Impact of Morbid Obesity and Obesity Phenotype on Outcomes After Transcatheter Aortic Valve Replacement
McInerney, Angela (Instituto de Investigación Sanitaria del Hospital Clínico San Carlos)
Tirado-Conte, Gabriela (Instituto de Investigación Sanitaria del Hospital Clínico San Carlos)
Rodes-Cabau, Josep (Laval University)
Campelo-Parada, F (Rangueil University Hospital)
Tafur Soto, Jose D. (Ochsner Medical Center)
Barbanti, Marco (University of Catania)
Muñoz-Garcia, Erika (Hospital Universitario Virgen de la Victoria (Màlaga, Andalusia))
Arif, Mobeena (Toronto University. St. Michael's Hospital)
Lopez, Diego (Hospital Clínico Universitario (Santiago de Compostela, Galícia))
Toggweiler, Stefan (Luzerner Kantonsspital)
Veiga, Gabriela (Instituto de Investigación Sanitaria Valdecilla (Santander, Cantàbria))
Pylko, Anna (National Institute of Cardiology)
Sevilla Ruiz, Teresa (Hospital Clínico Universitario de Valladolid)
Compagnone, Miriam (University Hospital of Bologna)
Regueiro, Ander (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
Serra, Viçent (Hospital Universitari Vall d'Hebron)
Carnero, Manuel (Instituto de Investigación Sanitaria del Hospital Clínico San Carlos)
Oteo, Juan F. (Hospital Universitario Puerta de Hierro Majadahonda (Madrid))
Rivero, Fernando (Instituto de Investigación Hospital Universitario de la Princesa)
Barbosa Ribeiro, Henrique (Heart Institute (Instituto de Coraçāo))
Guimaraes, Leonardo (Laval University)
Matta, Anthony (Rangueil University Hospital)
Giraldo Echavarria, Natalia (Ochsner Medical Center)
Valvo, Roberto (University of Catania)
Moccetti, Federico (Luzerner Kantonsspital)
Muñoz-Garcia, Antonio J. (Hospital Universitario Virgen de la Victoria (Màlaga, Andalusia))
Lopez-Pais, Javier (Hospital Clínico Universitario (Santiago de Compostela, Galícia))
García del Blanco, Bruno (Hospital Universitari Vall d'Hebron)
Campanha Borges, Diego Carter (Heart Institute (Instituto de Coraçāo))
Dumont, Eric (Laval University. Quebec Heart and Lung Institute)
Gonzalo, Nieves (Instituto de Investigación Sanitaria del Hospital Clínico San Carlos)
Criscione, Enrico (University of Catania)
Dabrowski, Maciej (National Institute of Cardiology)
Alfonso, Fernando (Instituto de Investigación Hospital Universitario de la Princesa)
de la Torre Hernández, Jose M.. (Instituto de Investigación Sanitaria Valdecilla (Santander, Cantàbria))
Cheema, Asim N. (University of Toronto)
Amat-Santos, Ignacio J. (Hospital Clínico Universitario de Valladolid)
Saia, Francesco (University Hospital of Bologna)
Escaned, Javier (Instituto de Investigación Sanitaria del Hospital Clínico San Carlos)
Nombela-Franco, Luís (Instituto de Investigación Sanitaria del Hospital Clínico San Carlos)

Fecha:	2021
Resumen:	There is a paucity of outcome data on patients who are morbidly obese (MO) undergoing transcatheter aortic valve replacement. We aimed to determine their periprocedural and midterm outcomes and investigate the impact of obesity phenotype. Consecutive patients who are MO (body mass index, ≥40 kg/m 2, or ≥35 kg/m 2 with obesity-related comorbidities; n=910) with severe aortic stenosis who underwent transcatheter aortic valve replacement in 18 tertiary hospitals were compared with a nonobese cohort (body mass index, 18. 5-29. 9 kg/m 2, n=2264). Propensity-score matching resulted in 770 pairs. Pre-transcatheter aortic valve replacement computed tomography scans were centrally analyzed to assess adipose tissue distribution; epicardial, abdominal visceral and subcutaneous fat. Major vascular complications were more common (6. 6% versus 4. 3%; P =0. 043) and device success was less frequent (84. 4% versus 88. 1%; P =0. 038) in the MO group. Freedom from all-cause and cardiovascular mortality were similar at 2 years (79. 4 versus 80. 6%, P =0. 731; and 88. 7 versus 87. 4%, P =0. 699; MO and nonobese, respectively). Multivariable analysis identified baseline glomerular filtration rate and nontransfemoral access as independent predictors of 2-year mortality in the MO group. An adverse MO phenotype with an abdominal visceral adipose tissue:subcutaneous adipose tissue ratio ≥1 (VAT:SAT) was associated with increased 2-year all-cause (hazard ratio [HR], 3. 06; 95% CI, 1. 20-7. 77; P =0. 019) and cardiovascular (hazard ratio, 4. 11; 95% CI, 1. 06-15. 90; P =0. 041) mortality, and readmissions (HR, 1. 81; 95% CI, 1. 07-3. 07; P =0. 027). After multivariable analysis, a (VAT:SAT) ratio ≥1 remained a strong predictor of 2-year mortality (hazard ratio, 2. 78; P =0. 035). Transcatheter aortic valve replacement in patients who are MO has similar short- and midterm outcomes to nonobese patients, despite higher major vascular complications and lower device success. An abdominal VAT:SAT ratio ≥1 identifies an obesity phenotype at higher risk of adverse clinical outcomes.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Epicardial adipose tissue ; Morbid obesity ; Subcutaneous adipose tissue ; Transcatheter aortic valve replacement ; Visceral adipose tissue ; Catheter-Based Coronary and Valvular Interventions ; Obesity ; Valvular Heart Disease
Publicado en:	Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol. 10 (may 2021) , ISSN 2047-9980

DOI: 10.1161/JAHA.120.019051
PMID: 34056919

25 p, 1.8 MB

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