Prognostic Impact of Change in Nutritional Risk on Mortality and Heart Failure After Transcatheter Aortic Valve Replacement

González‐Ferreiro, Rocío; Otero, Diego López; Rodríguez, Leyre Álvarez; García, O. Otero; Poza, Marta Pérez; Antúnez-Muiños, Pablo; Cacho-Antonio, Carla; Pais, J Lopez; Juskowa, Mária; Álvarez, Ana Belén Cid; Nouche, Ramiro Trillo; Pena, Xoan Carlos Sanmartín; Fernández, Pedro; Cruz-González, Ignacio; González-Juanatey, José Ramón

doi:10.1161/circinterventions.120.009342

Cited by 11 publications

(6 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Recent studies reported that patients with improved malnutrition after TAVR had better survival rates than patients with remained malnourished [ 32 , 33 ]. Considering it, knowing a low TCBI before the procedure may allow for identifying patients for necessary nutritional intervention and improve outcomes.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2023

View full text Add to dashboard Cite

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

show abstract

Section: Discussionmentioning

confidence: 99%

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

et al. 2023

View full text Add to dashboard Cite

show abstract

“… 27 , 28 It has been recently reported that those patients who are malnourished undergoing transcatheter aortic valve replacement that improve their nutritional status after the intervention have better prognostic outcomes. 29 This fact may be seen as a signal for a potential target to improve outcomes both in aortic and mitral population, if the nutrition status can be optimized beforehand. Unfortunately, we did not assess nutritional status change after mitral repair, and this hypothesis is speculative.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Impact of Nutritional Status After Transcatheter Edge‐to‐Edge Mitral Valve Repair: The MIVNUT Registry

Caneiro‐Queija¹,

Raposeiras‐Roubín²,

Adamo

et al. 2022

JAHA

View full text Add to dashboard Cite

Background Malnutrition is associated with poor prognosis in several cardiovascular diseases. However, its prognostic impact in patients undergoing transcatheter edge‐to‐edge mitral valve repair (TEER) is not well known. This study sought to assess the prevalence, clinical associations, and prognostic consequences of malnutrition in patients undergoing TEER. Methods and Results A total of 892 patients undergoing TEER from the international MIVNUT (Mitral Valve Repair and Nutritional Status) registry were studied. Malnutrition status was assessed with the Controlling Nutritional Status score. The association of nutritional status with mortality was analyzed with multivariable Cox regression models, whereas the association with heart failure admission was assessed by Fine‐Gray models, with death as a competing risk. According to the Controlling Nutritional Status score, 74.4% of patients with TEER had any degree of malnutrition at the time of TEER (75.1% in patients with body mass index <25 kg/m 2 , 72.1% in those with body mass index ≥25 kg/m 2 ). However, only 20% had moderate–severe malnutrition. TEER was successful in most of patients (94.2%). During a median follow‐up of 1.6 years (interquartile range, 0.6–3.0), 267 (29.9%) patients died and 256 patients (28.7%) were admitted for heart failure after TEER. Compared with normal nutritional status moderate–severe malnutrition resulted a strong predictor of mortality (adjusted hazard ratio [HR], 2.1 [95% CI, 1.1–2.4]; P <0.001) and heart failure admission (adjusted subdistribution HR, 1.6 [95% CI, 1.1–2.4]; P =0.015). Conclusions Malnutrition is common among patients submitted to TEER, and moderate–severe malnutrition is strongly associated with increased mortality and heart failure readmission. Assessment of nutritional status in these patients may help to improve risk stratification.

show abstract

“…Furthermore, because of their interactions with the cardiovascular system, hepatorenal function and nutritional status do not remain static, and their postoperative assessment may thus inform the clinical course beyond that of baseline evaluation alone. Egbe et al 11 showed an association between temporal deterioration of hepatorenal function and transplant‐free survival in patients with Ebstein anomaly, while Gonzalez Ferreiro et al 28 found that patients remaining at nutritional risk after transcatheter aortic valve implantation exhibited an increased risk of mortality and HF hospitalization. Extending these findings, our study demonstrates that concomitant hepatorenal dysfunction and malnutrition persisted in a substantial proportion (15%) of patients undergoing valvular surgery.…”

Section: Discussionmentioning

confidence: 99%

Concomitant Hepatorenal Dysfunction and Malnutrition in Valvular Heart Surgery: Long‐Term Prognostic Implications for Death and Heart Failure

Tse

Chandramouli

et al. 2022

JAHA

View full text Add to dashboard Cite

Background Strategies to improve long‐term prediction of heart failure and death in valvular surgery are urgently needed because of an increasing number of procedures globally. This study sought to report the prevalence, changes, and prognostic implications of concomitant hepatorenal dysfunction and malnutrition in valvular surgery. Methods and Results In 909 patients undergoing valvular surgery, 3 groups were defined based on hepatorenal function (the modified model for end‐stage liver disease excluding international normalized ratio score) and nutritional status (Controlling Nutritional Status score): normal hepatorenal function and nutrition (normal), hepatorenal dysfunction or malnutrition alone (mild), and concomitant hepatorenal dysfunction and malnutrition (severe). Overall, 32%, 46%, and 19% of patients were classified into normal, mild, and severe groups, respectively. Over a 4.1‐year median follow‐up, mild and severe groups incurred a higher risk of mortality (hazard ratio [HR], 3.17 [95% CI, 1.40–7.17] and HR, 9.30 [95% CI, 4.09–21.16], respectively), cardiovascular death (subdistribution HR, 3.29 [95% CI, 1.14–9.52] and subdistribution HR, 9.29 [95% CI, 3.09–27.99]), heart failure hospitalization (subdistribution HR, 2.11 [95% CI, 1.25–3.55] and subdistribution HR, 3.55 [95% CI, 2.04–6.16]), and adverse outcomes (HR, 2.11 [95% CI, 1.25–3.55] and HR, 3.55 [95% CI, 2.04–6.16]). Modified model for end‐stage liver disease excluding international normalized ratio and controlling nutritional status scores improved the predictive ability of European System for Cardiac Operative Risk Evaluation (area under the curve: 0.80 versus 0.73, P <0.001) and Society of Thoracic Surgeons score (area under the curve: 0.79 versus 0.72, P =0.004) for all‐cause mortality. One year following surgery (n=707), patients with persistent concomitant hepatorenal dysfunction and malnutrition (severe) experienced worse outcomes than those without. Conclusions Concomitant hepatorenal dysfunction and malnutrition was frequent and strongly linked to heart failure and mortality in valvular surgery.

show abstract

Prognostic Impact of Change in Nutritional Risk on Mortality and Heart Failure After Transcatheter Aortic Valve Replacement

Cited by 11 publications

References 21 publications

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

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

Prognostic Impact of Nutritional Status After Transcatheter Edge‐to‐Edge Mitral Valve Repair: The MIVNUT Registry

Concomitant Hepatorenal Dysfunction and Malnutrition in Valvular Heart Surgery: Long‐Term Prognostic Implications for Death and Heart Failure

Contact Info

Product

Resources

About