Prognostic impact of being underweight in patients undergoing mitral TEER: The OCEAN‐Mitral registry

Abstract

AimsMitral transcatheter edge‐to‐edge repair (M‐TEER) is a valid treatment option for severe mitral regurgitation (MR), necessitating accurate risk stratification of M‐TEER candidates for effective patient selection, optimal periprocedural care and improved long‐term outcomes. The body mass index (BMI) is a simple and practical prognostic index, and the obesity paradox has been widely reported.Methods and ResultsBetween April 2018 and June 2021, 2149 patients undergoing M‐TEER were registered in the prospective multicentre registry and classified into three groups: underweight (BMI < 18.5 kg/m2), normal weight (18.5 ≦ BMI < 25 kg/m2) and overweight and obese (25 kg/m2 ≦ BMI). The impact of underweight on the all‐cause, cardiovascular and non‐cardiovascular mortality following M‐TEER was evaluated [follow‐up duration: 436 (363–733) days]. The participants (median BMI: 21.1 kg/m2) were categorized as underweight (n = 450, 20.9%), normal weight (n = 1409, 65.6%) and overweight and obese (n = 290, 13.5%). Compared with the other two groups, the underweight group exhibited several negative prognostic factors, including older age, frailty, no dyslipidaemia, hypoalbuminaemia, residual MR and non‐home discharge. Underweight patients had the highest rate of all‐cause, cardiovascular and non‐cardiovascular mortality, whereas those in the other two groups were similar. As per the multivariate analysis, underweight itself was associated with all‐cause mortality (hazard ratio: 1.52, 95% confidence interval: 1.17–1.97, P = 0.009) and cardiovascular mortality (hazard ratio: 1.45, 95% confidence interval: 1.04–2.01, P = 0.028).ConclusionsUnderweight patients had the highest mortality rate after M‐TEER. Comorbidities, residual MR, discharge disposition and underweight status were correlated with postprocedural outcome.