Underweight is associated with inferior short and long-term outcomes after MitraClip implantation: Results from the German TRAnscatheter mitral valve interventions (TRAMI) registry.
Am Heart J
; 222: 73-82, 2020 04.
Article
in En
| MEDLINE
| ID: mdl-32018204
ABSTRACT
BACKGROUND:
Underweight and obesity represent classical risk factors for adverse outcome in patients treated for cardiovascular disease.AIMS:
The current analysis examines the impact of underweight, overweight and obesity on intra-hospital, short and long-term outcomes in patients treated by MitraClip therapy. METHODS ANDRESULTS:
From August 2010 until July 2013, 799 patients (age 75.3⯱â¯8.6 years, male gender 60.7%, median logistic EuroSCORE 20% [12; 31], functional mitral regurgitation (MR) 69.3%) were prospectively enrolled into the multicenter German Transcatheter Mitral Valve Interventions registry. Patients were stratified according to body mass index (BMI) into 4 groups BMI <20 kg/m2 (underweight), BMI 20.0 to <25.0 kg/m2 (normal weight, reference group), BMI 25.0 to <30.0 kg/m2 (overweight) and BMI ≥30 kg/m2 (obese). Significant increased rates of procedural failure, transfusion/bleeding, sepsis or multiorgan failure and low cardiac output failure were found for underweight patients only. Kaplan-Meier survival curves demonstrated inferior survival for underweight patients, but comparable outcomes for all other patients (global log rank test, Pâ¯<â¯.01). Multivariable Cox-regression analysis (adjusted for age, gender, creatinine ≥1.5 mg/dL, diabetes, left ventricular ejection fraction <30% and chronic obstructive pulmonary disease) confirmed underweight (as compared to normal weight) as an independent risk factor of death (hazard ratio [HR] 1.58, 95% confidence interval (CI) 1.01-2.46, Pâ¯=â¯.044) and overweight as protective against death (HR 0.71; 95%-CI 0.55-0.93; Pâ¯=â¯.011).CONCLUSIONS:
Compared to other weight groups, underweight patients undergoing MitraClip implantation are exposed to increased rates of procedural failure, bleeding and low cardiac output as well as increased short- and long-term mortality rates and should therefore be carefully discussed in the heart-team.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Postoperative Complications
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Thinness
/
Heart Valve Prosthesis
/
Cardiac Catheterization
/
Registries
/
Heart Valve Prosthesis Implantation
/
Mitral Valve Insufficiency
Type of study:
Diagnostic_studies
/
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Country/Region as subject:
Europa
Language:
En
Journal:
Am Heart J
Year:
2020
Type:
Article