<h2 class="section-title u-h3 u-margin-l-top u-margin-xs-bottom">Abstract</h2> <div id="as0005"> <h3 class="u-h4 u-margin-m-top u-margin-xs-bottom" id="st0010">Background</h3> <p id="sp0070">Data is controversial regarding the existence of an “obesity paradox” in patients undergoing <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/percutaneous-aortic-valve-replacement" title="Learn more about Transcatheter Aortic Valve Replacement from ScienceDirect's AI-generated Topic Pages" class="topic-link">Transcatheter Aortic Valve Replacement</a><span> (TAVR). We sought to investigate the prognostic value of the <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/body-mass-index" title="Learn more about body mass index from ScienceDirect's AI-generated Topic Pages" class="topic-link">body mass index</a> (BMI) on outcomes following TAVR.</span></p> </div> <div id="as0010"> <h3 class="u-h4 u-margin-m-top u-margin-xs-bottom" id="st0015">Methods</h3> <p id="sp0075">This is an observational, single-center study involving all patients who underwent TAVR from 2009 to 2019. BMI was calculated in all patients before TAVR. The cohort was subdivided into four groups: underweight (<20 kg/m<sup>2</sup>), normal weight (≥20 to <25 kg/m<sup>2</sup>), overweight (≥25 to <30 kg/m<sup>2</sup>) and obese (≥30 kg/m<sup>2</sup>). The main endpoint was all-cause 30-day and one-year mortality.</p> </div> <div id="as0015"> <h3 class="u-h4 u-margin-m-top u-margin-xs-bottom" id="st0020">Results</h3> <p id="sp0080"><span>A total of 412 patients (mean age 79.6 ± 7.8 years, mean <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/society-of-thoracic-surgeons-score" title="Learn more about STS score from ScienceDirect's AI-generated Topic Pages" class="topic-link">STS score</a> 5.3 ± 3.6) were included. Patients were grouped as follows: underweight (</span><em>n</em> = 35, 8.5%), normal weight (<em>n</em> = 121, 29.4%), overweight (<em>n</em> = 140, 34%) and obese (<em>n</em><span> = 116, 28.1%). Obese patients were younger, included more females and had lower <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/society-of-thoracic-surgeons-score" title="Learn more about STS score from ScienceDirect's AI-generated Topic Pages" class="topic-link">STS score</a> than the rest of the cohort whereas underweight patients were older, had higher STS score, more <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/chronic-kidney-disease" title="Learn more about chronic kidney disease from ScienceDirect's AI-generated Topic Pages" class="topic-link">chronic kidney disease</a>, more <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/heart-left-ventricle-failure" title="Learn more about left ventricular dysfunction from ScienceDirect's AI-generated Topic Pages" class="topic-link">left ventricular dysfunction</a> and more often underwent non-transfemoral TAVR. BMI predicted 30-day survival (AUC:0.692 [95%CI 0.522–0.862]; </span><em>p</em><span> = 0.030) with an optimal cut-off of 24.4 (sensitivity = 66.6%, specificity = 63.6%). On <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/multivariate-analysis" title="Learn more about multivariate analysis from ScienceDirect's AI-generated Topic Pages" class="topic-link">multivariate analysis</a>, higher BMI trended toward lower 30-day mortality (HR = 0.87 [95%CI 0.75–1.01]; </span><em>p</em> = 0.071).</p> <p id="sp0085">Thirty-day mortality was higher in the underweight group (8.3%) in comparison with other BMI subgroups (normal weight 2.5%, overweight 1.4%, obese 0.9%; <em>p</em> = 0.045). However, no significant difference was found after adjustment of confounders (all p = NS). BMI did not predict one-year mortality. No significant difference in one-year survival was observed between the four BMI subgroups (log rank <em>p</em> = 0.925).</p> </div> <div id="as0020"> <h3 class="u-h4 u-margin-m-top u-margin-xs-bottom" id="st0025">Conclusion</h3> <p id="sp0090">BMI could represent an interesting prognostic tool for short-term mortality in patients undergoing TAVR. BMI < 20 kg/m<sup>2</sup> was associated with higher 30-day mortality. Symptoms improved similarly in obese patients compared to lower BMI patients. For 30-day survivors, no evidence of the existence of an obesity paradox was observed in this cohort.</p> </div>