RT Journal Article
T1 Impact of Morbid Obesity and Obesity Phenotype on Outcomes After Transcatheter Aortic Valve Replacement.
A1 McInerney, Angela
A1 Tirado-Conte, Gabriela
A1 Rodes-Cabau, Josep
A1 Campelo-Parada, Francisco
A1 Tafur Soto, Jose D
A1 Barbanti, Marco
A1 Muñoz-Garcia, Erika
A1 Arif, Mobeena
A1 Lopez, Diego
A1 Toggweiler, Stefan
A1 Veiga, Gabriela
A1 Pylko, Anna
A1 Sevilla, Teresa
A1 Compagnone, Miriam
A1 Regueiro, Ander
A1 Serra, Viçent
A1 Carnero, Manuel
A1 Oteo, Juan F
A1 Rivero, Fernando
A1 Barbosa Ribeiro, Henrique
A1 Guimaraes, Leonardo
A1 Matta, Anthony
A1 Giraldo Echavarria, Natalia
A1 Valvo, Roberto
A1 Moccetti, Federico
A1 Muñoz-Garcia, Antonio J
A1 Lopez-Pais, Javier
A1 Garcia Del Blanco, Bruno
A1 Campanha Borges, Diego Carter
A1 Dumont, Eric
A1 Gonzalo, Nieves
A1 Criscione, Enrico
A1 Dabrowski, Maciej
A1 Alfonso, Fernando
A1 de la Torre Hernández, Jose M
A1 Cheema, Asim N
A1 Amat-Santos, Ignacio J
A1 Saia, Francesco
A1 Escaned, Javier
A1 Nombela-Franco, Luis
K1 epicardial adipose tissue
K1 morbid obesity
K1 subcutaneous adipose tissue
K1 transcatheter aortic valve replacement
K1 visceral adipose tissue
AB Background 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. Methods and Results Consecutive patients who are MO (body mass index, ≥40 kg/m2, or ≥35 kg/m2 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/m2, 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). Conclusions 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.
YR 2021
FD 2021-05-31
LK http://hdl.handle.net/10668/17854
UL http://hdl.handle.net/10668/17854
LA en
DS RISalud
RD Apr 6, 2025