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

Autor: Miriam Compagnone, José M. de la Torre Hernández, Ander Regueiro, Diego Lopez, Manuel Carnero, Natalia Giraldo Echavarria, Stefan Toggweiler, Ignacio J. Amat-Santos, Fernando Alfonso, Juan Francisco Oteo, Marco Barbanti, Nieves Gonzalo, Enrico Criscione, Roberto Valvo, Francisco Campelo-Parada, Javier Escaned, Asim N. Cheema, Anthony Matta, Francesco Saia, Federico Moccetti, Javier López-Pais, Jose D. Tafur Soto, Diego Carter Campanha Borges, Gabriela Veiga, Angela McInerney, Josep Rodés-Cabau, Teresa Sevilla, Eric Dumont, Maciej Dabrowski, Gabriela Tirado-Conte, Viçent Serra, Antonio J. Muñoz-García, Henrique Barbosa Ribeiro, Anna Pylko, Fernando Rivero, Luis Nombela-Franco, Bruno García del Blanco, Mobeena Arif, Erika Muñoz-García, Leonardo Guimaraes
Přispěvatelé: Institut Català de la Salut, [McInerney A, Tirado-Conte G] Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain. [Rodes-Cabau J] Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada. [Campelo-Parada F] Cardiology Department, Rangueil University Hospital, Toulouse, France. [Tafur Soto JD] The Ochsner Clinical School, Ochsner Medical Center, New Orleans, LA. [Barbanti M] Ferrarotto Hospital, University of Catania, Catania, Italy. [Serra V, Garcia Del Blanco B] Vall d’Hebron Hospital Universitari, Barcelona, Spain, Vall d'Hebron Barcelona Hospital Campus
Rok vydání: 2021
Předmět:
Male
Obesitat mòrbida - Cirurgia
Time Factors
Obesity phenotype
medicine.medical_treatment
Adipose tissue
030204 cardiovascular system & hematology
Severity of Illness Index
Body Mass Index
Postoperative Complications
0302 clinical medicine
Valve replacement
Catheter-Based Coronary and Valvular Interventions
Risk Factors
030212 general & internal medicine
visceral adipose tissue
Original Research
Adiposity
Aged
80 and over
intervenciones quirúrgicas::procedimientos quirúrgicos cardiovasculares::procedimientos quirúrgicos cardíacos::implantación de prótesis valvulares cardíacas::sustitución valvular aórtica con catéter [TÉCNICAS Y EQUIPOS ANALÍTICOS
DIAGNÓSTICOS Y TERAPÉUTICOS]
epicardial adipose tissue
Obesity
Morbid
Europe
Phenotype
Treatment Outcome
Cardiology
Female
Outcome data
Cardiology and Cardiovascular Medicine
subcutaneous adipose tissue
medicine.medical_specialty
Transcatheter aortic
Subcutaneous Fat
Intra-Abdominal Fat
Morbidly obese
Risk Assessment
Transcatheter Aortic Valve Replacement
Morbid obesity
03 medical and health sciences
Internal medicine
medicine
Humans
Obesity
Nutritional and Metabolic Diseases::Nutrition Disorders::Overnutrition::Obesity::Obesity
Morbid [DISEASES]
enfermedades nutricionales y metabólicas::trastornos nutricionales::hipernutrición::obesidad::obesidad mórbida [ENFERMEDADES]
Aged
Retrospective Studies
business.industry
diagnóstico::pronóstico::resultado del tratamiento [TÉCNICAS Y EQUIPOS ANALÍTICOS
DIAGNÓSTICOS Y TERAPÉUTICOS]
Aortic Valve Stenosis
Diagnosis::Prognosis::Treatment Outcome [ANALYTICAL
DIAGNOSTIC AND THERAPEUTIC TECHNIQUES
AND EQUIPMENT]
United States
morbid obesity
Vàlvula aòrtica - Cirurgia
Valvular Heart Disease
Avaluació de resultats (Assistència sanitària)
Epicardial adipose tissue
Surgical Procedures
Operative::Cardiovascular Surgical Procedures::Cardiac Surgical Procedures::Heart Valve Prosthesis Implantation::Transcatheter Aortic Valve Replacement [ANALYTICAL
DIAGNOSTIC AND THERAPEUTIC TECHNIQUES
AND EQUIPMENT]
business
Zdroj: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
Dipòsit Digital de Documents de la UAB
Universitat Autònoma de Barcelona
Scientia
ISSN: 2047-9980
DOI: 10.1161/jaha.120.019051
Popis: 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/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). 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.
Databáze: OpenAIRE
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