Kenichi Shibata1, Masanori Yamamoto2, Seiji Kano3, Yutaka Koyama1, Tetsuro Shimura3, Ai Kagase1, Sumio Yamada4, Toshihiro Kobayashi1, Norio Tada5, Toru Naganuma6, Motoharu Araki7, Futoshi Yamanaka8, Shinichi Shirai9, Kazuki Mizutani10, Minoru Tabata11, Hiroshi Ueno12, Kensuke Takagi13, Akihiro Higashimori14, Yusuke Watanabe15, Toshiaki Otsuka16, Kentaro Hayashida17. 1. Department of Cardiology, Nagoya Heart Canter, Nagoya, Japan. 2. Department of Cardiology, Nagoya Heart Canter, Nagoya, Japan; Department of Cardiology, Toyohashi Heart Canter, Toyohashi, Japan. Electronic address: yamamoto@heart-center.or.jp. 3. Department of Cardiology, Toyohashi Heart Canter, Toyohashi, Japan. 4. Department of Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan. 5. Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan. 6. Department of Cardiology, New Tokyo Hospital, Chiba, Japan. 7. Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan. 8. Department of Cardiology, Syonan Kamakura General Hospital, Kanagawa, Japan. 9. Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan. 10. Department of Cardiovascular Medicine, Osaka City University Graduates School of Medicine, Osaka, Japan. 11. Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center, Chiba, Japan. 12. Department of Cardiology, Toyama University Hospital, Toyama, Japan. 13. Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan. 14. Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada, Japan. 15. Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan. 16. Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan; Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan. 17. Department of cardiology, Keio University School of Medicine, Tokyo, Japan.
Abstract
BACKGROUND: Nutritional condition is one marker of patients' frailty. The Geriatric Nutritional Risk Index (GNRI) is a well-known marker of nutritional status. This study sought to assess the clinical outcomes of GNRI after transcatheter aortic valve replacement (TAVR). METHODS: We evaluated the GNRI value of 1,613 patients who underwent TAVR using data from a Japanese multicenter registry. According to baseline GNRI, patients were classified into 3 groups: GNRI ≥92 (n = 1,085; 67.3%), GNRI 82-92 (n = 396; 24.6%), and GNRI ≤82 (n = 132; 8.2%). Baseline characteristics, procedural outcomes, and cumulative mortality rates were compared. In addition, GNRI correlations with other frailty components (gait speed, grip strength, and Clinical Frailty Scale) and Society of Thoracic Surgeons (STS) score were also evaluated. RESULTS: Significantly increased mortality rates were observed across the 3 groups at 30 days (0.9%, 2.3%, and 6.8%, respectively; P < .001) and 1 year (6.5%, 16.4%, and 36.4%, respectively; P < .001). Both GNRI 82-92 and GNRI ≤82 (as a reference for GNRI ≥92) were independently associated with increased midterm mortality in the Cox regression multivariate model (hazard ratio: 1.97, 3.60; 95% confidence interval: 1.37-2.84, 2.30-5.64; P < .001, P < .001, respectively). The GNRI value was significantly correlated with gait speed (Spearman ρ = -0.15, P < .001), grip strength (ρ = 0.25, P < .001), Clinical Frailty Scale (ρ = -0.24, P < .001), and STS score (ρ = -0.29, P < .001). CONCLUSIONS: GNRI is related to both frailty components and the STS score and is an important surrogate marker for predicting worse clinical outcomes after TAVR. Assessment of the GNRI may be considered when deciding on TAVR.
BACKGROUND: Nutritional condition is one marker of patients' frailty. The Geriatric Nutritional Risk Index (GNRI) is a well-known marker of nutritional status. This study sought to assess the clinical outcomes of GNRI after transcatheter aortic valve replacement (TAVR). METHODS: We evaluated the GNRI value of 1,613 patients who underwent TAVR using data from a Japanese multicenter registry. According to baseline GNRI, patients were classified into 3 groups: GNRI ≥92 (n = 1,085; 67.3%), GNRI 82-92 (n = 396; 24.6%), and GNRI ≤82 (n = 132; 8.2%). Baseline characteristics, procedural outcomes, and cumulative mortality rates were compared. In addition, GNRI correlations with other frailty components (gait speed, grip strength, and Clinical Frailty Scale) and Society of Thoracic Surgeons (STS) score were also evaluated. RESULTS: Significantly increased mortality rates were observed across the 3 groups at 30 days (0.9%, 2.3%, and 6.8%, respectively; P < .001) and 1 year (6.5%, 16.4%, and 36.4%, respectively; P < .001). Both GNRI 82-92 and GNRI ≤82 (as a reference for GNRI ≥92) were independently associated with increased midterm mortality in the Cox regression multivariate model (hazard ratio: 1.97, 3.60; 95% confidence interval: 1.37-2.84, 2.30-5.64; P < .001, P < .001, respectively). The GNRI value was significantly correlated with gait speed (Spearman ρ = -0.15, P < .001), grip strength (ρ = 0.25, P < .001), Clinical Frailty Scale (ρ = -0.24, P < .001), and STS score (ρ = -0.29, P < .001). CONCLUSIONS: GNRI is related to both frailty components and the STS score and is an important surrogate marker for predicting worse clinical outcomes after TAVR. Assessment of the GNRI may be considered when deciding on TAVR.
Authors: Cheng-Hsi Yeh; Shao-Chun Wu; Sheng-En Chou; Wei-Ti Su; Ching-Hua Tsai; Chi Li; Shiun-Yuan Hsu; Ching-Hua Hsieh Journal: Int J Environ Res Public Health Date: 2020-12-10 Impact factor: 3.390
Authors: Amgad Mentias; Marwan Saad; Milind Y Desai; Phillip A Horwitz; James D Rossen; Sidakpal Panaich; Ayman Elbadawi; Abdul Qazi; Paul Sorajja; Hani Jneid; Samir Kapadia; Barry London; Mary S Vaughan Sarrazin Journal: J Am Heart Assoc Date: 2019-10-31 Impact factor: 5.501