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

Ryosuke Higuchi; Masaki Izumo; Yuki Izumi; Mike Saji; Mitsuaki Isobe; Yoshihiro Akashi; Masanori Yamamoto; Masahiko Asami; Yusuke Enta; Masaki Nakashima; Shinichi Shirai; Shingo Mizuno; Yusuke Watanabe; Makoto Amaki; Kazuhisa Kodama; Junichi Yamaguchi; Toru Naganuma; Hiroki Bota; Yohei Ohno; Masahiro Yamawaki; Hiroshi Ueno; Kazuki Mizutani; Shunsuke Kubo; Toshiaki Otsuka; Kentaro Hayashida; OCEAN‐Mitral Investigators

doi:10.1002/ehf2.15047

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

ESC Heart Fail. 2024 Sep 23. doi: 10.1002/ehf2.15047. Online ahead of print.

Authors

Ryosuke Higuchi^{1

2}, Masaki Izumo², Yuki Izumi¹, Mike Saji^{1

3}, Mitsuaki Isobe¹, Yoshihiro Akashi², Masanori Yamamoto^{4

5

6}, Masahiko Asami⁷, Yusuke Enta⁸, Masaki Nakashima⁸, Shinichi Shirai⁹, Shingo Mizuno¹⁰, Yusuke Watanabe¹¹, Makoto Amaki¹², Kazuhisa Kodama¹³, Junichi Yamaguchi¹⁴, Toru Naganuma¹⁵, Hiroki Bota¹⁶, Yohei Ohno¹⁷, Masahiro Yamawaki¹⁸, Hiroshi Ueno¹⁹, Kazuki Mizutani²⁰, Shunsuke Kubo²¹, Toshiaki Otsuka²², Kentaro Hayashida²³; OCEAN‐Mitral Investigators

Affiliations

¹ Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
² Division of Cardiology, St. Marianna University School of Medicine Hospital, Kawasaki, Japan.
³ Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
⁴ Department of Cardiology, Nagoya Heart Center, Nagoya, Japan.
⁵ Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan.
⁶ Division of Cardiology, Gifu Heart Center, Gifu, Japan.
⁷ Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan.
⁸ Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan.
⁹ Division of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan.
¹⁰ Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan.
¹¹ Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.
¹² Department of Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan.
¹³ Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan.
¹⁴ Department of Cardiology, Tokyo Woman's Medical University, Tokyo, Japan.
¹⁵ Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
¹⁶ Department of Cardiology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.
¹⁷ Deparment of Cardiology, Tokai University School of Medicine, Isehara, Japan.
¹⁸ Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan.
¹⁹ Second Department of Internal Medicine, Toyama University Hospital, Toyama, Japan.
²⁰ Division of Cardiology, Department of Medicine, Kindai University Faculty of Medicine, Osaka, Japan.
²¹ Department of Cardiology, Kurashiki Central Hospital, Okayama, Japan.
²² Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan.
²³ Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.

PMID: 39308333
DOI: 10.1002/ehf2.15047

Abstract

Aims: Mitral 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 results: Between 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).

Conclusions: Underweight patients had the highest mortality rate after M-TEER. Comorbidities, residual MR, discharge disposition and underweight status were correlated with postprocedural outcome.

Keywords: body mass index; obesity paradox; outcome; transcatheter edge‐to‐edge repair; underweight.

Abstract

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