Changes of body composition after valve surgery in patients with mitral valve disease

Abstract

BackgroundPatients with chronic heart failure have alteration in body composition as a reduction in fat mass, lean body mass and bone mass. However, body wasting in valvular heart disease and the impact of corrective valvular surgery on body composition has not been investigated.ObjectivesWe hypothesized that body wasting in severe mitral valve (MV) diseases is reversible through MV surgery.MethodsForty eight patients who were scheduled to undergo MV surgery were consecutively enrolled after excluding patients with combined valvular heart disease, ischemic heart disease, cardiomyopathies, and diseases or who were taking medications that could affect metabolism. All patients were subjected to simplified nutritional assessment questionnaire (SNAQ) for appetite, laboratory tests, echocardiography, and dual-energy X-ray absorptiometry (DXA) before and one year after MV surgery.ResultsOne year after MV surgery, the patients showed increased appetite and improved laboratory data as well as hemodynamic improvement.When we classified the patients according to the primary MV lesion, no changes in body weight were observed in both patients with mitral regurgitation (MR) and mitral stenosis (MS). However, significant increase in bone mineral density and body fat percentage were observed in patients with MR and not in patients with MS. In patients with MR, patients with Δfat ≥ 2% showed significantly higher pre-operative estimated right ventricular systolic pressure (eRVSP) level and greater decrease in eRVSP after surgery than those with Δfat < 2% and both ΔSNAQ and Δfat showed significant negative relationship with ΔeRVSP, respectively.ConclusionsIn patients with severe MV disease, corrective MV surgery led to favorable outcomes in wasting process as well as hemodynamic improvement. Particularly, right ventricular pressure overload showed a close association with the changes in appetite and body fat percentage in patients with MR.

Weight gain potential—a neglected entity during valve replacement

“…With proper weight maintenance, patient can overcome adverse effect of PPM and may have better hemodynamics, despite PPM. In 2018, Kim et al [23] from Korea 48 patients who underwent MV surgery using simplified nutritional assessment questionnaire for appetite laboratory tests, echocardiography, and dual-energy X-ray absorptiometry before and 1 year after MV surgery. They found that post MV surgery, all patients had increased appetite and improved laboratory data.…”

Screening for the Anorexia of Aging

“…In a study of 186 heart failure patients, both the CNAQ and SNAQ were shown to have construct validity and internal consistency validity (14). Additionally, a separate study of 48 patients undergoing mitral valve surgery concluded the SNAQ showed significant appetite improvement after one year of recovery from surgery (20). Another study of 99 patients undergoing aortic valve replacement found the SNAQ was able to detect those who were considered to be moderately malnourished (21).…”