Predictors and Prognostic Impact of Nutritional Changes After Transcatheter Aortic Valve Replacement |
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| Affiliation: | 1. Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany;2. Department of Cardiology, Marienkrankenhaus Hamburg, Hamburg, Germany;3. Department of Cardiothoracic Surgery, University Heart Center Hamburg, Hamburg, Germany;4. Department of Biostatistics and Mathematical Modelling, Goethe University Frankfurt a.M., Frankfurt a.M., Germany;5. German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Frankfurt, Germany;6. Department of Cardiology, Robert-Bosch-Hospital Stuttgart, Stuttgart, Germany;7. Department of Cardiac and Thoracic Vascular Surgery, University Heart Center Lübeck, Lübeck, Germany;8. Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt a.M., Frankfurt a.M., Germany;9. German Society of Thoracic, Cardiac and Vascular Surgery, Berlin, Germany;10. Department of Cardiology, Heart Center University Cologne, Cologne, Germany;11. Department of Cardiology, University of Giessen, Giessen, Germany;12. Department of Cardiology, Kerkhoff Heart and Thorax Center, Bad Nauheim, Germany;13. Department of Internal Medicine, St.-Johannes-Hospital, Dortmund, Germany;14. Clinic for Thoracic and Cardiovascular Surgery, Herz-und Diabeteszentrum NRW, Bad Oeynhausen, Germany;1. Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California;2. Department of Cardiovascular Medicine, The University of Tokyo, Graduate School of Medicine, Tokyo, Japan;3. Queen Sirikit Heart Center of the Northeast, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand;4. Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel;5. Department of Cardiology, Jeonbuk National University Hospital, Jeonju, Republic of Korea |
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| Abstract: | BackgroundLittle is known about changes in nutritional status as an index of frailty on clinical outcomes after transcatheter aortic valve replacement (TAVR). This study aimed to assess the clinical impact of serum albumin changes after TAVR.MethodsChanges in serum albumin levels from baseline to 1 year after TAVR were evaluated in 1524 patients who were classified as having hypoalbuminemia (<3.5 g/dl) and normoalbuminemia (≥3.5 g/dl) at each timepoint. The patients were categorized into 4 groups: NN (baseline normoalbuminemia, 1-year normoalbuminemia: n = 1119), HN (baseline hypoalbuminemia, 1-year normoalbuminemia: n = 202), NH (baseline normoalbuminemia, 1-year hypoalbuminemia: n = 121), and HH (baseline hypoalbuminemia, 1-year hypoalbuminemia: n = 82). We also defined late hypoalbuminemia as hypoalbuminemia identified at the 1-year assessment. Clinical outcomes were compared among 4 groups. Multivariable analysis was driven to assess the variables associated with late hypoalbuminemia and long-term mortality.ResultsThe cumulative 3-year mortality was significantly different among the 4 groups (NN: 11.4%, HN: 10.7%, NH: 25.4%, HH: 44.4%, p < 0.001). Multivariable Cox regression analysis revealed that the NH group had a higher mortality risk (hazard ratio [HR]; 2.80 and 3.53, 95% confidence interval [CI]; 1.71–4.57 and 2.06–6.06, p < 0.001 and p < 0.001, respectively), whereas the HN group had a similar risk (HR; 1.16, 95% CI; 0.66–2.06, p = 0.61) compared with the NN group. Baseline hypoalbuminemia, low body mass index, liver disease, peripheral artery disease, and hospital readmission within 1 year were predictors of late hypoalbuminemia (all p < 0.05).ConclusionSerial albumin assessment may identify poor prognostic subsets in patients with persistent and late acquired malnutrition after TAVR. |
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