TCT-385 Prognostic Impact of Nutritional Status After Transcatheter Edge-to-Edge Mitral Valve Repair: The MIVNUT Registry

Caneiro‐Queija, Berenice; Roubín, Sergio Raposeiras; Adamo, Marianna; Freixa, Xavier; Arzamendi, Dabit; Pascual, Isaac; Franco, Luis Nombela; Hernández, Antonio Portolés; Godino, Cosmo; Romo, Andrés Íñiguez; Estévez‐Loureiro, Rodrigo

doi:10.1016/j.jacc.2021.09.1238

Cited by 5 publications

(7 citation statements)

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“…22 Specifically in patients undergoing TEER, it has been found in the MIVNUT registry of 892 patients that 20% of patients had moderate-severe malnutrition and this comorbidity was associated with both mortality and HFH. 23 Despite albumin's role in regulating osmotic pressure and intravascular volume, HFHs have not been uniformly associated with low albumin levels, consistent with our findings. 7,19,20 However, multiple studies have shown that hypoalbuminaemia in patients with HF is associated with both short-term and long-term mortality.…”

Section: Discussionsupporting

confidence: 90%

Association between serum albumin and outcomes in heart failure and secondary mitral regurgitation: the COAPT trial

Feng

Ambrosy

Zhou

et al. 2023

European J of Heart Fail

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Aims Low serum albumin levels are associated with poor prognosis in numerous chronic disease states but the relationship between albumin and outcomes in patients with heart failure (HF) and secondary mitral regurgitation (SMR) has not been described. Methods and results The randomized COAPT trial evaluated the safety and effectiveness of transcatheter edge‐to‐edge repair (TEER) with the MitraClipTM plus guideline‐directed medical therapy (GDMT) versus GDMT alone in patients with symptomatic HF and moderate‐to‐severe or severe SMR. Baseline serum albumin levels were measured at enrolment. Among 614 patients enrolled in COAPT, 559 (91.0%) had available baseline serum albumin levels (median 4.0 g/dl, interquartile range 3.7–4.2 g/dl). Patients with albumin <4.0 g/dl compared with ≥4.0 g/dl were older and more likely to have ischaemic cardiomyopathy and a hospitalization within the year prior to enrolment. After multivariable adjustment, patients with albumin <4.0 g/dl had higher 4‐year rates of all‐cause death (63.7% vs. 47.6%; adjusted hazard ratio 1.34, 95% confidence interval 1.02–1.74; p = 0.032), but there were no significant differences in HF hospitalizations (HFH) or all‐cause hospitalizations according to baseline serum albumin level. The relative effectiveness of TEER plus GDMT versus GDMT alone was consistent in patients with low and high albumin levels (pinteraction = 0.19 and 0.35 for death and HFH, respectively). Conclusion Low baseline serum albumin levels were independently associated with reduced 4‐year survival in patients with HF and severe SMR enrolled in the COAPT trial, but not with HFH. Patients treated with TEER derived similarly robust reductions in both death and HFH regardless of baseline albumin level.

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Section: Discussionsupporting

confidence: 90%

Association between serum albumin and outcomes in heart failure and secondary mitral regurgitation: the COAPT trial

Feng

Ambrosy

Zhou

et al. 2023

European J of Heart Fail

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“…The CONUT score was originally designed to predict "acute worsening" in surgical patients and subsequently adapted for chronic HF, which may affect its applicability in patients undergoing TEER using the MitraClip procedure. 28 In other studies, 11,26 the association between the CONUT score at the time of hospitalization and adverse outcomes was reported in patients with acute decompensated HF, and the CONUT score on admission expressed a malignant cycle in patients with HF, whereby HF caused malnutrition through fluid retention and malnutrition, leading to inflammation and neurohormonal activation. Recently, Kalbacher et al reported that being underweight (body mass index <20 kg/m 2 ) was associated with procedural failure, bleeding, and transfusion in hospital deaths after MitraClip implantation.…”

Section: Predictors Of All-cause Deathmentioning

confidence: 87%

“…We consider that these underlying mechanisms were closely linked to not only nutrition status but also acute exacerbation of HF due to severe MR; it has been hypothesized that the preprocedural CONUT score, and a complex of immune conditions, metabolism, and protein profile are associated with adverse outcomes for patients undergoing TEER using with the MitraClip. 28 In this study, 4 patients were excluded because of the morphology of their mitral valve made MitraClip implantation unfeasible or impossible according to the EVEREST criteria. In such high-risk cases, death may occur from complications 1.…”

Section: Discussionmentioning

confidence: 99%

Preprocedural Controlling Nutritional Status Score as a Predictor of Mortality in Patients Undergoing Transcatheter Mitral Valve Repair　― A Single Center Experience in Japan ―

Noda,

Doi,

Kuwata

et al. 2023

Circ Rep

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with heart failure (HF), mortality rates remain high, and could be related to altered intestinal function caused by malnutrition in HF patients, 10,11 which is considered a source of inflammation. 12-14 The controlling nutritional status (CONUT) score is a risk evaluation tool for assessing nutritional status, 15-18 and a high CONUT score is associated with adverse outcomes in patients with chronic HF. 18,19 However, for patients in whom the MitraClip yields mechanical improvement of MR, little is known about the association between nutritional status and death. Transcatheter edge-to-edge mitral valve repair (TEER) with the MitraClip TM (Abbott Vascular, Santa Clara, CA, USA) System (Abbott Vascular) has become the first-line interventional treatment for patients with severe functional mitral regurgitation (MR) after optimal medical therapy, 1-6 and MitraScore, 7-9 as a prediction tool for death in patients undergoing TEER, was recently reported as opposed to the EuroSCORE II and Society of Thoracic Surgeons score. Despite recent developments in medical and surgical therapy for patients

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“…It was developed using backward stepwise regression analysis based on data from 1109 patients enrolled in the international MIVNUT registry, a European and Canadian registry investigating the correlation between nutritional status and prognosis in TEER patients. 23 Interestingly, despite the reported correlation of post-operative residual MR with worse prognosis in TEER patients, 24,25 this score, developed for TEER patients, does not include a parameter regarding MR. This might be explained by the high procedural success rate of 94.2% for TEER in the development cohort, which diminished the prognostic effect of MR in most patients.…”

Section: Applicability Of Mitrascore For Transcatheter Edge-to-edge R...mentioning

confidence: 99%

“…This might be explained by the high procedural success rate of 94.2% for TEER in the development cohort, which diminished the prognostic effect of MR in most patients. 23 Once MR is resolved, it is not surprising that TEER patients share common comorbidities and risk factors because those receiving TEER are elderly, sick, and have more comorbidities, all of which also characterize HF patients. Indeed, HF risk factors were reportedly useful in patients undergoing TEER.…”

Section: Applicability Of Mitrascore For Transcatheter Edge-to-edge R...mentioning

confidence: 99%

Prognostic impact of MitraScore in elderly Asian patients with heart failure: sub‐analysis of FRAGILE‐HF

Kaneko,

Kagiyama,

Kasai

et al. 2024

ESC Heart Failure

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AimsMitraScore is a novel, simple, and manually calculatable risk score developed as a prognostic model for patients undergoing transcatheter edge‐to‐edge repair (TEER) for mitral regurgitation. As its components are considered prognostic in heart failure (HF), we aimed to investigate the usefulness of the MitraScore in HF patients.Methods and resultsWe calculated MitraScore for 1100 elderly patients (>65 years old) hospitalized for HF in the prospective multicentre FRAGILE‐HF study and compared its prognostic ability with other simple risk scores. The primary endpoint was all‐cause deaths, and the secondary endpoints were the composite of all‐cause deaths and HF rehospitalization and cardiovascular deaths. Overall, the mean age of 1100 patients was 80 ± 8 years, and 58% were men. The mean MitraScore was 3.2 ± 1.4, with a median of 3 (interquartile range: 2–4). A total of 326 (29.6%), 571 (51.9%), and 203 (18.5%) patients were classified into low‐, moderate‐, and high‐risk groups based on the MitraScore, respectively. During a follow‐up of 2 years, 226 all‐cause deaths, 478 composite endpoints, and 183 cardiovascular deaths were observed. MitraScore successfully stratified patients for all endpoints in the Kaplan–Meier analysis (P < 0.001 for all). In multivariate analyses, MitraScore was significantly associated with all endpoints after covariate adjustments [adjusted hazard ratio (HR) (95% confidence interval): 1.22 (1.10–1.36), P < 0.001 for all‐cause deaths; adjusted HR 1.17 (1.09–1.26), P < 0.001 for combined endpoints; and adjusted HR 1.24 (1.10–1.39), P < 0.001 for cardiovascular deaths]. The Hosmer–Lemeshow plot showed good calibration for all endpoints. The net reclassification improvement (NRI) analyses revealed that the MitraScore performed significantly better than other manually calculatable risk scores of HF: the GWTG‐HF risk score, the BIOSTAT compact model, the AHEAD score, the AHEAD‐U score, and the HANBAH score for all‐cause and cardiovascular deaths, with respective continuous NRIs of 0.20, 0.22, 0.39, 0.39, and 0.29 for all‐cause mortality (all P‐values < 0.01) and 0.20, 0.22, 0.42, 0.40, and 0.29 for cardiovascular mortality (all P‐values < 0.02).ConclusionsMitraScore developed for patients undergoing TEER also showed strong discriminative power in HF patients. MitraScore was superior to other manually calculable simple risk scores and might be a good choice for risk assessment in clinical practice for patients receiving TEER and those with HF.

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TCT-385 Prognostic Impact of Nutritional Status After Transcatheter Edge-to-Edge Mitral Valve Repair: The MIVNUT Registry

Cited by 5 publications

References 0 publications

Association between serum albumin and outcomes in heart failure and secondary mitral regurgitation: the COAPT trial

Association between serum albumin and outcomes in heart failure and secondary mitral regurgitation: the COAPT trial

Preprocedural Controlling Nutritional Status Score as a Predictor of Mortality in Patients Undergoing Transcatheter Mitral Valve Repair　― A Single Center Experience in Japan ―

Prognostic impact of MitraScore in elderly Asian patients with heart failure: sub‐analysis of FRAGILE‐HF

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TCT-385 Prognostic Impact of Nutritional Status After Transcatheter Edge-to-Edge Mitral Valve Repair: The MIVNUT Registry

Cited by 5 publications

References 0 publications

Association between serum albumin and outcomes in heart failure and secondary mitral regurgitation: the COAPT trial

Association between serum albumin and outcomes in heart failure and secondary mitral regurgitation: the COAPT trial

Preprocedural Controlling Nutritional Status Score as a Predictor of Mortality in Patients Undergoing Transcatheter Mitral Valve Repair ― A Single Center Experience in Japan ―

Prognostic impact of MitraScore in elderly Asian patients with heart failure: sub‐analysis of FRAGILE‐HF

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Preprocedural Controlling Nutritional Status Score as a Predictor of Mortality in Patients Undergoing Transcatheter Mitral Valve Repair　― A Single Center Experience in Japan ―