Prognostic value of objective nutritional status after transcatheter aortic valve replacement

Abstract

Background: This study aimed to elucidate the prognostic value of objective nutritional status after transcatheter aortic valve replacement (TAVR).

Methods: This study enrolled 150 consecutive patients who underwent TAVR between February 2014 and March 2017. Nutritional status was assessed using the Controlling Nutritional Status (CONUT) score before TAVR. Patients were divided into a high CONUT score (malnutrition status >4 points, n=30) or low CONUT score (normal nutritional status 1-4 points, n=120) group. The primary endpoint was mortality within 1-year post-TAVR.

Results: Patients in the high CONUT group were characterized by low body mass index (kg/m²) (20.3±2.4 vs. 22.8±3.5, p<0.001), a higher prevalence of atrial fibrillation (43% vs. 23%, p=0.03), and more common frailty [median (interquartile range) Clinical Frailty Scale (CFS) score, 4.5 (3.75-6) vs. 4 (3-5), p<0.001]. Mortality rate within 1-year post-TAVR was significantly higher in the high CONUT group (43.6% vs. 6.7%, p<0.001). High CONUT score was independently associated with poor prognosis post-TAVR [adjusted hazard ratio, 8.20; 95% confidence interval (CI), 3.10-22.6; p<0.001]. On integrated discrimination improvement (IDI) analysis, malnutrition status improved CFS for predicting mortality post-TAVR (IDI, 0.15; 95% CI, 0.07-0.23; p<0.001).

Conclusions: Objective malnutrition status was predictive of mortality post-TAVR and provided complementary prognostic information to the CFS. Thus, objective nutritional status may refine the clinical risk stratification of patients who undergo TAVR.

Keywords: Clinical frailty scale; Nutritional status; Prognosis; Transcatheter aortic valve replacement.