Underweight is associated with inferior short and long-term outcomes after MitraClip implantation: Results from the German TRAnscatheter mitral valve interventions (TRAMI) registry
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Underweight is associated with inferior short and long-term outcomes after MitraClip implantation: Results from the German TRAnscatheter mitral valve interventions (TRAMI) registry. / Kalbacher, Daniel; Tigges, Eike; Boekstegers, Peter; Puls, Miriam; Plicht, Björn; Eggebrecht, Holger; Nickenig, Georg; Bardeleben, Ralph Stephan von; Zuern, Christine Stephanie; Franke, Jennifer; Sievert, Horst; Ouarrak, Taoufik; Senges, Jochen; Lubos, Edith.
In: AM HEART J, Vol. 222, 04.2020, p. 73-82.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Underweight is associated with inferior short and long-term outcomes after MitraClip implantation: Results from the German TRAnscatheter mitral valve interventions (TRAMI) registry
AU - Kalbacher, Daniel
AU - Tigges, Eike
AU - Boekstegers, Peter
AU - Puls, Miriam
AU - Plicht, Björn
AU - Eggebrecht, Holger
AU - Nickenig, Georg
AU - Bardeleben, Ralph Stephan von
AU - Zuern, Christine Stephanie
AU - Franke, Jennifer
AU - Sievert, Horst
AU - Ouarrak, Taoufik
AU - Senges, Jochen
AU - Lubos, Edith
N1 - Copyright © 2020 Elsevier Inc. All rights reserved.
PY - 2020/4
Y1 - 2020/4
N2 - 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 AND RESULTS: From August 2010 until July 2013, 799 patients (age 75.3 ± 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, P < .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, P = .044) and overweight as protective against death (HR: 0.71; 95%-CI: 0.55-0.93; P = .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.
AB - 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 AND RESULTS: From August 2010 until July 2013, 799 patients (age 75.3 ± 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, P < .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, P = .044) and overweight as protective against death (HR: 0.71; 95%-CI: 0.55-0.93; P = .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.
KW - Cardiac Catheterization/methods
KW - Echocardiography
KW - Follow-Up Studies
KW - Germany/epidemiology
KW - Heart Valve Prosthesis
KW - Heart Valve Prosthesis Implantation/methods
KW - Hospital Mortality/trends
KW - Incidence
KW - Mitral Valve/diagnostic imaging
KW - Mitral Valve Insufficiency/complications
KW - Postoperative Complications/epidemiology
KW - Registries
KW - Retrospective Studies
KW - Risk Factors
KW - Survival Rate/trends
KW - Thinness/complications
KW - Time Factors
KW - Treatment Outcome
U2 - 10.1016/j.ahj.2019.12.022
DO - 10.1016/j.ahj.2019.12.022
M3 - SCORING: Journal article
C2 - 32018204
VL - 222
SP - 73
EP - 82
JO - AM HEART J
JF - AM HEART J
SN - 0002-8703
ER -
