Heart failure is strongly associated with malnutrition or poor nutrition, which has been linked to increased mortality during follow-up.
We know that mitral regurgitation causes progressive heart failure and affects nutrition.
The COAPT Study has demonstrated the benefits of edge-to-edge treatment in mitral regurgitation when combined with comprehensive medical treatment and maximum tolerated doses. However, nutritional condition and its evolution in this context have not been investigated.
A subanalysis of the COAPT Study was conducted to evaluate nutritional condition using the Geriatric Nutritional Risk Index (GNRI), defining malnutrition as a value equal to or less than 98.
The study included 552 patients who offered all the necessary data to calculate the GNRI. Of them, 94 (17%) suffered from malnutrition (MLN).
The primary endpoint evaluated over a 4-year term was all-cause mortality.
There were no differences in the number of patients with malnutrition based on the type of treatment received: edge-to-edge treatment versus comprehensive medical treatment at maximum tolerated doses (guideline-directed medical therapy, GDMT).
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Patients with malnutrition were older, had a lower body mass index, higher STS mortality scores, higher BNP levels, and lower serum albumin levels. However, there were no differences in terms of comorbidities, presence of atrial fibrillation, or coronary artery disease. There were no differences in echocardiographic variables either.
The primary endpoint was more frequent in patients with malnutrition (68.3% vs. 52.8%; p=0.001), and so were the deaths from cardiovascular causes (59.9% vs. 45.5%; p=0.006) and the deaths from heart failure (48.6% vs. 28.8%; p=0.0001).
Researchers conducted an analysis of patients with malnutrition based on the type of treatment received, and it was observed that all-cause mortality, cardiovascular mortality, and death from heart failure were more frequent in those who received GDMT compared with those who underwent edge-to-edge treatment.
In a multivariate analysis, malnutrition was an independent predictor of 4-year mortality in patients with malnutrition who received GDMT compared with those who underwent edge-to-edge treatment.
While combined edge-to-edge treatment plus GDMT was superior to GDMT alone in terms of hospitalization for heart failure, there were no significant differences between the two strategies in the presence of malnutrition (MLN).
Malnutrition (MLN) increased non-cardiac hospitalizations in both groups, but no significant differences were found between them.
Conclusion
Malnutrition was observed in approximately one in six patients with heart failure and severe secondary mitral regurgitation. It was independently associated with increased mortality over a four-year term, but no association with hospitalization for heart failure was found. On the other hand, edge-to-edge treatment was shown to reduce the rates for both mortality and hospitalization for heart failure in patients with and without malnutrition.
Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.
Original Title: Impact of Malnutrition in Patients With Heart Failure and Secondary Mitral Regurgitation. The COAPT Trial.
Reference: Scotti, et al. J Am Coll Cardiol 2023 Article In press.
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