Greater mitral valve area in obese patients with rheumatic heart disease: a new evidence of obesity paradox ?

Type of funding sources: None.

 The existence of obesity paradox’s been proposed this past decade, suggesting obese individuals may have survival benefit when there"s acute cardiovascular decompensation or congestive heart failure. Adiponectin, a residual protein from fat, has a cardioprotective role against inflammation.

PURPOSE : In this study, we look at mitral valve stenosis (MS), an inflammatory result of rheumatic heart disease (RHD), to determine the relationship between BMI (body mass index) and degree of MS.

 A cross-sectional study was conducted over 463 medical records from RHD patients at a Heart Service Installation. Anthropometric and echocardiography results were taken and analysed statistically. Mitral valve area (MVA) was calculated using planimetry method and classified based on EAE/ASE guideline.

 Based on BMI criteria (WHO Asia Pacific), the underweight, normal, overweight, and obese percentage of all patients are 16.8%, 46.7%, 15.1%, and 21.4% respectively. Most patients have normal BMI in all stenosis degree. Categorically, the relationship between BMI and MS degree is insignificant (p > 0.05). Meanwhile, the median of MVA in the obese group shows the greatest (1.0 vs 0.79, 0.86, and 0.90 ; p value <0.05). A post-hoc analysis carried out and shows significant difference among MVA value in underweight to obese patients (p < 0.05) and also in normal to obese patients (p < 0.05)

 Significant relationship of MVA value in RHD patients according to BMI is noted with greater median of MVA in obese group. This may provide evidence of the obesity paradox in RHD patients with mitral stenosis.

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