Nutrition and mobility predict all-cause mortality in patients 12 months after transcatheter aortic valve implantation

Abstract

BackgroundThe aim of the study was to determine pre-interventional predictors for all-cause mortality in patients after transcatheter aortic valve implantation (TAVI) with a 12-month follow-up.MethodsFrom 10/2013 to 07/2015, 344 patients (80.9 ± 5.0 years, 44.5% male) with an elective TAVI were consecutively enrolled prospectively in a multicentre cohort study. Prior to the intervention, sociodemographic parameters, echocardiographic data and comorbidities were documented. All patients performed a 6-min walk test, Short Form 12 and a Frailty Index (score consisting of activities of daily living, cognition, nutrition and mobility). Peri-interventional complications were documented. Vital status was assessed over telephone 12 months after TAVI. Predictors for all-cause mortality were identified using a multivariate regression model.ResultsAt discharge, 333 patients were alive (in-hospital mortality 3.2%; n = 11). During a follow-up of 381.0 ± 41.9 days, 46 patients (13.8%) died. The non-survivors were older (82.3 ± 5.0 vs. 80.6 ± 5.1 years; p = 0.035), had a higher number of comorbidities (2.6 ± 1.3 vs. 2.1 ± 1.3; p = 0.026) and a lower left ventricular ejection fraction (51.0 ± 13.6 vs. 54.6 ± 10.6%; p = 0.048). Additionally, more suffered from diabetes mellitus (60.9 vs. 44.6%; p = 0.040). While the global Frailty Index had no predictive power, its individual components, particularly nutrition (OR 0.83 per 1 pt., CI 0.72–0.95; p = 0.006) and mobility (OR 5.12, CI 1.64–16.01; p = 0.005) had a prognostic impact. Likewise, diabetes mellitus (OR 2.18, CI 1.10–4.32; p = 0.026) and EuroSCORE (OR 1.21 per 5%, CI 1.07–1.36; p = 0.002) were associated with a higher risk of all-cause mortality.ConclusionsBesides EuroSCORE and diabetes mellitus, nutrition status and mobility of patients scheduled for TAVI offer prognostic information for 1-year all-cause mortality and should be advocated in the creation of contemporary TAVI risk scores.

Geriatric or cardiac rehabilitation? Predictors of treatment pathways in advanced age patients after transcatheter aortic valve implantation

“…Single components such as instrumental activities of daily living or mobility reveal strong prediction on their own for the referral to either geriatric or cardiac rehabilitation and thus for the characterization of this new patient group. This conforms to results of an own study where mobility and nutrition had a prognostic relevance for one-year allcause mortality in patients after TAVI [29].…”

Frailty and Exercise Training: How to Provide Best Care after Cardiac Surgery or Intervention for Elder Patients with Valvular Heart Disease

“…However, other authors have not confirmed the predictive value of this instrument and found that it only partly predicted unfavorable outcome after TAVI (nutrition and mobility) [ 41 ]. More studies with VHD patients and MGA should be done in order to receive higher level evidence, but its possibility of evaluating most of complex frailty syndrome components looks promising not only in screening but also in frailty dynamics after CR.…”

“…The results demonstrated that although all MFFC components were associated with increased risk of adverse outcomes, only albumin (<3.5 g/dL) was predictive of 30-day all-cause mortality [ 28 ]. Eichler et al focused on nutrition assessment but used another instrument, validated MNA scale [ 41 ]. Moreover, one of the components of the successful frailty risk score for the elderly undergoing aortic valve replacement (EFT) is low pre-procedural albumin level [ 24 ].…”

Nutritional risk index is a better predictor of early mortality than conventional nutritional markers after transcatheter aortic valve replacement: A prospective cohort study

“…Several nutritional tools have been used in TAVR to assess nutritional status such as grip strength, gait speed, bioimpedance analysis, or nutritional questionnaires (e.g. Mini Nutritional Assessment [MNA]) [24,25]. The main limitation of GNRI is that it is mainly based on albumin, a biochemical marker that can be affected by other co-morbidities, such as hepatic cirrhosis; moreover, inflammatory disorders are known to result in a catabolic state and a reduced liver synthesis of albumin.…”

“…Previous studies in TAVR have shown that some parameters besides the conventional risk scores (EuroSCORE II and STS score) offer prognostic information; that is diabetes mellitus, mobility and nutritional status measured with questionnaires [25]. Other studies have suggested adding baseline albumin levels to risk stratification factors before TAVR [4,27].…”