Midterm Outcomes of Underweight Patients Undergoing Transcatheter Aortic Valve Implantation: Insight From the LAPLACE-TAVR Registry

Taiyo Tezuka; Ryosuke Higuchi; Kenichi Hagiya; Mike Saji; Itaru Takamisawa; Mamoru Nanasato; Nobuo Iguchi; Atsushi Shimizu; Jun Shimizu; Shinichiro Doi; Shinya Okazaki; Kei Sato; Harutoshi Tamura; Hiroaki Yokoyama; Takayuki Onishi; Tetsuya Tobaru; Shuichiro Takanashi; Morimasa Takayama

doi:10.1016/j.jacasi.2022.08.014

Midterm Outcomes of Underweight Patients Undergoing Transcatheter Aortic Valve Implantation: Insight From the LAPLACE-TAVR Registry

JACC Asia. 2022 Dec 13;3(1):78-89. doi: 10.1016/j.jacasi.2022.08.014. eCollection 2023 Feb.

Authors

Taiyo Tezuka¹, Ryosuke Higuchi¹, Kenichi Hagiya¹, Mike Saji¹, Itaru Takamisawa¹, Mamoru Nanasato¹, Nobuo Iguchi¹, Atsushi Shimizu², Jun Shimizu³, Shinichiro Doi⁴, Shinya Okazaki⁴, Kei Sato⁵, Harutoshi Tamura⁶, Hiroaki Yokoyama⁷, Takayuki Onishi⁸, Tetsuya Tobaru⁸, Shuichiro Takanashi^{2

9}, Morimasa Takayama¹

Affiliations

¹ Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
² Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
³ Department of Anesthesiology, Sakakibara Heart Institute, Tokyo, Japan.
⁴ Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
⁵ Department of Cardiology, Mie University Hospital, Mie, Japan.
⁶ Department of Cardiology, Pulmonology and Nephrology, Yamagata University Hospital, Yamagata, Japan.
⁷ Department of Cardiology, Hirosaki University Graduate School of Medicine, Aomori, Japan.
⁸ Department of Cardiology, Kawasaki Saiwai Hospital, Kanagawa, Japan.
⁹ Department of Cardiac Surgery, Kawasaki Saiwai Hospital, Kanagawa, Japan.

Abstract

Background: Obesity is a major risk factor for cardiovascular disease; however, a paradoxical effect of obesity has been reported in patients with heart failure or myocardial infarction. Although several studies have suggested the same obesity paradox in patients undergoing transcatheter aortic valve replacement (TAVR), they included a limited number of underweight patients.

Objectives: This study aimed to clarify the effect of being underweight on TAVR outcomes.

Methods: We retrospectively analyzed 1,693 consecutive patients undergoing TAVR between 2010 and 2020. The patients were categorized according to body mass index: underweight (<18.5 kg/m²; n = 242), normal weight (18.5 to 25 kg/m²; n = 1,055), and overweight (>25 kg/m²; n = 396). We compared midterm outcomes after TAVR among the 3 groups; all clinical events were in accordance with the Valve Academic Research Consortium-2 criteria.

Results: Underweight patients were more likely to be women and have severe heart failure symptoms, peripheral artery disease, anemia, hypoalbuminemia, and pulmonary dysfunction. They also had lower ejection fractions, smaller aortic valve areas, and higher surgical risk scores. Device failure, life-threatening bleeding, major vascular complications, and 30-day mortality occurred more frequently in underweight patients. The midterm survival rate of the underweight group was inferior to those of the other 2 groups (P < 0.0001; average follow-up, 717 days). In the multivariate analysis, underweight was associated with noncardiovascular mortality (HR: 1.78; 95% CI: 1.16-2.75) but not cardiovascular mortality (HR: 1.28; 95% CI: 0.58-1.88) after TAVR.

Conclusions: Underweight patients had a worse midterm prognosis, demonstrating the obesity paradox in this TAVR population. (Outcomes of transcatheter aortic valve implantation in Japanese patients with aortic stenosis: multi-center registry; UMIN000031133).

Keywords: AS, aortic stenosis; BMI, body mass index; CV, cardiovascular; TAVR, transcatheter aortic valve replacement; VARC, Valve Academic Research Consortium; body mass index; obesity paradox; transcatheter aortic valve replacement.