title: Prognostic value of body mass index and body surface area on clinical outcomes after transcatheter aortic valve implantation.
abstract: BACKGROUND
  Inverse associations between Body Mass Index (BMI) and Body Surface Area (BSA) with mortality in patients after Transcatheter Aortic Valve Implantation (TAVI) have been reported. This "obesity paradox" is controversial, and it remains unclear which parameter, BMI or BSA, is of greater prognostic value. The aim of this study was to investigate the association of BMI and BSA on short- and mid-term outcomes after TAVI.
  
  
  RESULTS
  This prospective, observational study consisted of 917 consecutive patients undergoing TAVI at our center from 2011 to 2014. The association between BMI/BSA and mortality (at 30 days and 1 year) was assessed using restricted cubic spline functions in propensity-adjusted (by Society of Thoracic Surgeons (STS) risk factors) logistic and Cox proportional models, respectively. The median age of the patients was 82.6 years, with a mean STS Predicted Risk of Mortality (STS-PROM) of 6.6 ± 4.3 %. Throughout the study period (mean follow-up time was 297 days), 150 (16.4 %) patients died; 72 (7.9 %) patients died within 30 days of TAVI. After risk adjustment, the association between body constitution and 30-day mortality was not significant for either measure (BMI p = 0.25; BSA p = 0.32). However, BMI (p = 0.01), but not BSA (p = 0.13), was significantly associated with 1-year survival. There was no association between stroke, vascular complications, or length of stay with BMI or BSA.
  
  
  CONCLUSIONS
  BMI was associated with survival at 1-year after TAVI. Despite the trend towards implementing BSA in risk score calculation, BMI may be more suitable for the assessment of TAVI patients.
authors.affiliation: Department of Cardiac Surgery, Heart Center, Kerckhoff-Klinik, Benekestrasse 2-8, 61231, 06032-9960, Bad Nauheim, Germany. m.arsalan@kerckhoff-klinik.de.
authors.forename: Mani
authors.identifier: http://orcid.org/0000-0001-5861-891X
authors.initials: M
authors.lastname: Arsalan
authors.affiliation: Department of Epidemiology, Baylor Scott and White Health, Dallas, TX, USA.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Filardo
authors.affiliation: Department of Cardiology, Heart Center, Kerckhoff-Klinik, Bad Nauheim, Germany.
authors.forename: Won-Keun
authors.initials: WK
authors.lastname: Kim
authors.affiliation: The Heart Hospital Baylor Plano, Plano, TX, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Squiers
authors.affiliation: Department of Epidemiology, Baylor Scott and White Health, Dallas, TX, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Pollock
authors.affiliation: Department of Cardiology, Heart Center, Kerckhoff-Klinik, Bad Nauheim, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Liebetrau
authors.affiliation: Department of Cardiology, Heart Center, Kerckhoff-Klinik, Bad Nauheim, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Blumenstein
authors.affiliation: Department of Cardiac Surgery, Heart Center, Kerckhoff-Klinik, Benekestrasse 2-8, 61231, 06032-9960, Bad Nauheim, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Kempfert
authors.affiliation: Department of Cardiac Surgery, Heart Center, Kerckhoff-Klinik, Benekestrasse 2-8, 61231, 06032-9960, Bad Nauheim, Germany.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Van Linden
authors.affiliation: Department of Cardiac Surgery, Heart Center, Kerckhoff-Klinik, Benekestrasse 2-8, 61231, 06032-9960, Bad Nauheim, Germany.
authors.forename: Annika
authors.initials: A
authors.lastname: Arsalan-Werner
authors.affiliation: Department of Cardiology, Heart Center, Kerckhoff-Klinik, Bad Nauheim, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Hamm
authors.affiliation: The Heart Hospital Baylor Plano, Plano, TX, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mack
authors.affiliation: Department of Cardiology, Heart Center, Kerckhoff-Klinik, Bad Nauheim, Germany.
authors.forename: Helge
authors.initials: H
authors.lastname: Moellmann
authors.affiliation: Department of Cardiac Surgery, Heart Center, Kerckhoff-Klinik, Benekestrasse 2-8, 61231, 06032-9960, Bad Nauheim, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Walther
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015992:Body Mass Index; D001830:Body Surface Area; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D009765:Obesity / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D057216:Propensity Score; D016016:Proportional Hazards Models; D011446:Prospective Studies; D065840:Protective Factors; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: BMI; BSA; Obese; TAVI; TAVR