In BAV patients, overweight status was associated with the best 10-year survival, while normal weight and obesity raised mortality risk by 44% and 63%, respectively.
Does body mass index and left ventricular remodeling pattern affect 10-year all-cause mortality in adult patients with bicuspid aortic valve?
In adult patients with bicuspid aortic valve, there is a U-shaped association between BMI and 10-year mortality, with overweight patients demonstrating the most favorable survival.
Abstract Introduction The obesity paradox, i.e. higher body mass index (BMI) being associated with improved outcome, has never been examined in patients with bicuspid aortic valve (BAV). Purpose To explore the association between BMI and outcome and the possible influence of left ventricular (LV) remodeling in a large cohort of BAV patients. Methods From a multicentre registry adult patients diagnosed with BAV were included. Patients were stratified into normal weight (25 kg/m2), overweight (≥25 and 30 kg/m2), and obesity (≥30 kg/m2). Clinical and echocardiographic characteristics were collected, and LV hypertrophy was defined as a LV mass index of 115 g/m2 in males and 95 g/m2 in females. LV remodeling was then further classified as: (i) normal geometry (no LV hypertrophy and relative wall thickness RWT ≤0.42); (ii) concentric remodeling: no LV hypertrophy, RWT0.42; (iii) concentric hypertrophy: LV hypertrophy, RWT0.42; and (iv) eccentric hypertrophy: LV hypertrophy, RWT≤0.42. The primary outcome was 10-year all-cause mortality. Aortic valve replacement during follow up was coded as a time-dependent covariate. Results A total of 4533 patients (mean age 49±17 years, 29% female) were included. The normal weight, overweight, and obesity group had 1751, 1598, and 812 patients, respectively. These 3 groups showed significant clinical and echocardiographic differences (Figure 1). In particular, obese patients had the lowest prevalence of significant aortic regurgitation (overall P0.001), and the highest frequency of significant aortic stenosis (overall P=0.028). Also, LV remodeled significantly differently across the BMI spectrum (overall P0.001), where the obese patients demonstrated the lowest proportion of eccentric hypertrophy but the highest frequency of concentric remodeling. During a median follow up of 2019 (769, 3600) days, 349 events occurred. Overweight patients showed the best survival, demonstrated by the U-shaped restricted cubic spline curve (Figure 2). In the multivariable analysis adjusting for age, sex, comorbidities, LV ejection fraction, significant aortic valve disease, aortopathy, and surgery, both the BMI category (overweight as reference, normal weight: HR 1.44, 95%CI 1.04-2.00, P=0.027; obesity: HR 1.63, 95% CI 1.11-2.39, P=0.012) and LV remodeling patterns (concentric remodeling: HR 1.87, 95% CI 1.17-2.97, P=0.008; concentric hypertrophy: HR 1.77, 95% CI 1.15-2.73, P=0.009; eccentric hypertrophy: HR 1.04, 95% CI 0.62-1.73, P=0.89) were independently associated with 10-year mortality. Conclusions In BAV patients, BMI is associated with different extents of LV hypertrophy. Obese patients are more likely to present with concentric remodeling and less likely with eccentric hypertrophy. The association between BMI and mortality appeared to be "U-shaped", with overweight patients having the most favorable survival even after adjusting for important covariates.
He et al. (2025) studied this question. In BAV patients, overweight status was associated with the best 10-year survival, while normal weight and obesity raised mortality risk by 44% and 63%, respectively.