The obesity paradox: association of obesity with improved survival in medically managed severe aortic stenosis
| Autor: | Hui Wen Sim, Tiong-Cheng Yeo, Nicholas Chew, William K.F. Kong, Benjamin Yong-Qiang Tan, Kian Keong Poh, Jinghao Nicholas Ngiam, Ching-Hui Sia |
|---|---|
| Rok vydání: | 2022 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Severity of Illness Index Ventricular Function Left Valve replacement Risk Factors Internal medicine medicine Humans Ventricular outflow tract Obesity Aged Retrospective Studies Aged 80 and over Heart Valve Prosthesis Implantation Ejection fraction business.industry Hazard ratio Stroke Volume Aortic Valve Stenosis General Medicine Middle Aged medicine.disease Stenosis Aortic Valve Heart failure Cardiology Original Article business Body mass index Obesity paradox |
| Zdroj: | Singapore Med J |
| ISSN: | 2737-5935 0037-5675 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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