P1669Prognostic impact of computed tomography-derived abdominal fat area in patients undergoing transcatheter aortic valve implantation

Background: Obesity has previously been identified as an indicator of good prognosis in patients undergoing transcatheter aortic valve implantation (TAVI), which is known as the “obesity paradox”. Purpose: We aimed to investigate whether abdominal total fat area (TFA), visceral fat area (VFA), or subcutaneous fat area (SFA) can be a prognostic indicator for long-term clinical outcomes in patients undergoing TAVI. Methods: We retrospectively analyzed 100 consecutive patients who underwent TAVI at our institution from December 2013 to April 2017. TFA, VFA, and SFA were measured from routine pre-procedural computed tomography (CT) images. Patients were divided into two groups according to the median values of TFA, VFA, or SFA. The primary endpoint was the composite of all-cause death and re-hospitalization due to heart failure after TAVI. The secondary endpoint was all-cause death. Results: At a median follow up of 492 days, patients with higher SFA, compared with lower SFA, showed significantly lower incidence rates of the composite outcome and all-cause death (10.5% vs. 28.2%, p<0.01; 4.4% vs. 15.0%, p<0.05, respectively). However, patients with higher TFA or VFA did not show significant reduction in the composite outcome or all-cause death (TFA:18.0% vs. 21.4%, p=0.18; 9.9% vs. 10.2%, p=0.44, respectively. VFA: 19.8% vs. 19.4%, p=0.66; 12.9% vs. 6.9%, p=0.71, respectively). After adjustment for age and gender, higher SFA was independently associated with lower incidence of composite outcome (HR 0.32, 95% CI: 0.12 to 0.88; p=0.03).