Impact of Malnutrition on Outcomes Following Transcatheter Aortic Valve Implantation (from a National Cohort)

Emami, Sara; Rudasill, Sarah; Bellamkonda, Nikhil; Sanaiha, Yas; Cale, Mario; Madrigal, Josef; Christian-Miller, Nathaniel; Benharash, Peyman

doi:10.1016/j.amjcard.2019.12.038

Cited by 13 publications

(14 citation statements)

References 24 publications

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“…Poor nutritional status has been shown to increase the risk of adverse outcomes after TAVR 5–9 . Analysis of more than 100,000 patients undergoing TAVR for severe AS found that malnutrition was an independent predictor of increased mortality (adjusted odds ratio [OR] 2.68, p < 0.001), complications (adjusted OR 2.09, p < 0.001) and 30‐day readmission (adjusted OR 1.34, p < 0.001) 7 . Assessment of patients' nutritional status might aid in pre‐procedural risk stratification and identify those who may benefit from nutritional interventions before or after an intervention.…”

Section: Discussionmentioning

confidence: 99%

“…Frailty is associated with worse outcomes in patients with severe AS, 24 and poor nutrition is an important contributor to frailty 25 . Poor nutritional status has been shown to increase the risk of adverse outcomes after TAVR 5–9 . Analysis of more than 100,000 patients undergoing TAVR for severe AS found that malnutrition was an independent predictor of increased mortality (adjusted odds ratio [OR] 2.68, p < 0.001), complications (adjusted OR 2.09, p < 0.001) and 30‐day readmission (adjusted OR 1.34, p < 0.001) 7 .…”

Section: Discussionmentioning

confidence: 99%

“…As a hallmark of frailty, malnutrition is common among elderly patients 1–5 and is a predictor of poor outcomes in patients with severe aortic stenosis (AS) 5–9 . Various methods have been used to evaluate the nutritional status of patients undergoing transcatheter aortic valve replacement (TAVR), although no single tool is considered standard in the routine clinical practice setting 5,10–15 …”

Section: Introductionmentioning

confidence: 99%

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Frailty in patients undergoing transcatheter aortic valve replacement: prognostic value of the Geriatric Nutritional Risk Index

Seoudy

Al‐Kassou

Shamekhi

et al. 2021

J cachexia sarcopenia muscle

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Background Malnutrition is a hallmark of frailty, is common among elderly patients, and is a predictor of poor outcomes in patients with severe symptomatic aortic stenosis (AS). The Geriatric Nutritional Risk Index (GNRI) is a simple and well‐established screening tool to predict the risk of morbidity and mortality in elderly patients. In this study, we evaluated whether GNRI may be used in the risk stratification and management of patients undergoing transcatheter aortic valve replacement (TAVR). Methods Patients with symptomatic severe AS (n = 953) who underwent transfemoral TAVR at the University Hospital Schleswig‐Holstein Kiel, Germany, between 2010 and 2019 (development cohort) were divided into two groups: normal GNRI ≥ 98 (no nutrition‐related risk; n = 618) versus low GNRI < 98 (at nutrition‐related risk; n = 335). The results were validated in an independent (validation) cohort from another high‐volume TAVR centre (n = 977). Results The low‐GNRI group had a higher proportion of female patients (59.1% vs. 52.1%), higher median age (82.9 vs. 81.8 years), prevalence of atrial fibrillation (50.4% vs. 40.0%), median logistic EuroSCORE (17.5% vs. 15.0%) and impaired left ventricular function (<35%: 10.7% vs. 6.8%), lower median estimated glomerular filtration rate (50 vs. 57 mL/min/1.73 m2) and median albumin level (3.5 vs. 4.0 g/dL) compared with the normal‐GNRI group. Among peri‐procedural complications, Acute Kidney Injury Network (AKIN) Stage 3 was more common in the low‐GNRI group (3.6% vs. 0.6%, p = 0.002). After a mean follow‐up of 21.1 months, all‐cause mortality was significantly increased in the low‐GNRI group compared with the normal‐GNRI group (p < 0.001). This was confirmed in the validation cohort (p < 0.001). Low GNRI < 98 was identified as an independent risk factor for all‐cause mortality (hazard ratio 1.44, 95% CI 1.01–2.04, p = 0.043). Other independent risk factors included albumin level < median of 4.0 g/dL, high‐sensitive troponin T in the highest quartile (> 45.0 pg/mL), N‐terminal pro‐B‐type natriuretic peptide in the highest quartile (> 3595 pg/mL), grade III–IV tricuspid regurgitation, pulmonary arterial hypertension, life‐threatening bleeding, AKIN Stage 3 and disabling stroke. Conclusions Low GNRI score was associated with an increased risk of all‐cause mortality in patients undergoing TAVR, implying that this vulnerable group may benefit from improved preventive measures.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Frailty in patients undergoing transcatheter aortic valve replacement: prognostic value of the Geriatric Nutritional Risk Index

Seoudy

Al‐Kassou

Shamekhi

et al. 2021

J cachexia sarcopenia muscle

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“…In fact, it could help to choose the best strategy for each patient, and in patients considered for TAVR it could help acknowledge the possibility of futility. Indeed, Emami et al [10] demonstrated that malnourished patients (defined according to Healthcare Cost and Utilization Project) undergoing TAVR experienced a higher rate of mortality (10.4% vs. 2.2%, p < 0.001); furthermore, the incidence of functional decline and poor outcomes at one year after was >50% in frail elderly. It has been demonstrated that one-year all-cause mortality occurred in the 27.7% of malnourished patients undergoing aortic valve replacement, in the 16.3% of patients at risk for malnutrition, and in the 9.7% of the well-nourished patients (p < 0.001) [6].…”

Section: Resultsmentioning

confidence: 99%

“…In recent years, several studies have investigated and validated different tools to assess malnutrition in patients affected by aortic stenosis (Table 2 shows the main results) [4][5][6][7][8][9][9][10][11][12]. Nutritional assessment of AS should be performed during hospitalization for any reason with the evidence of symptomatic AS or during outpatient cardiological visits.…”

Section: When How and Where To Assess Malnutritionmentioning

confidence: 99%

Tools for the Assessment of the Malnutrition Status and Possible Interventions in Elderly with Cardiovascular Diseases

Tonet

Campana

Caglioni

et al. 2021

JCM

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Malnutrition represents a common and important feature in elderly people affected by cardiovascular diseases. Several studies have investigated its prevalence and prognostic role in most clinical settings, including cardiovascular disease. However, in daily practice it usually remains unrecognized and consequently untreated. The present review was ideated to answer the main questions about nutritional status assessment in patients with cardiovascular disease: why, when, where, how to evaluate it, and what to do to improve it. The three main cardiovascular diseases, namely aortic stenosis, ischaemic heart disease, and heart failure were considered. First, the main evidence supporting the prognostic role of malnutrition are summarized and analyzed. Second, the main tools for the assessment of malnutrition in the hospital and outpatient setting are reported for each condition. Finally, the possible strategies and interventions to address malnutrition are discussed.

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Frailty, malnutrition, and the endocrine system impact outcome in patients undergoing aortic valve replacement

Al‐Kassou

Shamekhi

Weber

et al. 2021

Cathet Cardio Intervent

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Background: Frailty is a multidimensional syndrome that affects mortality after aortic valve replacement (AVR). Malnutrition is often associated with the development of frailty.However, data regarding the association of frailty with nutritional status and underlying endocrinological dysregulation in patients with severe aortic valve stenosis are limited.Objectives: We aimed to systematically screen for frailty and malnutrition, to evaluate for underlying endocrinological disorders and inflammation, and to assess the ability of these parameters to predict outcomes after AVR.Methods: Our study included 373 patients undergoing transcatheter and surgical AVR. Frailty was assessed using the Fried Frailty Phenotype (FFP), Essential Frailty Toolset, Lawton-Brody, and Katz Index. Malnutrition was measured using the Mini Nutritional Assessment (MNA-LF) and Controlling Nutritional Status. Outcomes of interest were 30-day and one-year mortality. Results:The prevalence of frailty ranged from 6.4% to 65.7% and malnutrition from 5.9% to 10.5%, depending on the evaluation tool. Both parameters were associated with higher levels of cortisol and parathormone as well as lower levels of IGF-1, testosterone, DHEAS, and c-reactive protein. Malnutrition was associated with increased 30-day mortality, and both frailty and malnutrition with increased oneyear mortality. In a multivariate analysis, malnutrition measured by the MNA-LF (OR: 2.32 [95%CI: 1.19-4.53], p = 0.01) and frailty as assessed by the FFP (OR:1.42 [95%CI: 1.02-1.96], p = 0.03) were independent predictors of one-year mortality.Baravan Al-Kassou and Jasmin Shamekhi are contributed equally to the manuscript

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Impact of Malnutrition on Outcomes Following Transcatheter Aortic Valve Implantation (from a National Cohort)

Cited by 13 publications

References 24 publications

Frailty in patients undergoing transcatheter aortic valve replacement: prognostic value of the Geriatric Nutritional Risk Index

Frailty in patients undergoing transcatheter aortic valve replacement: prognostic value of the Geriatric Nutritional Risk Index

Tools for the Assessment of the Malnutrition Status and Possible Interventions in Elderly with Cardiovascular Diseases

Frailty, malnutrition, and the endocrine system impact outcome in patients undergoing aortic valve replacement

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