Prognostic Impact of Change in Nutritional Risk on Mortality and Heart Failure After Transcatheter Aortic Valve Replacement.

Autor:	González Ferreiro R; Cardiology Department, University Hospital of Salamanca, Institute for Biomedical Research of Salamanca (IBSAL), University of Salamanca, and CIBERCV, Spain (R.G.F., P.L.S.F., I.C.-G.).; Cardiology Department, University Hospital Complex of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), and CIBERCV, Spain (R.G.F., D.L.O., L.A.R., O.O.G., M.P.P., P.J.A.M., C.C.A., J.L.P., M.J., A.B.C.A., R.T.N., X.C.S.P., J.R.G.J.)., López Otero D; Cardiology Department, University Hospital Complex of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), and CIBERCV, Spain (R.G.F., D.L.O., L.A.R., O.O.G., M.P.P., P.J.A.M., C.C.A., J.L.P., M.J., A.B.C.A., R.T.N., X.C.S.P., J.R.G.J.)., Álvarez Rodríguez L; Cardiology Department, University Hospital Complex of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), and CIBERCV, Spain (R.G.F., D.L.O., L.A.R., O.O.G., M.P.P., P.J.A.M., C.C.A., J.L.P., M.J., A.B.C.A., R.T.N., X.C.S.P., J.R.G.J.)., Otero García Ó; Cardiology Department, University Hospital Complex of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), and CIBERCV, Spain (R.G.F., D.L.O., L.A.R., O.O.G., M.P.P., P.J.A.M., C.C.A., J.L.P., M.J., A.B.C.A., R.T.N., X.C.S.P., J.R.G.J.)., Pérez Poza M; Cardiology Department, University Hospital Complex of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), and CIBERCV, Spain (R.G.F., D.L.O., L.A.R., O.O.G., M.P.P., P.J.A.M., C.C.A., J.L.P., M.J., A.B.C.A., R.T.N., X.C.S.P., J.R.G.J.)., Antúnez Muiños PJ; Cardiology Department, University Hospital Complex of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), and CIBERCV, Spain (R.G.F., D.L.O., L.A.R., O.O.G., M.P.P., P.J.A.M., C.C.A., J.L.P., M.J., A.B.C.A., R.T.N., X.C.S.P., J.R.G.J.)., Cacho Antonio C; Cardiology Department, University Hospital Complex of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), and CIBERCV, Spain (R.G.F., D.L.O., L.A.R., O.O.G., M.P.P., P.J.A.M., C.C.A., J.L.P., M.J., A.B.C.A., R.T.N., X.C.S.P., J.R.G.J.)., López Pais J; Cardiology Department, University Hospital Complex of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), and CIBERCV, Spain (R.G.F., D.L.O., L.A.R., O.O.G., M.P.P., P.J.A.M., C.C.A., J.L.P., M.J., A.B.C.A., R.T.N., X.C.S.P., J.R.G.J.)., Juskowa M; Cardiology Department, University Hospital Complex of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), and CIBERCV, Spain (R.G.F., D.L.O., L.A.R., O.O.G., M.P.P., P.J.A.M., C.C.A., J.L.P., M.J., A.B.C.A., R.T.N., X.C.S.P., J.R.G.J.)., Cid Álvarez AB; Cardiology Department, University Hospital Complex of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), and CIBERCV, Spain (R.G.F., D.L.O., L.A.R., O.O.G., M.P.P., P.J.A.M., C.C.A., J.L.P., M.J., A.B.C.A., R.T.N., X.C.S.P., J.R.G.J.)., Trillo Nouche R; Cardiology Department, University Hospital Complex of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), and CIBERCV, Spain (R.G.F., D.L.O., L.A.R., O.O.G., M.P.P., P.J.A.M., C.C.A., J.L.P., M.J., A.B.C.A., R.T.N., X.C.S.P., J.R.G.J.)., Sanmartín Pena XC; Cardiology Department, University Hospital Complex of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), and CIBERCV, Spain (R.G.F., D.L.O., L.A.R., O.O.G., M.P.P., P.J.A.M., C.C.A., J.L.P., M.J., A.B.C.A., R.T.N., X.C.S.P., J.R.G.J.)., Sánchez Fernández PL; Cardiology Department, University Hospital of Salamanca, Institute for Biomedical Research of Salamanca (IBSAL), University of Salamanca, and CIBERCV, Spain (R.G.F., P.L.S.F., I.C.-G.)., Cruz-González I; Cardiology Department, University Hospital of Salamanca, Institute for Biomedical Research of Salamanca (IBSAL), University of Salamanca, and CIBERCV, Spain (R.G.F., P.L.S.F., I.C.-G.)., González Juanatey JR; Cardiology Department, University Hospital Complex of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), and CIBERCV, Spain (R.G.F., D.L.O., L.A.R., O.O.G., M.P.P., P.J.A.M., C.C.A., J.L.P., M.J., A.B.C.A., R.T.N., X.C.S.P., J.R.G.J.).
Jazyk:	angličtina
Zdroj:	Circulation. Cardiovascular interventions [Circ Cardiovasc Interv] 2021 Feb; Vol. 14 (2), pp. e009342. Date of Electronic Publication: 2021 Feb 05.
DOI:	10.1161/CIRCINTERVENTIONS.120.009342
Abstrakt:	Background: Limited data are available regarding change in the nutritional status after transcatheter aortic valve replacement (TAVR). This study evaluated the prognostic impact of the change in the geriatric nutritional risk index following TAVR. Methods: TAVR patients were analyzed in a prospective and observational study. To analyze the change in nutritional status, geriatric nutritional risk index of the patients was calculated on the day of TAVR and at 3-month follow-up. The impact of the change in nutritional risk index after TAVR on all-cause mortality, heart failure hospitalization (HF-h), and the composite of all-cause death and HF hospitalization was analyzed using the Cox Proportional Hazards model. Results: Four hundred thirty-three patients were included. After TAVR, 68.4% (n=182) patients with baseline nutritional risk improved compared with 31.6% (n=84) who remained at nutritional risk. The change from no-nutritional risk to nutritional risk after TAVR occurred in 15.0% (n=25), while 85.0% (n=142) remained without risk of malnutrition. During follow-up, 157 (36.3%) patients died and 172 patients (39.7%) were hospitalized due to HF. Patients who continued to be at nutritional risk had a higher risk of mortality (hazard ratio [HR], 2.10 [95% CI, 1.30-3.39], P =0.002), HF-h (HR, 1.97 [95% CI, 1.26-3.06], P =0.000), and the composite of death and HF-h (HR, 2.0 [95% CI, 1.37-2.91], P <0.001). The change to non-nutritional risk after TAVR significantly impacted mortality (HR, 0.48 [95% CI, 0.30-0.78], P =0.003), HF-h (HR, 0.50 [95% CI, 0.34-0.74], P =0.001), and the composite outcome (HR, 0.44 [95% CI, 0.32-0.62], P <0.001). Conclusions: Remaining at nutritional risk after TAVR confers a poor prognosis and is associated with an increased risk of mortality and HF-h, while the change from risk of malnutrition to non-nutritional risk after TAVR was associated with a halving of the risk of mortality and HF-h. Further studies are needed to identify whether patients at nutritional risk would benefit from nutritional intervention during processes of care of TAVR programs.
Databáze:	MEDLINE
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