Long-Term Outcomes Stratified by Body Mass Index in Patients Undergoing Transcatheter Aortic Valve Implantation

Quine, E.; Dagan, M.; William, J.; Nanayakkara, Shane; Dawson, L.; Duffy, Stephen J.; Stehli, Julia; Dick, Ron; Htun, N.; Walton, Antony

doi:10.1016/j.amjcard.2020.09.039

Cited by 14 publications

(8 citation statements)

References 21 publications

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“…Despite the relatively small number of patients, our TAVI cohort appears representative of the general TAVI population, since the overall 1‐year survival rate among patients undergoing TAVI in this study was 82%, which is similar to those reported by others. 4 , 50 Accordingly, besides circulating musclin, univariate predictors of adverse outcome in our study cohort were frailty, 28 , 29 COPD, 35 preprocedural absence of AR, 33 , 34 and EuroSCORE II, 8 which were also reported by previous studies. However, some limitations of our study need to be emphasized.…”

Section: Discussionsupporting

confidence: 87%

“…In addition, diabetes, insulin therapy, and body mass index were included in a second multiple Cox regression analysis (model 2 with an effect size of 0.109), as musclin has been implicated as a putative target for obesity and associated diseases. 14 , 24 To assess the predictive capacity of musclin in terms of 1‐year cumulative survival, the following variables were included as possible confounders: previous percutaneous coronary intervention, 25 , 26 EuroSCORE II, 8 left ventricular dysfunction, 27 frailty, 28 , 29 atrial fibrillation, 30 NTproBNP, 31 high‐sensitivity troponin T, 32 absence of preexisting AR, 33 , 34 chronic obstructive pulmonary disease, 35 arterial hypertension, peripheral artery disease, 36 albumin level, 37 age, sex, 38 , 39 body mass index, 40 , 41 diabetes, 24 , 42 and insulin therapy 43 . For exploratory purposes, we further estimated improved risk stratification by log‐rank test for linear trend to compare survival curves based on dichotomized circulating musclin and clinical risk: (1) higher musclin level (≥2.862 ng/mL) and low clinical risk (EuroSCORE II <4%); (2) higher musclin level (≥2.862 ng/mL) and intermediate EuroSCORE II; (3) lower musclin level (<2.862 ng/mL) and low EuroSCORE II; and (4) lower musclin level (<2.862 ng/mL) and intermediate EuroSCORE II.…”

Section: Methodsmentioning

confidence: 99%

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Low Circulating Musclin is Associated With Adverse Prognosis in Patients Undergoing Transcatheter Aortic Valve Implantation at Low‐Intermediate Risk

Kattih

Carstens

Boeckling

et al. 2022

JAHA

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Background Musclin is an activity‐stimulated and cardioprotective myokine that attenuates pathological cardiac remodeling. Musclin deficiency, in turn, results in reduced physical endurance. The aim of this study was to assess the prognostic value of circulating musclin as a novel, putative biomarker to identify patients undergoing transcatheter aortic valve implantation (TAVI) who are at a higher risk of death. Methods and Results In this study, we measured systemic musclin levels in 368 patients undergoing TAVI who were at low to intermediate clinical risk (median EuroSCORE [European System for Cardiac Operative Risk Evaluation] II: 3.5; quartile 1–quartile, 2.2%–5.3%), whereby 209 (56.8%) patients were at low and 159 (43.2%) were at intermediate risk. Median preprocedural musclin levels were 2.7 ng/mL (quartile 1–quartile 3, 1.5–4.6 ng/mL). Musclin levels were dichotomized in low (<2.862 ng/mL, n=199 [54.1%]) or high (≥ 2.862 ng/mL, n=169 [45.9%]) groups using cutoff values determined by classification and regression tree analysis. The primary end point was 1‐year overall survival. Patients with low circulating musclin levels exhibited a significantly higher prevalence of frailty, low albumin values, hypertension, and history of stroke as well as higher N‐terminal pro‐B‐type natriuretic peptide. Low musclin levels significantly predicted risk of death in univariable (hazard ratio, 1.81; 95% CI, 1.00–3.53 [ P =0.049]) and multivariable (adjusted hazard ratio, 2.45; 95% CI, 1.06–5.69 [ P =0.037]) Cox regression analyses. Additionally, low musclin levels in combination with conventional EuroSCORE II suggested improved risk stratification in patients undergoing TAVI who were at low to intermediate clinical risk into subgroups with reduced 1‐year survival rates by log‐rank test ( P for trend=0.003). Conclusions Circulating musclin is an independent predictor of 1‐year overall survival in patients undergoing TAVI. Combined with EuroSCORE II, circulating musclin might help to improve prediction of mortality in patients undergoing TAVI who are at low to intermediate clinical risk.

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Section: Discussionsupporting

confidence: 87%

Section: Methodsmentioning

confidence: 99%

Low Circulating Musclin is Associated With Adverse Prognosis in Patients Undergoing Transcatheter Aortic Valve Implantation at Low‐Intermediate Risk

Kattih

Carstens

Boeckling

et al. 2022

JAHA

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“…There were 22 studies 92–113 (178,002 participants) with cardiovascular populations (Table S3): 7 cohorts in Europe, 6 in North America, 5 in East Asia, 2 were international cohorts, and 1 each West Asia and the Pacific. Mean age of participants ranged from 37 to 83 years.…”

Section: Resultsmentioning

confidence: 99%

Associations between body mass index and all‐cause mortality: A systematic review and meta‐analysis

2023

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SummaryFasting insulin and c‐reactive protein confound the association between mortality and body mass index. An increase in fat mass may mediate the associations between hyperinsulinemia, hyperinflammation, and mortality. The objective of this study was to describe the “average” associations between body mass index and the risk of mortality and to explore how adjusting for fasting insulin and markers of inflammation might modify the association of BMI with mortality. MEDLINE and EMBASE were searched for studies published in 2020. Studies with adult participants where BMI and vital status was assessed were included. BMI was required to be categorized into groups or parametrized as non‐first order polynomials or splines. All‐cause mortality was regressed against mean BMI squared within seven broad clinical populations. Study was modeled as a random intercept. β coefficients and 95% confidence intervals are reported along with estimates of mortality risk by BMIs of 20, 30, and 40 kg/m2. Bubble plots with regression lines are drawn, showing the associations between mortality and BMI. Splines results were summarized. There were 154 included studies with 6,685,979 participants. Only five (3.2%) studies adjusted for a marker of inflammation, and no studies adjusted for fasting insulin. There were significant associations between higher BMIs and lower mortality risk in cardiovascular (unadjusted β −0.829 [95% CI −1.313, −0.345] and adjusted β −0.746 [95% CI −1.471, −0.021]), Covid‐19 (unadjusted β −0.333 [95% CI −0.650, −0.015]), critically ill (adjusted β −0.550 [95% CI −1.091, −0.010]), and surgical (unadjusted β −0.415 [95% CI −0.824, −0.006]) populations. The associations for general, cancer, and non‐communicable disease populations were not significant. Heterogeneity was very large (I2 ≥ 97%). The role of obesity as a driver of excess mortality should be critically re‐examined, in parallel with increased efforts to determine the harms of hyperinsulinemia and chronic inflammation.

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“…1,11,15,21,25,27,29,40,41,43,48,50 The previous literature regarding the obesity paradox has focused primarily on CABG and TAVR. 1,9,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] The literature regarding valve surgery and the obesity paradox has grown in recent years. This systematic review of the relevant literature has demonstrated several important points.…”

Section: Postoperative Complicationsmentioning

confidence: 99%

“…To date, numerous studies have demonstrated the obesity paradox in postoperative outcomes after cardiac surgery, although most have focused predominantly on coronary artery bypass grafting (CABG) and transcatheter aortic valve replacement (TAVR). 1,9,11,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Surgical valve repair and replacement have been less prominently explored with respect to the influence of obesity on postoperative outcomes. Herein, we look to compile and review the data published to date investigating the impact of obesity on surgical and transcatheter valve repair and replacement.…”

Section: Introductionmentioning

confidence: 99%

Heart valve surgery and the obesity paradox: A systematic review

et al. 2021

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Obesity has been associated with increased incidence of comorbidities and shorter life expectancy, and it has generally been assumed that patients with obesity should have inferior outcomes after surgery. Previous literature has often demonstrated equivalent or even improved rates of mortality after cardiac surgery when compared to their lower-weight counterparts, coined the obesity paradox. Herein, we aim to review the literature investigating the impact of obesity on surgical valve interventions. PubMed and Embase were systematically searched for articles published from

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Long-Term Outcomes Stratified by Body Mass Index in Patients Undergoing Transcatheter Aortic Valve Implantation

Cited by 14 publications

References 21 publications

Low Circulating Musclin is Associated With Adverse Prognosis in Patients Undergoing Transcatheter Aortic Valve Implantation at Low‐Intermediate Risk

Low Circulating Musclin is Associated With Adverse Prognosis in Patients Undergoing Transcatheter Aortic Valve Implantation at Low‐Intermediate Risk

Associations between body mass index and all‐cause mortality: A systematic review and meta‐analysis

Heart valve surgery and the obesity paradox: A systematic review

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