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. 2022 Oct 4;11(19):e026294.
doi: 10.1161/JAHA.122.026294. Epub 2022 Sep 29.

Prevalence and Prognostic Significance of Malnutrition in Older Japanese Adults at High Surgical Risk Undergoing Transcatheter Aortic Valve Implantation

Kenichi Ishizu  1 , Shinichi Shirai  1 , Hiroaki Tashiro  1 , Kazuki Kitano  1 , Hiroyuki Tabata  1 , Miho Nakamura  1 , Toru Morofuji  1 , Naoto Murakami  1 , Takashi Morinaga  1 , Masaomi Hayashi  1 , Akihiro Isotani  1 , Yoshio Arai  2 , Nobuhisa Ohno  2 , Shinichi Kakumoto  3 , Kenji Ando  1
Affiliations

Prevalence and Prognostic Significance of Malnutrition in Older Japanese Adults at High Surgical Risk Undergoing Transcatheter Aortic Valve Implantation

Kenichi Ishizu et al. J Am Heart Assoc. .

Abstract

Background The usefulness of preprocedural nutritional status to stratify prognosis after transcatheter aortic valve implantation has been evaluated; however, the studies conducted so far have been relatively small and/or focused on a single nutritional index. This study sought to assess the prevalence and prognostic impact of malnutrition in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation. Methods and Results We applied the Controlling Nutritional Status score, Geriatric Nutritional Risk Index, and Prognostic Nutritional Index to 1040 consecutive older Japanese patients at high surgical risk who underwent transcatheter aortic valve implantation. According to the Controlling Nutritional Status score, Geriatric Nutritional Risk Index, and Prognostic Nutritional Index, 16.6%, 60.5%, and 13.8% patients had moderate or severe malnutrition, respectively; 89.3% were at least mildly malnourished by at least 1 score. Worse nutritional status was associated with older age, lower body mass index, higher degree of frailty, worse symptoms and renal function, atrial fibrillation, and anemia. During a median follow-up of 986 days (interquartile range, 556-1402 days), 273 (26.3%) patients died. Compared with normal nutrition, malnutrition was associated with an increased risk for all-cause death (adjusted hazard ratio for moderate and severe malnutrition, respectively: 2.19 (95% CI, 1.45-3.31; P<0.001) and 6.13 (95% CI, 2.75-13.70; P<0.001) for the Controlling Nutritional Status score, 2.02 (95% CI, 1.36-3.02; P=0.001) and 3.24 (95% CI, 1.86-5.65; P<0.001) for the Geriatric Nutritional Risk Index, and 1.60 (95% CI, 1.06-2.39; P=0.024) and 2.32 (95% CI, 1.50-3.60; P<0.001) for the Prognostic Nutritional Index). Conclusions Malnutrition is common in patients undergoing transcatheter aortic valve implantation and is associated with increased mortality.

Keywords: body mass index; frailty; nutrition assessment; nutritional status; prognosis; transcatheter aortic valve replacement.

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Figures

Figure 1
Figure 1. Study workflow.
The flowchart providing information about the included and excluded patients. TAVI indicates transcatheter aortic valve implantation.
Figure 2
Figure 2. Prevalence of malnutrition according to the 3 scoring indexes.
A, Formula and prevalence of malnutrition for each nutritional index. B, Venn diagrams demonstrating the frequency of malnutrition according to each nutritional index with the percentages of the total 1040 patients. The overlapping area shows the frequency with which the identification of malnutrition by an index overlaps with the others. CONUT indicates Controlling Nutritional Status; GNRI, Geriatric Nutritional Risk Index; and PNI, Prognostic Nutritional Index.
Figure 3
Figure 3. Causes of death after transcatheter aortic valve implantation.
The pie chart showing the distribution of diseases causing mortality during the follow‐up period. CVD indicates cardiovascular death.
Figure 4
Figure 4. Association between nutritional indexes and incidence rate of all‐cause mortality.
The incidence rate of all‐cause mortality is shown after adjustment for age, sex, body mass index, and Society of Thoracic Surgeons Predicted Risk of Mortality score for each nutritional index: (A) CONUT score, (B) GNRI, and (C) PNI. The right y‐axis shows the incidence rate (events per 100 person‐years). The x‐axis shows the score of malnutrition indexes. The blue curves show the incidence with 95% CIs of the estimates. Poisson models were used to estimate the incidence rates. Histograms show the population distribution of malnutrition indexes. CONUT indicates Controlling Nutritional Status; GNRI, Geriatric Nutritional Risk Index; and PNI, Prognostic Nutritional Index.
Figure 5
Figure 5. Malnutrition degrees and clinical outcomes.
Kaplan–Meier curves for (left) all‐cause mortality, (middle) cardiovascular mortality, and (right) heart failure hospitalization by the CONUT score, GNRI, and PNI. CONUT indicates Controlling Nutritional Status; GNRI, Geriatric Nutritional Risk Index; and PNI, Prognostic Nutritional Index.
Figure 6
Figure 6. Discrimination ability of each nutritional index for all‐cause mortality, cardiovascular mortality, and heart failure hospitalization.
Receiver operating characteristic curves with comparative analyses of the discrimination of each nutritional index for (A) all‐cause mortality, (B) cardiovascular mortality, and (C) heart failure hospitalization. CONUT indicates Controlling Nutritional Status; GNRI, Geriatric Nutritional Risk Index; NPV, negative predictive value; PNI, Prognostic Nutritional Index; and PPV, positive predictive value.
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