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. 2020 Oct;22(10):1826-1836.
doi: 10.1002/ejhf.1752. Epub 2020 Feb 26.

Nutritional status in tricuspid regurgitation: implications of transcatheter repair

Christian Besler  1 , Matthias Unterhuber  1 , Karl-Philipp Rommel  1 , Elisabeth Unger  1 , Philipp Hartung  1 , Maximilian von Roeder  1 , Thilo Noack  2 , Markus Zachäus  3 , Ulrich Halm  3 , Michael Borger  2 , Steffen Desch  1 , Holger Thiele  1 , Philipp Lurz  1
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Nutritional status in tricuspid regurgitation: implications of transcatheter repair

Christian Besler et al. Eur J Heart Fail. 2020 Oct.

Abstract

Aims: To characterize the prevalence and clinical relevance of malnutrition in patients undergoing transcatheter tricuspid valve edge-to-edge repair (TTVR).

Methods and results: Overall, 86 consecutive patients (mean age 78 ± 7 years) with moderate-to-severe tricuspid regurgitation (TR) at prohibitive surgical risk were analysed. Mini Nutritional Assessment (MNA), quality of life assessment, 6-min walk test distance and laboratory analyses were performed before and 1 month after TTVR. A total of 43 patients (50%) underwent concomitant transcatheter mitral valve repair. According to MNA, 81 patients (94%) were malnourished or at risk of malnutrition before TTVR. Following TTVR, MNA improved in 64 patients (74%). As compared to patients without MNA improvement, patients with increased MNA score had greater reductions in TR [regurgitation volume -17.0 (interquartile range, IQR -25.0; -7.0) mL vs. -26.4 (IQR -40.3; -14.5) mL, P < 0.001] and inferior vena cava diameter. Only patients with increased MNA score displayed a decrease in N-terminal pro-brain natriuretic peptide levels [-320 (IQR -1294; 105) pg/mL vs. +708 (IQR -342; 2708) pg/mL, P = 0.009], improvements in cholinesterase levels (0.0 ± 11.9 μmoL/L vs. +10.9 ± 16.7 μmoL/L, P < 0.001) and renal function during follow-up. Beneficial effects on quality of life scores and 6-min walk test distance following TTVR were observed exclusively in patients with improvement in MNA. During a median follow-up of 6 months, patients with worsened MNA had an increased risk of death and rehospitalization for heart failure.

Conclusion: Nutritional impairment is common and of prognostic importance in patients undergoing TTVR. Hepatorenal function modestly improves after successful TTVR. Further study of extracardiac implications of TR-associated right heart failure is warranted to improve care in this vulnerable patient population.

Keywords: Liver function; Malnutrition; Renal function; Right heart failure; Transcatheter tricuspid valve edge-to-edge repair; Tricuspid regurgitation.

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