Clinical implications of Body Mass Index and sarcopenic obesity in patients with severe aortic stenosis

BACKGROUND: Aortic valve stenosis (AS) often coexists with various comorbidities and concurrent cardiovascular risk factors. However, the clinical impact of obesity, considering sarcopenia, remains unexplored in patients with severe symptomatic AS evaluated by a Heart Team. This study evaluates Body Mass Index (BMI)'s discriminative power and clinical implications regarding adverse clinical events in severe symptomatic AS patients assessed by a Heart Team, while considering sarcopenia. METHODS: This retrospective single-center cohort study included severe symptomatic AS patients evaluated by a Heart Team, analyzing baseline characteristics, anatomo-functional data, biochemical parameters, and adverse clinical events during a 2-year follow-up. The cohort was stratified by BMI and the presence of sarcopenia, determined using the validated SARC-F Questionnaire. RESULTS: The mean age of the study cohort (N.=278) was 83.25 +/- 6.88 years (51.1% female), with a median follow-up of 13.05 months (IQR 5.96-24.50). The AUC for the primary outcome related to BMI was 0.623 ([95% CI 0.543-0.704]; P=0.004), with the optimal BMI threshold at 24.95 kg/m(2). Patients with a BMI>24.95 kg/m(2) exhibited improved survival (HR 0.508 [95% CI 0.303-0.853]; P=0.010). Conditional dependence regarding the presence of sarcopenia was observed in the relationship between BMI and adverse clinical events (sarcopenic patients, P=0.015 vs. non-sarcopenic, P=0.618; Cochran-Mantel-Haenszel test P=0.171). CONCLUSIONS: Among severe symptomatic AS patients evaluated by a Heart Team, BMI predicts adverse clinical outcomes. Remarkably, normal-weight patients have higher mortality rates than obese patients. This association was only evident in the absence of sarcopenic obesity.