BMI and Long-Term Mortality After TAVI

Long-term mortality rates were lower in patients undergoing transcatheter aortic valve implantation (TAVI) who were overweight vs obese or normal weight, according to a study published in The American Journal of Cardiology.

A total of 632 patients (mean age, 82.7±6.7 years; 46% women; average body mass index [BMI], 27.5±5.0 kg/m²; and median Society of Thoracic Surgeons-Predicted Risk of Mortality [STS-PROM] score, 3.6; interquartile range [IQR], 2.7-5.6) undergoing TAVI between 2008 and 2019 at 2 centers in Australia were enrolled. Access route to the aortic valve (subclavian, apical, femoral, or direct) was determined based on imaging that included echocardiograms conducted ahead the TAVI procedure. Patients were assessed for mortality and major adverse cardiovascular events at 30 days and annually thereafter. Normal weight was defined as BMI between 18.5 and 24.9 kg/m² (n=214), overweight as BMI between 25 and 29.9 kg/m² (n=234), and obese as BMI >30 kg/m² (n=185).

Patients who were overweight or obese vs normal weight tended to be younger (P <.001), have lower STS-PROM scores (P <.002), diabetes (P <.001), and chronic obstructive pulmonary disease (P =.009).

Patients who were normal weight vs overweight or obese on pre-procedural echocardiographs were more likely to have moderate to severe aortic regurgitation (P =.02) and smaller aortic valve area (P =.003). Patients who were overweight or obese vs normal weight on post-procedural echocardiographs had higher mean pressure gradients at 1- (P <.001) and 2- (P =.003) years after the TAVI procedure.

At 1- and 2-years, mortality was lowest among patients who were overweight compared with those who were normal weight (P =.03) or obese (P =.02). Long-term mortality was lowest in patients who were overweight (hazard ratio [HR], 0.56; 95% CI, 0.38-0.85; P =.006) compared with normal weight. Patients who were obese did not have significantly different risk for long-term mortality compared with those who had a normal weight (HR, 0.71; 95% CI, 0.46-1.08; P =.11).

Additional cofactors associated with long-term mortality were prior balloon aortic valvuloplasty (HR, 2.00; 95% CI, 1.38-2.91; P <.001), gender (HR, 1.68; 95% CI, 1.17-2.42; P =.005), STS-PROM score (HR, 1.07; 95% CI, 1.02-1.12; P =.006), age (HR, 1.03; 95% CI, 1.01-1.07; P =.009), and chronic obstructive pulmonary disease (HR, 1.50; 95% CI, 1.01-2.24; P =.04).

Study limitations include an overwhelmingly White cohort.

“[These results add] to the developing weight of evidence relating to improved outcomes in overweight and obese patients in numerous aspects of cardiovascular medicine and suggests clinicians need to remain open-minded to the impact of BMI given its traditional association with increased cardiovascular risk,” noted the study authors.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Quine E J, Dagan M, William J, et al. Long-term outcomes stratified by body mass index in patients undergoing transcatheter aortic valve implantation.J Pediatr. 2020;S0022-3476(20)31244-0. doi:10.1016/j.jpeds.2020.09.052