Malnutrition linked to higher mortality in patients with HF and severe secondary mitral regurgitation

The findings were presented at the annual TVT conference hosted by the Cardiovascular Research Foundation and published in the Journal of the American College of Cardiology.

About 1 of 6 patients with heart failure and severe SMR enrolled in COAPT were affected by poor nutrition status. Transcatheter edge-to-edge repair (TEER) reduced heart failure hospitalization and mortality in patients with and without malnutrition.

The researchers reported that among the 17% of trial participants with a combination of low serum albumin and low BMI indicating malnutrition, 68.3% died within four years compared with 52.8% without malnutrition. Reductions in all-cause mortality and heart failure hospitalization seen with mitral TEER were similar regardless of nutrition status.

Malnutrition is linked with poor prognosis in various diseases, but there is no clear understanding of its prognostic impact in patients with heart failure and SMR. To clarify the same, Andrea Scotti, Cardiovascular Research Foundation, New York, New York, USA, and colleagues aimed to evaluate the impact and prevalence of malnutrition in HF patients with severe secondary mitral regurgitation. They were randomized to TEER with the MitraClip plus GDMT (guideline-directed medical therapy) versus GDMT alone in the COAPT trial.

The researchers calculated baseline malnutrition risk using the validated GNRI (geriatric nutritional risk index) score. Patients were divided as having "malnutrition" (GNRI ≤98) versus "no malnutrition" (GNRI >98). Assessment of the outcomes was done over four years. The primary endpoint was all-cause mortality.

The study led to the following findings:

• Among 552 patients, the median baseline GNRI was 109; 17.0% had malnutrition.
• All-cause mortality at four years was more significant in patients with vs those without malnutrition (68.3% vs 52.8%).
• Using multivariable analysis, both baseline malnutrition (adjusted-HR [adj-HR]: 1.37) and randomization to TEER plus GDMT compared with GDMT alone (adj-HR: 0.65) 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).
• The reductions in death and heart failure hospitalization with TEER were consistent in patients with and without malnutrition.

Limitations of the analysis were that malnutrition was not prespecified as a subgroup, and the findings might not generalize to a non-COAPT-like population. Repeat albumin levels were not available for enough patients to evaluate.

Reference:

Journal of the American College of Cardiology. Scotti A, et al. "Impact of malnutrition in patients with heart failure and secondary mitral regurgitation: The COAPT trial" J Am Coll Cardiol 2023; DOI: 10.1016/j.jacc.2023.04.047.