DOI: 10.1161/circ.148.suppl_1.13502 ISSN: 0009-7322

Abstract 13502: Obesity Paradox in Severe Rheumatic Mitral Stenosis: A Prospective Analysis Using a Machine Learning-Based Approach

Alexandre Negrao Pantaleao, Antonio Mutarelli, Thiago Petrilli Maffei Dardis, Guillaume GOUDOT, Renata Matheus Faccioli, Mauri Brandão de Medeiros Neto, Ghazal Sanadgol, Koushiar Moshe Yaghoubian, Eula Neves, Marina Marangoni Roschel, Maria C Nunes
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Background: The obesity paradox posits that obese patients have better prognosis in cardiovascular diseases. Scarce data exists on the obesity paradox in rheumatic mitral stenosis (RMS)

Hypothesis: Obesity is associated with a favorable prognosis in severe RMS

Methods: Patients with severe RMS referred to a tertiary center from 2011 to 2022 were prospectively included. Patients with previous valve interventions were excluded; clinical and echocardiographic data were collected at baseline. Severe RMS was defined as a mitral valve area ≤ 1.5 cm2 by planimetry and patients were divided into 2 groups: (1) BMI ≥ 30 kg/m 2 ; (2) BMI < 30 kg/m 2 . A combined outcome of percutaneous mitral valvuloplasty, mitral replacement and cardiovascular death was set. Logistic regression adjusted for confounders and gradient boosted decision-tree analysis were used

Results: A total of 315 patients (82.2% female, mean age 53.3 years) were included. Over a median follow up of 30 months, 87% of patients had the outcome. MVA was higher in group 1 (p<0.001) while left atrial volume index (LAVi) and net atrioventricular compliance were lower (p=0.008 both). Overall, BMI was not a good independent predictor of outcome (OR 0.98, 95% CI: 0.91-1.06, p=0.50) and occurrence of outcome was similar between groups (p=0.481). In both groups, mean importance of BMI in determining the outcome was similar (17.7 ± 6.1% and 17.0 ± 2.6% respectively)

Conclusion: Obese patients had higher MVA and lower LAVi. However, our data suggests that BMI was not a significant independent predictor of poorer prognosis and its importance was not different between the groups. These findings challenge the obesity paradox in severe RMS

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