and VAT was associated with worse clinical outcomes compared with high-volume area of SAT and VAT in patients who underwent TAVR (log-rank test P = 0.016 and P = 0.014). High CT density of SAT and VAT was associated with increasing mortality in comparison with low CT density of SAT and VAT (log-rank test P < 0.001 and P = 0.007). The Cox regression multivariate analysis demonstrated the independent association of increased all-cause mortality in the high SAT and VAT density (hazard ratio [HR]: 1.41, 95% confidence interval [CI]: 1.06-1.88, P = 0.019, and HR: 1.34, 95% CI: 1.03-1.76, P = 0.031, respectively), but not in the low SAT and VAT area (HR: 0.85, 95% CI: 0.74-1.29, P = 0.85, and HR: 0.78, 95% CI: 0.60-1.03, P = 0.085, respectively). CONCLUSIONS CT-derived AT characteristics, particularly the qualitative assessments, were useful for predicting the prognosis in patients after TAVR.
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Affiliation(s)
- Kenichi Shibata
- Department of Cardiology, Nagoya Heart Canter, Nagoya, Japan
| | - Masanori Yamamoto
- Department of Cardiology, Nagoya Heart Canter, Nagoya, Japan
- Department of Cardiology, Toyohashi Heart Canter, Toyohashi, Japan
| | - Sumio Yamada
- Department of Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Satoshi Morita
- Department of Cardiology, Nagoya Heart Canter, Nagoya, Japan
| | - Ai Kagase
- Department of Cardiology, Nagoya Heart Canter, Nagoya, Japan
| | - Takahiro Tokuda
- Department of Cardiology, Nagoya Heart Canter, Nagoya, Japan
| | - Testuro Shimura
- Department of Cardiology, Toyohashi Heart Canter, Toyohashi, Japan
| | - Tatsuya Tsunaki
- Department of Cardiology, Toyohashi Heart Canter, Toyohashi, Japan
| | - Norio Tada
- Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Motoharu Araki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Futoshi Yamanaka
- Department of Cardiology, Syonan Kamakura General Hospital, Kanagawa, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Kazuki Mizutani
- Department of Cardiovascular Medicine, Osaka City University Graduates School of Medicine, Osaka, Japan
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center, Chiba, Japan
| | - Hiroshi Ueno
- Department of Cardiology, Toyama University Hospital, Toyama, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan
| | | | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - OCEAN-TAVI investigators
- Department of Cardiology, Nagoya Heart Canter, Nagoya, Japan
- Department of Cardiology, Toyohashi Heart Canter, Toyohashi, Japan
- Department of Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
- Department of Cardiology, Syonan Kamakura General Hospital, Kanagawa, Japan
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
- Department of Cardiovascular Medicine, Osaka City University Graduates School of Medicine, Osaka, Japan
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center, Chiba, Japan
- Department of Cardiology, Toyama University Hospital, Toyama, Japan
- Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan
- Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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Cone JT, Benjamin ER, Alfson DB, Biswas S, Demetriades D. The effect of body mass index on outcomes following severe blunt chest trauma. Injury 2020; 51:2076-2081. [PMID: 32646649 DOI: 10.1016/j.injury.2020.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 06/19/2020] [Accepted: 07/04/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Obesity has been described as a significant risk factor for adverse outcomes in hospitalized patients. However, recent literature reports an "obesity paradox", suggesting that obesity may have a protective effect in a subset of surgical and critically ill patients. The present study assesses the effect of body mass index (BMI) on outcomes following severe isolated blunt chest trauma. METHODS This was a TQIP database study including patients with severe isolated blunt chest injury (chest AIS 3-5, extrathoracic AIS <3). Patients were excluded for age <20 or >89, death on arrival, facility transfer, or BMI <10 or >55. Patients were divided into five groups according to BMI: underweight (BMI <18.5), normal weight (18.5-24.9), overweight (25.0-29.9), obesity class 1 (30.0-34.9), obesity class 2 (35.0-39.9) and obesity class 3 (≥40.0). Logistic regression models were constructed to evaluate the effect of BMI on outcomes. RESULTS 28,820 patients met criteria for inclusion in the analysis. After multivariable analysis, underweight patients as well as obesity class 2 and 3 patients had a significantly higher mortality (OR 1.86 [95% CI, 1.12-3.10], OR 1.48 [95% CI, 1.02-2.16], and OR 1.60 [95% CI, 1.03-2.50]), respectively. Underweight patients had significantly higher risk of overall complications as compared to normal weight patients (OR 1.58 [95% CI, 1.34-1.88]). Obesity class 2 and 3 were independently associated with increased respiratory complications (OR 1.60 [95% CI, 1.27-2.01] and OR 1.58 [95% CI, 1.20-2.09], respectively) and all classes of overweight and obese patients were associated with increased risk of VTE complications (OR 1.68 [95% CI, 1.23-2.27], OR 1.98 [95% CI, 1.42-2.77], OR 2.32 [95% CI, 1.55-3.48], OR 2.02 [95% CI, 1.23-3.33], respectively for overweight and obesity class 1, 2, 3). CONCLUSIONS The obesity paradox does not extend to severe blunt chest trauma. Underweight and obesity class 2 and 3 patients have worse mortality than normal weight patients. Obesity was independently associated with an increased risk of pulmonary and VTE complications.
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Affiliation(s)
- Jennifer T Cone
- Division of Trauma and Acute Care Surgery, University of Chicago, Chicago, IL, USA
| | - Elizabeth R Benjamin
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, 2051 Marengo Street, Inpatient Tower (C), 5th Floor, C5L100, Los Angeles 90033, CA, USA.
| | - Daniel B Alfson
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, 2051 Marengo Street, Inpatient Tower (C), 5th Floor, C5L100, Los Angeles 90033, CA, USA
| | - Subarna Biswas
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, 2051 Marengo Street, Inpatient Tower (C), 5th Floor, C5L100, Los Angeles 90033, CA, USA
| | - Demetrios Demetriades
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, 2051 Marengo Street, Inpatient Tower (C), 5th Floor, C5L100, Los Angeles 90033, CA, USA
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Yamamoto M, Otsuka T, Shimura T, Yamaguchi R, Adachi Y, Kagase A, Tokuda T, Yashima F, Watanabe Y, Tada N, Naganuma T, Araki M, Yamanaka F, Mizutani K, Tabata M, Watanabe S, Sato Y, Ueno H, Takagi K, Higashimori A, Shirai S, Hayashida K. Clinical risk model for predicting 1-year mortality after transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2020; 97:E544-E551. [PMID: 32729657 PMCID: PMC7983930 DOI: 10.1002/ccd.29130] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/10/2020] [Accepted: 06/20/2020] [Indexed: 01/08/2023]
Abstract
Objectives Estimating 1‐year life expectancy is an essential factor when evaluating appropriate indicators for transcatheter aortic valve replacement (TAVR). Background It is clinically useful in developing a reliable risk model for predicting 1‐year mortality after TAVR. Methods We evaluated 2,588 patients who underwent TAVR using data from the Optimized CathEter vAlvular iNtervention (OCEAN) Japanese multicenter registry from October 2013 to May 2017. The 1‐year clinical follow‐up was achieved by 99.5% of the entire population (n = 2,575). Patients were randomly divided into two cohorts: the derivation cohort (n = 1,931, 75% of the study population) and the validation cohort (n = 644). Considerable clinical variables including individual patient's comorbidities and frailty markers were used for predicting 1‐year mortality following TAVR. Results In the derivation cohort, a multivariate logistic regression analysis demonstrated that sex, body mass index, Clinical Frailty Scale, atrial fibrillation, peripheral artery disease, prior cardiac surgery, serum albumin, renal function as estimated glomerular filtration rate, and presence of pulmonary disease were independent predictors of 1‐year mortality after TAVR. Using these variables, a risk prediction model was constructed to estimate the 1‐year risk of mortality after TAVR. In the validation cohort, the risk prediction model revealed high discrimination ability and acceptable calibration with area under the curve of 0.763 (95% confidence interval, 0.728–0.795, p < .001) in the receiver operating characteristics curve analysis and a Hosmer–Lemeshow χ2 statistic of 5.96 (p = .65). Conclusions This risk prediction model for 1‐year mortality may be a reliable tool for risk stratification and identification of adequate candidates in patients undergoing TAVR.
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Affiliation(s)
- Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan.,Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Toshiaki Otsuka
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan.,Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan
| | - Tetsuro Shimura
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Ryo Yamaguchi
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Yuya Adachi
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Ai Kagase
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Takahiro Tokuda
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Fumiaki Yashima
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan.,Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Norio Tada
- Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Motoharu Araki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Futoshi Yamanaka
- Department of Cardiology, Syonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Kazuki Mizutani
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center, Chiba, Japan
| | - Shun Watanabe
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center, Chiba, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University, Minato, Japan
| | - Hiroshi Ueno
- Department of Cardiology, Toyama University Hospital, Toyama, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan
| | | | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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Keller K, Hobohm L, Geyer M, Kreidel F, Ostad MA, Lavie CJ, Lankeit M, Konstantinides S, Münzel T, von Bardeleben RS. Impact of obesity on adverse in-hospital outcomes in patients undergoing percutaneous mitral valve edge-to-edge repair using MitraClip® procedure - Results from the German nationwide inpatient sample. Nutr Metab Cardiovasc Dis 2020; 30:1365-1374. [PMID: 32513574 DOI: 10.1016/j.numecd.2020.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 03/29/2020] [Accepted: 04/08/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND AIM The number of percutaneous edge-to-edge mitral regurgitation (MR) valve repairs with MitraClip® implantations increased exponentially in recent years. Studies have suggested an obesity survival paradox in patients with cardiovascular diseases. We investigated the influence of obesity on adverse in-hospital outcomes in patients with MitraClip® implantation. METHODS AND RESULTS We analyzed data on characteristics of patients and in-hospital outcomes for all percutaneous mitral valve repairs using the edge-to-edge MitraClip®-technique in Germany 2011-2015 stratified for obesity vs. normal-weight/over-weight. The nationwide inpatient sample comprised 13,563 inpatients undergoing MitraClip® implantations. Among them, 1017 (7.5%) patients were coded with obesity. Obese patients were younger (75 vs.77 years,P < 0.001), more often female (45.4% vs.39.5%,P < 0.001), had more often heart failure (87.1% vs.79.2%,P < 0.001) and renal insufficiency (67.0% vs.56.4%,P < 0.001). Obese and non-obese patients were comparable regarding major adverse cardiac and cerebrovascular events (MACCE) and in-hospital death. The combined endpoint of cardio-pulmonary resuscitation (CPR), mechanical ventilation and death was more often reached in non-obese than in obese patients with a trend towards significance (20.6%vs.18.2%,P = 0.066). Obesity was an independent predictor of reduced events regarding the combined endpoint of CPR, mechanical ventilation and death (OR 0.75, 95%CI 0.64-0.89,P < 0.001), but not for reduced in-hospital mortality (P = 0.355) or reduced MACCE rate (P = 0.108). Obesity class III was associated with an elevated risk for pulmonary embolism (OR 5.66, 95%CI 1.35-23.77,P = 0.018). CONCLUSIONS We observed an obesity paradox regarding the combined endpoint of CPR, mechanical ventilation and in-hospital death in patients undergoing MitraClip® implantation, but our results failed to confirm an impact of obesity on in-hospital survival or MACCE.
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Affiliation(s)
- Karsten Keller
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Heart Center Mainz, Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.
| | - Lukas Hobohm
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Heart Center Mainz, Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Martin Geyer
- Heart Center Mainz, Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Felix Kreidel
- Heart Center Mainz, Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Mir A Ostad
- Heart Center Mainz, Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Carl J Lavie
- Department of Cardiovascular Disease, John Ochsner Heart & Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, United States
| | - Mareike Lankeit
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Department of Internal Medicine and Cardiology, Campus Virchow Klinikum (CVK), Charité-University Medicine, Berlin, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Stavros Konstantinides
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Department of Cardiology, Democritus University Thrace, Alexandroupolis, Greece
| | - Thomas Münzel
- Heart Center Mainz, Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Ralph Stephan von Bardeleben
- Heart Center Mainz, Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
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Zieliński K, Kalińczuk Ł, Chmielak Z, Mintz GS, Dąbrowski M, Pręgowski J, Świerczewski M, Kowalik I, Demkow M, Hryniewiecki T, Michałowska I, Witkowski A. Additive Value of High-Density Lipoprotein Cholesterol and C-Reactive Protein Level Assessment for Prediction of 2-year Mortality After Transcatheter Aortic Valve Implantation. Am J Cardiol 2020; 126:66-72. [PMID: 32340714 DOI: 10.1016/j.amjcard.2020.03.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/27/2020] [Accepted: 03/27/2020] [Indexed: 12/13/2022]
Abstract
Available prediction models are inaccurate in elderly who underwent transcatheter aortic valve implantation (TAVI). The aim of present study was to analyze the separate and combined prognostic values of baseline HDL-C and C-reactive protein (CRP) levels in patients treated successfully with TAVI who had complete 2-year follow-up. We analyzed 334 patients treated with TAVI from 01/2010 to 07/2017 who had measurements of HDL-C and CRP on admission or during qualification for the procedure. Baseline HDL-C ≤46 mg/dl (areas under the curve [AUC] = 0.657) and CRP ≥0.20 mg/dl (AUC = 0.634) were predictive of 2-year mortality. After stratification with both cutoffs, patients with low HDL-C and concomitant high CRP most often had LVEF ≤50% and were high risk as per EuroSCORE II. Those with isolated CRP elevation had the lowest frequency of LVEF ≤50%, but more sarcopenia (based on psoas muscle area). After adjustment in the multivariate analysis for other identified predictors including EuroSCORE II and statin therapy, isolated HDL-C ≤46 mg/dl (identified in 40 patients) and isolated CRP ≥0.20 mg/dl (n = 109) were both independent predictors of 2-year mortality (hazard ratio [HR] = 2.92 and HR = 2.42, respectively) compared with patients with both markers within established cutoffs (n = 105) who had the lowest 2-year mortality (9.5%). Patients with both markers exceeding cutoffs (n = 80) had the highest risk (HR = 4.53) with 2-year mortality of 42.5%. High CRP was associated with increased mortality within the first year of follow-up, whereas low HDL-C increased mortality in the second year. The combination of both markers with EuroSCORE II enhanced mortality prediction (AUC = 0.697). In conclusion, low baseline HDL-C and high CRP jointly contribute to the prediction of increased all-cause mortality after TAVI.
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Chang HH, Chen PL, Leu HB, Chen IM, Wu NY, Chen YH. Sex difference in the prognostic role of body composition parameters in Taiwanese patients undergoing transcatheter aortic valve implantation. BMC Cardiovasc Disord 2020; 20:283. [PMID: 32522169 PMCID: PMC7288684 DOI: 10.1186/s12872-020-01569-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 06/03/2020] [Indexed: 02/02/2023] Open
Abstract
Background Evidence on association between body composition and outcomes of transcatheter aortic valve implantation (TAVI) is limited for Asian patients. This study investigated the prognostic role of body composition parameters in Taiwanese patients undergoing TAVI. Materials and methods Data of consecutive patients undergoing TAVI for severe aortic stenosis between May 1, 2010 and August 31, 2019 were prospectively collected in this observational study. The association between body composition parameters (body mass index [BMI], body surface area [BSA], lean body mass [LBM], and LBM index) and cumulative mortality was analyzed using Cox proportional hazard regression model. Results A total of 221 patients (mean age 81.4 years), including 125 (56.6%) males, were included with median follow-up duration of 23.8 months. In males, multivariate analysis revealed that higher BMI (P = 0.035), BMI ≥ 20 kg/m2 (P = 0.026), and higher LBM index (P = 0.023) significantly predicted lower overall all-cause cumulative mortality. In females, none of the body composition parameters was significantly associated with all-cause cumulative mortality. Paradoxical association between BMI and estimated all-cause cumulative mortality was only significant among male patients. Conclusion In Taiwanese TAVI patients, the prognostic effects of BMI and LBM index on cumulative mortality were only observed in males, not in females. Sex differences must be considered when stratifying risk among patients undergoing TAVI.
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Affiliation(s)
- Hsiao-Huang Chang
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, School of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Biomedical Sciences and Engineering, National Central University, Taoyuan, Taiwan
| | - Po-Lin Chen
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsin-Bang Leu
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei, 11217, Taiwan
| | - I-Ming Chen
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Nai-Yuan Wu
- Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan
| | - Ying-Hwa Chen
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei, 11217, Taiwan.
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Miklisanskaya SV, Mazur NA, Solomasova LV, Chigineva VV. [The «obesity paradox» and its degree of proof]. TERAPEVT ARKH 2020; 92:84-90. [PMID: 32598704 DOI: 10.26442/00403660.2020.04.000421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Indexed: 11/22/2022]
Abstract
The article gives a critical assessment of the so-called obesity paradox. Methodological errors that occur in the organization of studies that studied the obesity paradox and the formation of comparison groups are highlighted. There are also examples of the disappearance of the obesity paradox when taking into account additional risk factors. The organization of prospective studies or more careful consideration of all currently known risk factors for cardiovascular diseases (CVD) will significantly improve the results of the study of the effect of overweight and obesity on mortality in patients with CVD. Thus, despite the biological possibility of the existence of a positive effect of adipose tissue in CVD, the presence of a large number of errors identified in the analysis of the work of researchers obesity paradox require to reconsider the existence of this phenomenon, it should be taken into account the possibility that the obesity paradox may be a consequence of improper design studies to investigate this phenomenon.
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Affiliation(s)
| | - N A Mazur
- Russian Medical Academy of Continuous Professional Education
| | - L V Solomasova
- Russian Medical Academy of Continuous Professional Education
| | - V V Chigineva
- Russian Medical Academy of Continuous Professional Education
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Okuno T, Koseki K, Nakanishi T, Ninomiya K, Tomii D, Tanaka T, Sato Y, Osanai A, Sato K, Koike H, Yahagi K, Kishi S, Komiyama K, Aoki J, Yokozuka M, Miura S, Tanabe K. Prognostic Impact of Computed Tomography-Derived Abdominal Fat Area on Transcatheter Aortic Valve Implantation. Circ J 2018; 82:3082-3089. [DOI: 10.1253/circj.cj-18-0709] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Taishi Okuno
- Division of Cardiology, Mitsui Memorial Hospital
| | - Keita Koseki
- Division of Cardiology, Mitsui Memorial Hospital
| | | | - Kai Ninomiya
- Division of Cardiology, Mitsui Memorial Hospital
| | | | - Tetsu Tanaka
- Division of Cardiology, Mitsui Memorial Hospital
| | - Yu Sato
- Division of Cardiology, Mitsui Memorial Hospital
| | - Akira Osanai
- Division of Cardiovascular Surgery, Mitsui Memorial Hospital
| | - Kei Sato
- Division of Cardiology, Mitsui Memorial Hospital
| | - Hideki Koike
- Division of Cardiology, Mitsui Memorial Hospital
| | | | - Satoru Kishi
- Division of General Internal Medicine, Nakahara Medical Clinic
| | | | - Jiro Aoki
- Division of Cardiology, Mitsui Memorial Hospital
| | | | - Sumio Miura
- Division of Cardiovascular Surgery, Mitsui Memorial Hospital
| | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital
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Incidence and impact of prosthesis–patient mismatch following transcatheter aortic valve implantation. Clin Res Cardiol 2018; 108:660-668. [DOI: 10.1007/s00392-018-1394-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 11/15/2018] [Indexed: 12/28/2022]
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Rocca B, Fox KAA, Ajjan RA, Andreotti F, Baigent C, Collet JP, Grove EL, Halvorsen S, Huber K, Morais J, Patrono C, Rubboli A, Seljeflot I, Sibbing D, Siegbahn A, Ten Berg J, Vilahur G, Verheugt FWA, Wallentin L, Weiss TW, Wojta J, Storey RF. Antithrombotic therapy and body mass: an expert position paper of the ESC Working Group on Thrombosis. Eur Heart J 2018; 39:1672-1686f. [PMID: 29509886 DOI: 10.1093/eurheartj/ehy066] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 02/08/2018] [Indexed: 02/11/2024] Open
Affiliation(s)
- Bianca Rocca
- Institute of Pharmacology, Catholic University School of Medicine, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Keith A A Fox
- Centre for Cardiovascular Science, University and Royal Infirmary of Edinburgh, 51 Little France Cres, Edinburgh EH16 4SA, UK
| | - Ramzi A Ajjan
- Leeds Institute for Cardiovascular and Metabolic Medicine, the LIGHT Laboratories, University of Leeds, Leeds LS2?9JT, UK
| | - Felicita Andreotti
- Cardiovascular Department, Catholic University Hospital, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Colin Baigent
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford OX3 7LF, UK
| | - Jean-Philippe Collet
- Institute of Cardiology, Pitié-Salpêtrière Hospital (AP-HP), Sorbonne Université Paris 06 (UPMC), ACTION Study Group, INSERM UMR_S 1166, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Bd de l'hopital, 75013 Paris, France
| | - Erik L Grove
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus; Denmark
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ulleval and University of Oslo, P.O. Box 1171 Blindern, 0318 Oslo, Norway
| | - Kurt Huber
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Montleartstrasse 37, A-1160 Vienna and Sigmund Freud University, Medical School, Kelsenstrasse 2, A-1030 Vienna, Austria
| | - João Morais
- Division of Cardiology, Leiria Hospital Center, R. de Santo André, 2410-197 Leiria, Portugal
| | - Carlo Patrono
- Institute of Pharmacology, Catholic University School of Medicine, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Andrea Rubboli
- Division of Cardiology, Laboratory of Interventional Cardiology, Ospedale Maggiore, Largo Nigrisoli 2, 40133 Bologna, Italy
| | - Ingebjorg Seljeflot
- Department of Cardiology, Center for Clinical Heart Research, Oslo University Hospital Ullevål and University of Oslo, P.O. Box 1171 Blindern, 0318 Oslo, Norway
| | - Dirk Sibbing
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-Universität, Munich, Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Marchioninistrasse 15, 81377 Munich, Germany
| | - Agneta Siegbahn
- Department of Medical Sciences, Clinical Chemistry, Uppsala University, 751 85 Uppsala, Sweden
| | - Jurrien Ten Berg
- Department of Cardiology, St Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
| | - Gemma Vilahur
- Cardiovascular Science Institute-ICCC, IIB-Sant Pau, CiberCV, Hospital de Sant Pau, Avda. S. Antoni M. Claret 167, 08025 Barcelona, Spain
| | - Freek W A Verheugt
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis (OLVG), Oosterpark 9, 1091 AC Amsterdam, The Netherlands
| | - Lars Wallentin
- Department of Medical Sciences, Cardiology, Uppsala University & Uppsala Clinical Research Center, Uppsala Science Park, MTC, Dag Hammarskjölds väg 14B, SE-752 37 Uppsala, Sweden
| | - Thomas W Weiss
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Montleartstrasse 37, A-1160 Vienna and Sigmund Freud University, Medical School, Kelsenstrasse 2, A-1030 Vienna, Austria
| | - Johann Wojta
- Department of Internal Medicine II, Medical University Vienna, Vienna, Austria
- Core Facilities, Medical University Vienna, Vienna, Austria
- Ludwig Boltzmann Cluster for Cardiovascular Research, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Robert F Storey
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Beech Hill Road, Sheffield, South Yorkshire S10 2RX, UK
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Lv W, Li S, Zhao Z, Liao Y, Li Y, Chen M, Feng Y. Diabetes mellitus is an independent prognostic factor for mid-term and long-term survival following transcatheter aortic valve implantation: a systematic review and meta-analysis. Interact Cardiovasc Thorac Surg 2018. [PMID: 29528407 DOI: 10.1093/icvts/ivy040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Wenyu Lv
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Shuangjiang Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhengang Zhao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yanbiao Liao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yijian Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Feng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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Chacon MM, Cheruku SR, Neuburger PJ, Lester L, Shillcutt SK. Perioperative Care of the Obese Cardiac Surgical Patient. J Cardiothorac Vasc Anesth 2017; 32:1911-1921. [PMID: 29358013 DOI: 10.1053/j.jvca.2017.12.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Indexed: 02/06/2023]
Abstract
Morbid obesity is associated with impairment of cardiovascular, pulmonary, gastrointestinal, and renal physiology with significant perioperative consequences and has been linked with higher morbidity and mortality after cardiac surgery. Cardiac surgery patients have a higher incidence of difficult airway and difficult laryngoscopy than general surgery patients do, and obesity is associated with difficult mask ventilation and direct laryngoscopy. Positioning injuries occur more frequently because obese patients are at greater risk of pressure injury, such as rhabdomyolysis and compartment syndrome. Despite the association between obesity and several chronic disease states, the effects of obesity on perioperative outcomes are conflicting. Studies examining outcomes of overweight and obese patients in cardiac surgery have reported varying results. An "obesity paradox" has been described, in which the mortality for overweight and obese patients is lower compared with patients of normal weight. This review describes the physiologic abnormalities and clinical implications of obesity in cardiac surgery and summarizes recommendations for anesthesiologists to optimize perioperative care of the obese cardiac surgical patient.
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