Background

Obesity and underweight represent classical risk factors for outcome in patients treated for cardiovascular disease. The current study describes the impact of different body mass index (BMI) categories on 1-year clinical outcome in patients with tricuspid regurgitation (TR) undergoing transcatheter-edge-to-edge repair (TEER).

Methods

We analyzed 211 consecutive patients (age 78.3 ± 7.2 years, gender female 55.5%, median EuroSCORE II 8.0 ± 6.7) with tricuspid regurgitation undergoing TEER from June 2015 until May 2021. Patients were prospectively enrolled in our single center registry and were prospectively analyzed. 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), BMI 25.0 to >30.0 kg/m² (overweight) and BMI ≥30 kg/m² (obese).

Kaplan Meier-survival curves demonstrated inferior survival for underweight and obese patients, but comparable outcomes for all other patients (global log rank test, p < 0.01). There were comparable rates of procedural failure, bleeding, stroke and myocardial infarction. Multivariable Cox regression analysis (adjusted for age, gender, coronary artery disease, chronic obstructive pulmonary disease, tricuspid annular plane systolic excursion, left-ventricular ejection fraction) confirmed underweight (HR 3.97; 95%-CI: 1.70-9.28; p < 0.01) and obesity (HR 2.76; 95%-CI: 1.17-6.49; p = 0.02) as independent risk factors for 1 year mortality.

Conclusions

Compared to normal and overweight patients, obesity and underweight patients undergoing TEER are exposed to significant higher 1-year all-cause mortality and should therefore be carefully discussed before procedure.