The obesity paradox: An analysis of pre-procedure weight trajectory on survival outcomes in patients undergoing transcatheter aortic valve implantation. Issue 1 (January 2018) - De Palma, Rodney
Highlights: An obesity paradox of reduced mortality is observed in cardiovascular disorders including aortic stenosis. Weight loss or gain compared to stable weight before transcatheter valve replacement is associated with increased mortality. The obesity paradox may be confounded by weight trajectory. Summary: Introduction: Increased mortality has been observed in those with cardiovascular diseases who are of normal body mass index (BMI) compared to the overweight and the obese. A similar association has been demonstrated in patients undergoing transcatheter aortic valve (TAVI) implantation. However, it still remains unclear whether low or normal BMI itself is unfavourable or whether this is merely a reflection of cardiac cachexia due to severe aortic stenosis. The hypothesis for the study was that weight change prior to TAVI may be associated with increased mortality following the procedure. Subjects, materials and methods: Single centre retrospective analysis using the SWEDEHEART registry, national mortality statistics and local hospital database. Body mass index was used as the anthropomorphic measurement and patients grouped by WHO categories and weight change trajectory before and at TAVI. Kaplan–Meier survival was constructed and a Cox proportional hazard model used to evaluate predictors of outcome. Results: Consecutive data on 493 patients with three year follow-up between 2008–2015 were evaluated. Overweight and obese body mass index categories (BMI > 25) were associated with improved mortality compared to normal and underweight patients (BMI < 25) (log rank p = 0.02), hazard ratio of 0.68 (0.50–0.93). Weight loss trajectory was associated with increased mortality compared to stable weight (log rank p = 0.01), hazard ratio 1.64 p = 0.025. Conclusion: The pre-procedural weight trajectory of patients undergoing TAVI is an important predictor of clinical outcome after TAVI. Patients with stable weight trajectories are associated with improved mortality outcome compared to those with decreasing weight.