Low body mass index and risk of mortality after mitral transcatheter edge‐to‐edge repair procedure: The “obesity paradox”

Background Most patients undergoing the mitral transcatheter edge‐to‐edge repair (TEER) technique are elderly comorbid patients. Low body mass index (BMI) < 23 kg/m 2 has been identified in other elderly populations as a risk factor, but has not been studied sufficiently in mitral TEER. Aims We aimed to study the impact of low BMI (23 kg/m2) on the outcome after mitral TEER. Methods Patients undergoing first‐time TEER for mitral regurgitation at a single tertiary center were included, with the exclusion of patients with preprocedural hemodynamic instability or missing BMI. The primary endpoint was all‐cause mortality. Secondary endpoints were long‐term major bleeding or admission with heart failure. Results A total of 120 patients (mean age 76 ± 10 years, 76% men) were included in the study. Thirty‐nine (31%) had low BMI. Patients with low BMI had a similar symptomatic benefit as patients with BMI ≥ 23 kg/m 2 at 1 year regarding decrease in diuretics dose and decrease in New York Heart Association (NYHA) class ( p > 0.05). In a multivariable Cox regression analysis, BMI as a continuous variable (hazard ratio [HR]: 0.93 [95% confidence interval, CI: 0.87–0.99], p = 0.03) and low BMI (HR: 1.99 [95% CI: 1.12–3.52], p = 0.02) were associated with the primary outcome. Low BMI was not significantly associated with major bleeding (subdistribution hazard ratio [SHR]: 2.39 [95% CI: 0.96–5.97], p = 0.06) or admission with heart failure (SHR: 1.06 [95% CI: 0.61–1.88], p = 0.83) during follow‐up with univariable competing risk regression analysis. Conclusion Low BMI is a risk factor for mortality after mitral valve TEER, confirming the presence of an “obesity paradox” in this population and should receive attention in patient selection.