Potential Confounders of the Obesity Paradox in Older Patients Following Transcatheter Aortic Valve Replacement

Overview

Journal Eur Geriatr Med

Specialty Geriatrics

Date 2023 Sep 3

PMID 37660344

Authors

Satoshi Higuchi

Hidenari Matsumoto

Ryota Masaki

Takaho Hirano

Shiori Fuse

Hiroki Tanisawa

Tomoaki Masuda

Yasuhide Mochizuki

Kazuto Maruta

Seita Kondo

Tadashi Omoto

Atsushi Aoki

Toshiro Shinke

Affiliations

Soon will be listed here.

Abstract

Purpose: A higher body mass index (BMI) is associated with lower mortality in older patients following transcatheter aortic valve replacement (TAVR) for severe aortic valve stenosis. The current study aimed to investigate potential confounders of association between BMI and prognosis.

Methods: The retrospective single-center study included consecutive patients following TAVR and excluded those in whom subcutaneous fat accumulation (SFA), visceral fat accumulation (VFA), and major psoas muscle (MPM) volume were not assessed by computed tomography. Cachexia was defined as a combination of BMI < 20 kg/m and any biochemical abnormalities.

Results: After 2 patients were excluded, 234 (age, 86 ± 5 years; male, 77 [33%]; BMI, 22.4 ± 3.8 kg/m; SFA, 109 (54-156) cm; VFA, 71 (35-115) cm; MPM, 202 (161-267) cm; cachexia, 49 [21%]) were evaluated. SFA and VFA were strongly correlated with BMI (ρ = 0.734 and ρ = 0.712, respectively), whereas MPM was weakly correlated (ρ = 0.346). Two-year all-cause mortality was observed in 31 patients (13%). Higher BMI was associated with lower mortality (adjusted hazard ratio [aHR], 0.86; 95% confidence interval [CI], 0.77-0.95). A similar result was observed in the multivariate model including SFA (aHR in an increase of 20 cm, 0.87; 95% CI, 0.77-0.98) instead of BMI, whereas VFA was not significant. Cachexia was a worse predictor (aHR, 2.51; 95% CI 1.11-5.65).

Conclusions: Association of higher BMI with lower mortality may be confounded by SFA in older patients following TAVR. Cachexia might reflect higher mortality in patients with lower BMI.

Citing Articles

Cachectic biomarkers as confounders behind the obesity paradox in patients with acute decompensated heart failure.

Miura Y, Higuchi S, Kohno T, Shiraishi Y, Kitamura M, Nagatomo Y Int J Obes (Lond). 2025; .

PMID: 39863776 DOI: 10.1038/s41366-025-01716-6.

Effect of Elevated Body Mass Index on Outcomes of Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis.

Yamashita Y, Baudo M, Sicouri S, Zafar M, Rodriguez R, Gnall E Anatol J Cardiol. 2024; .

PMID: 39373331 PMC: 11633792. DOI: 10.14744/AnatolJCardiol.2024.4637.

Impact of multiple comorbidities on long-term mortality in older patients following transcatheter aortic valve replacement.

Higuchi S, Matsumoto H, Masaki R, Kondo S, Mochizuki Y, Fuse S Heliyon. 2024; 10(17):e36724.

PMID: 39263118 PMC: 11387374. DOI: 10.1016/j.heliyon.2024.e36724.

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