Impact of Malnutrition in Patients With Heart Failure and Secondary Mitral Regurgitation: The COAPT Trial

Andrea Scotti; Augustin Coisne; Juan F Granada; Elissa Driggin; Mahesh V Madhavan; Zhipeng Zhou; Björn Redfors; Saibal Kar; D Scott Lim; David J Cohen; JoAnn Lindenfeld; William T Abraham; Michael J Mack; Federico M Asch; Gregg W Stone

doi:10.1016/j.jacc.2023.04.047

Impact of Malnutrition in Patients With Heart Failure and Secondary Mitral Regurgitation: The COAPT Trial

J Am Coll Cardiol. 2023 Jul 11;82(2):128-138. doi: 10.1016/j.jacc.2023.04.047. Epub 2023 Jun 9.

Authors

Affiliations

¹ Cardiovascular Research Foundation, New York, New York, USA; Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
² Cardiovascular Research Foundation, New York, New York, USA; Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA; University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France.
³ Cardiovascular Research Foundation, New York, New York, USA.
⁴ Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA.
⁵ Cardiovascular Research Foundation, New York, New York, USA; Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA.
⁶ Cardiovascular Research Foundation, New York, New York, USA; Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA; Department of Cardiology, Sahlgerenska University Hospital, Gothenburg, Sweden.
⁷ Los Robles Regional, Thousand Oaks, California, USA; Bakersfield Heart Hospital, Bakersfield, California, USA.
⁸ Division of Cardiology, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA.
⁹ Cardiovascular Research Foundation, New York, New York, USA; Saint Francis Hospital, Roslyn, New York, USA.
¹⁰ Advanced Heart Failure and Cardiac Transplantation Section, Vanderbilt Heart and Vascular Institute, Nashville, Tennessee, USA.
¹¹ Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA.
¹² Baylor Scott & White Health, Plano, Texas, USA.
¹³ MedStar Health Research Institute, Georgetown University, Washington, DC, USA.
¹⁴ The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Electronic address: gregg.stone@mountsinai.org.

PMID: 37306651
DOI: 10.1016/j.jacc.2023.04.047

Abstract

Background: Although malnutrition is associated with poor prognosis in several diseases, its prognostic impact in patients with heart failure (HF) and secondary mitral regurgitation (SMR) is not understood.

Objectives: The purpose of this study was to assess the prevalence and impact of malnutrition in HF patients with severe SMR randomized to transcatheter edge-to-edge repair (TEER) with the MitraClip plus guideline-directed medical therapy (GDMT) vs GDMT alone in the COAPT trial.

Methods: Baseline malnutrition risk was calculated using the validated geriatric nutritional risk index (GNRI) score. Patients were categorized as having "malnutrition" (GNRI ≤98) vs "no malnutrition" (GNRI >98). Outcomes were assessed through 4 years. The primary endpoint of interest was all-cause mortality.

Results: Among 552 patients, median baseline GNRI was 109 (IQR: 101-116); 94 (17.0%) had malnutrition. All-cause mortality at 4 years was greater in patients with vs those without malnutrition (68.3% vs 52.8%; P = 0.001). Using multivariable analysis, both baseline malnutrition (adjusted-HR [adj-HR]: 1.37; 95% CI: 1.03-1.82; P = 0.03) and randomization to TEER plus GDMT compared with GDMT alone (adj-HR: 0.65; 95% CI: 0.51-0.82; P = 0.0003) were independent predictors of 4-year mortality. In contrast, GNRI was unrelated to the 4-year rate of heart failure hospitalization (HFH), although TEER treatment reduced HFH (adj-HR: 0.46; 95% CI: 0.36-0.56). The reductions in death (adj-P_interaction = 0.46) and HFH (adj-P_interaction = 0.67) with TEER were consistent in patients with and without malnutrition.

Conclusions: Malnutrition was present in 1 of 6 patients with HF and severe SMR enrolled in COAPT and was independently associated with increased 4-year mortality (but not HFH). TEER reduced mortality and HFH in patients with and without malnutrition. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation [The COAPT Trial] and COAPT CAS [COAPT]; NCT01626079).

Keywords: COAPT Trial; geriatric nutritional risk index; malnutrition; mitral regurgitation; transcatheter edge-to-edge repair.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Heart Failure* / complications
Heart Failure* / epidemiology
Heart Failure* / therapy
Heart Valve Prosthesis Implantation*
Humans
Mitral Valve / surgery
Mitral Valve Insufficiency* / complications
Mitral Valve Insufficiency* / epidemiology
Mitral Valve Insufficiency* / surgery
Outcome Assessment, Health Care
Prognosis
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT01626079