A simply calculated nutritional index provides clinical implications in patients undergoing transcatheter aortic valve replacement

Abstract

Background Malnutrition is associated with adverse outcomes in patients with aortic stenosis. The Triglycerides × Total Cholesterol × Body Weight Index (TCBI) is a simple scoring model to evaluate the status of nutrition. However, the prognostic relevance of this index in patients undergoing transcatheter aortic valve replacement (TAVR) is unknown. This study aimed to evaluate the association of the TCBI with clinical outcomes in patients undergoing TAVR. Methods A total of 1377 patients undergoing TAVR were evaluated in this study. The TCBI was calculated by the formula; triglyceride (mg/dL) × total cholesterol (mg/dL) × body weight (kg)/1000. The primary outcome was all-cause mortality within 3 years. Results Patients with a low TCBI, based on a cut-off value of 985.3, were more likely to have elevated right atrial pressure (p = 0.04), elevated right ventricular pressure (p < 0.01), right ventricular systolic dysfunction (p < 0.01), tricuspid regurgitation ≥ moderate (p < 0.01). Patients with a low TCBI had a higher cumulative 3-year all-cause (42.3% vs. 31.6%, p < 0.01; adjusted HR 1.36, 95% CI 1.05–1.77, p = 0.02) and non-cardiovascular mortality (15.5% vs. 9.1%, p < 0.01; adjusted HR 1.95, 95% CI 1.22–3.13, p < 0.01) compared to those with a high TCBI. Adding a low TCBI to EuroSCORE II improved the predictive value for 3-year all-cause mortality (net reclassification improvement, 0.179, p < 0.01; integrated discrimination improvement, 0.005, p = 0.01). Conclusion Patients with a low TCBI were more likely to have right-sided heart overload and exhibited an increased risk of 3-year mortality. The TCBI may provide additional information for risk stratification in patients undergoing TAVR. Graphical abstract

Association Between TCBI (Triglycerides, Total Cholesterol, and Body Weight Index) and Stroke-Associated Pneumonia in Acute Ischemic Stroke Patients

“…16 Recent studies indicate that TCBI could serve as a significant prognostic nutrition-related marker in critically ill cardiac patients needing mechanical circulatory support, experiencing acute decompensated heart failure, suffering from acute myocardial infarction, or undergoing transcatheter aortic valve replacement. 17,18,25,26 Figure 3 Association of TCBI with risk of stroke-associated pneumonia. Odds ratios and 95% confidence intervals derived from restricted cubic spline regression, with knots placed at the 5th, 35th, 65th, and 95th percentiles of the distribution of Log TCBI.…”

“… 16 Recent studies indicate that TCBI could serve as a significant prognostic nutrition-related marker in critically ill cardiac patients needing mechanical circulatory support, experiencing acute decompensated heart failure, suffering from acute myocardial infarction, or undergoing transcatheter aortic valve replacement. 17 , 18 , 25 , 26 …”

A Novel Score to Predict One-Year Mortality after Transcatheter Aortic Valve Replacement, Naples Prognostic Score

“…Approximately 68% of patients were on statins, which was significantly higher in the low-TCBI group. The authors concluded that the association between TCBI and all-cause mortality remained consistent regardless of statin use [ 27 ].…”

Clinical implication of the Naples prognostic score on transcatheter aortic valve replacement in patients with severe aortic stenosis

“…Recently, several investigators have reported that malnutrition is a predictor of worse outcomes in patients with severe AS undergoing surgical aortic valve replacement 14,22 . Likewise, Sudo et al have recently shown that patients with low nutritional status were more likely to have right‐sided heart overload and exhibited an increased risk of 3‐year mortality 23 . A recent meta‐analysis indicated that malnutrition was associated with a higher risk of 1‐year all‐cause mortality, and baseline malnutrition, as assessed by objective indices, is associated with worse outcomes after TAVR 24 …”

“…14,22 Likewise, Sudo et al have recently shown that patients with low nutritional status were more likely to have right-sided heart overload and exhibited an increased risk of 3-year mortality. 23 A recent meta-analysis indicated that malnutrition was associated with a higher risk of 1-year all-cause mortality, and baseline malnutrition, as assessed by objective indices, is associated with worse outcomes after TAVR. 24 One of the most up-to-date scoring systems for malnutrition is the NPS which consists of serum albumin, total cholesterol level, LMR, and NLR parameters.…”