A Meta-Analysis on the Impact of High BMI in Patients Undergoing Transcatheter Aortic Valve Replacement

Jiyoung Seo, Weijia Li, Israel Safiriyu, Amrin Kharawala, Sanjana Nagraj, Arooj Tahir, Ioannis Doundoulakis, Leonidas Koliastasis, Saul Rios, Leonidas Palaiodimos, Damianos G Kokkinidis, Jiyoung Seo, Weijia Li, Israel Safiriyu, Amrin Kharawala, Sanjana Nagraj, Arooj Tahir, Ioannis Doundoulakis, Leonidas Koliastasis, Saul Rios, Leonidas Palaiodimos, Damianos G Kokkinidis

Abstract

Background: A paradoxical association of obesity with lower risk of transcatheter aortic valve replacement (TAVR) outcomes has been reported. We aimed to systematically review the literature and compare TAVR-related morbidity and mortality among individuals with overweight or obesity and their peers with normal body mass index (BMI).

Methods: PubMed and Embase databases were systematically searched for studies reporting TAVR outcomes in different BMI groups. Separate meta-analyses were conducted for studies reporting hazard ratios (HR) and odds ratios/relative risks. Short- and mid-/long-term outcomes were examined.

Results: 26 studies with a total of 74,163 patients were included in our study. Overweight was associated with lower risk of short-term mortality (HR: 0.77; 95% CI: 0.60-0.98) and mid-/long-term mortality (HR: 0.79; 95% CI: 0.70-0.89). Obesity was associated with lower risk for mid-/long-term mortality (HR: 0.79; 95% CI: 0.73-0.86), but no difference was observed in short-term mortality, although a trend was noted (HR: 0.87l 95% CI: 0.74-1.01). Individuals with obesity demonstrated an association with higher odds of major vascular complications (OR: 1.33; 95% CI: 1.05-1.68). Both overweight (OR: 1.16; 95% CI: 1.03-1.30) and obesity (OR: 1.26; 95% CI: 1.06-1.50) were associated with higher likelihood for receiving permanent pacemakers after TAVR.

Conclusion: Individuals with overweight and obesity were associated with lower mortality risk compared to those with normal BMI but with higher likelihood of major vascular complications and permanent pacemaker implantation after TAVR.

Keywords: high body mass index; obesity paradox; transcatheter aortic valve replacement.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram of the study selection process.
Figure 2
Figure 2
Short-term (30-day) mortality after TAVR among different BMI categories. (A) Normal BMI vs. Overweight. (B) Normal BMI vs. Obesity. (C), Normal BMI vs. Overweight. (D) Normal BMI vs. Obesity. HR: hazard ratio; Nl: normal BMI; OW: overweight; OB: obesity; OR: odds ratio [7,9,10,12,23,24,26,30,31,34,37,40,41,42,43].
Figure 3
Figure 3
Long-term mortality after TAVR among different BMI categories. (A) Normal BMI vs. Overweight. (B) Normal BMI vs. Obesity. (C) Normal BMI vs. Overweight. (D) Normal BMI vs. Obesity. HR: hazard ratio; Nl: normal BMI; OW: overweight; OB: obesity; OR: odds ratio [9,12,23,24,26,27,29,31,34,35,37,39,40,41,43].
Figure 4
Figure 4
Complication rates after TAVR between normal BMI and overweight categories. (A) Major bleeding. (B) Major vascular complications. (C) Cerebrovascular events. (D) Myocardial infarction. (E) Acute kidney injury. (F) Permanent pacemaker insertion. (G) Atrial fibrillation. Nl: normal BMI; OW: overweight; OB: obesity; OR: odds ratio [7,9,12,22,23,24,25,26,29,31,32,34,35,36,37,42,43].
Figure 5
Figure 5
Complication rates after TAVR between normal BMI and obesity categories. (A) Major bleeding. (B) Major vascular complications. (C) Cerebrovascular events. (D) Myocardial infarction. (E) Acute kidney injury. (F) Permanent pacemaker insertion. (G) Atrial fibrillation. Nl: normal BMI; OW: overweight; OB: obesity; OR: odds ratio [9,10,12,23,24,25,26,29,30,31,32,34,35,36,37,42,43].

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