Main Article Content
Objective: Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure employed to treat aortic valve disease in patients who are ineligible for open-heart surgery. Undergoing TAVR patients generally include the elderly and frail. Malnutrition is associated with high morbidity and mortality in patients with undergoing TAVR. The aim of this study was to investigate the prognostic value of the prognostic nutritional index (PNI) for two-year survival after TAVR.
Material and Methods: A cohort of 213 consecutive patients with severe aortic stenosis who underwent transcatheter aortic valve replacement between March 2019 and July 2021. The study population was divided into two groups according to the cut-off PNI level in a receiver operator characteristic (ROC) curve analysis. The two-year follow-up results of the patients were recorded retrospectively. PNI was defined according to the following formula: PNI = (10 x serum albumin [g/dl]) + (0.005 x total lymphocyte counts [1000/mcL]).
Results: Mean age of the patients was 76.15, and 93 (43.7%) of them were males. Patients with low PNI (group 1) were significantly older. The mean PNI of group 1 was 43.17 ± 4.04 and the mean PNI of group 2 was 54.23 ± 4.30. Mortality at two-year was 32.6% in low PNI group and 10.7% in high PNI group. Hypertension and PNI were independent predictors of mortality after TAVR. In ROC curve analysis, PNI at a cut off value of 48.325 predicted the mortality after TAVR with 63.5% sensitivity and 70.1% specificity. Kaplan-Meier curves for two-year mortality between low and high PNI groups showed worse outcomes in patients with low PNI.
Conclusion: PNI is a practical and useful nutritional index that predicts two-year mortality after TAVR.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. European heart journal. 2022;43(7):561-632. DOI: https://doi.org/10.1093/ejcts/ezac209
Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, 3rd, Guyton RA, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology. 2014;63(22):2438-88. DOI: https://doi.org/10.1016/j.jacc.2014.02.537
Stortecky S, Schoenenberger AW, Moser A, Kalesan B, Jüni P, Carrel T, et al. Evaluation of multidimensional geriatric assessment as a predictor of mortality and cardiovascular events after transcatheter aortic valve implantation. JACC Cardiovascular interventions. 2012;5(5):489-96. DOI: https://doi.org/10.1016/j.jcin.2012.02.012
Bonilla-Palomas JL, Gámez-López AL, Anguita-Sánchez MP, Castillo-Domínguez JC, García-Fuertes D, Crespin-Crespin M, et al. [Impact of malnutrition on long-term mortality in hospitalized patients with heart failure]. Revista espanola de cardiologia. 2011;64(9):752-8. DOI: https://doi.org/10.1016/j.rec.2011.03.008
Agra Bermejo RM, González Ferreiro R, Varela Román A, Gómez Otero I, Kreidieh O, Conde Sabarís P, et al. Nutritional status is related to heart failure severity and hospital readmissions in acute heart failure. International journal of cardiology. 2017; 230: 108-14. DOI: https://doi.org/10.1016/j.ijcard.2016.12.067
Barge-Caballero E, García-López F, Marzoa-Rivas R, Barge-Caballero G, Couto-Mallón D, Paniagua-Martín MJ, et al. Prognostic Value of the Nutritional Risk Index in Heart Transplant Recipients. Revista espanola de cardiologia (English ed). 2017;70(8):639-45. DOI: https://doi.org/10.1016/j.rec.2017.01.005
Wada H, Dohi T, Miyauchi K, Doi S, Naito R, Konishi H, et al. Prognostic Impact of the Geriatric Nutritional Risk Index on Long-Term Outcomes in Patients Who Underwent Percutaneous Coronary Intervention. The American journal of cardiology. 2017;119(11):1740-5. DOI: https://doi.org/10.1016/j.amjcard.2017.02.051
Eichler S, Salzwedel A, Harnath A, Butter C, Wegscheider K, Chiorean M, et al. Nutrition and mobility predict all-cause mortality in patients 12 months after transcatheter aortic valve implantation. Clinical research in cardiology : official journal of the German Cardiac Society. 2018;107(4):304-11. DOI: https://doi.org/10.1007/s00392-017-1183-1
Sannino A, Schiattarella GG, Toscano E, Gargiulo G, Giugliano G, Galderisi M, et al. Meta-Analysis of Effect of Body Mass Index on Outcomes After Transcatheter Aortic Valve Implantation. The American journal of cardiology. 2017;119(2):308-16. DOI: https://doi.org/10.1016/j.amjcard.2016.09.031
González Ferreiro R, Muñoz-García AJ, López Otero D, Avanzas P, Pascual I, Alonso-Briales JH, et al. Nutritional risk index predicts survival in patients undergoing transcatheter aortic valve replacement. International journal of cardiology. 2019; 276: 66-71. DOI: https://doi.org/10.1016/j.ijcard.2018.11.097
Arsalan M, Filardo G, Kim WK, Squiers JJ, Pollock B, Liebetrau C, et al. Prognostic value of body mass index and body surface area on clinical outcomes after transcatheter aortic valve implantation. Clinical research in cardiology : official journal of the German Cardiac Society. 2016;105(12):1042-8. DOI: https://doi.org/10.1007/s00392-016-1027-4
Honda Y, Yamawaki M, Shigemitsu S, Kenji M, Tokuda T, Tsutumi M, et al. Prognostic value of objective nutritional status after transcatheter aortic valve replacement. Journal of cardiology. 2019;73(5):401-7. DOI: https://doi.org/10.1016/j.jjcc.2018.11.013
Lindman BR, Alexander KP, O'Gara PT, Afilalo J. Futility, benefit, and transcatheter aortic valve replacement. JACC Cardiovascular interventions. 2014;7(7):707-16. DOI: https://doi.org/10.1016/j.jcin.2014.01.167
Green P, Woglom AE, Genereux P, Daneault B, Paradis JM, Schnell S, et al. The impact of frailty status on survival after transcatheter aortic valve replacement in older adults with severe aortic stenosis: a single-center experience. JACC Cardiovascular interventions. 2012;5(9):974-81. DOI: https://doi.org/10.1016/j.jcin.2012.06.011
Buzby GP, Mullen JL, Matthews DC, Hobbs CL, Rosato EF. Prognostic nutritional index in gastrointestinal surgery. American journal of surgery. 1980;139(1):160-7. DOI: https://doi.org/10.1016/0002-9610(80)90246-9
Nozoe T, Kohno M, Iguchi T, Mori E, Maeda T, Matsukuma A, et al. The prognostic nutritional index can be a prognostic indicator in colorectal carcinoma. Surgery today. 2012;42(6):532-5. DOI: https://doi.org/10.1007/s00595-011-0061-0
Okada S, Shimada J, Kato D, Tsunezuka H, Teramukai S, Inoue M. Clinical Significance of Prognostic Nutritional Index After Surgical Treatment in Lung Cancer. The Annals of thoracic surgery. 2017;104(1):296-302. DOI: https://doi.org/10.1016/j.athoracsur.2017.01.085
Zencirkiran Agus H, Kahraman S. Prognostic nutritional index predicts one-year outcome in heart failure with preserved ejection fraction. Acta cardiologica. 2020;75(5):450-5. DOI: https://doi.org/10.1080/00015385.2019.1661139
Cheng YL, Sung SH, Cheng HM, Hsu PF, Guo CY, Yu WC, et al. Prognostic Nutritional Index and the Risk of Mortality in Patients With Acute Heart Failure. Journal of the American Heart Association. 2017;6(6). DOI: https://doi.org/10.1161/JAHA.116.004876
Chen QJ, Qu HJ, Li DZ, Li XM, Zhu JJ, Xiang Y, et al. Prognostic nutritional index predicts clinical outcome in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Scientific reports. 2017;7(1):3285. DOI: https://doi.org/10.1038/s41598-017-03364-x
Yost G, Tatooles A, Bhat G. Preoperative Nutritional Assessment with the Prognostic Nutrition Index in Patients Undergoing Left Ventricular Assist Device Implantation. ASAIO journal (American Society for Artificial Internal Organs : 1992). 2018;64(1):52-5. DOI: https://doi.org/10.1097/MAT.0000000000000625
Onodera T, Goseki N, Kosaki G. [Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients]. Nihon Geka Gakkai zasshi. 1984;85(9):1001-5.
Edwards FH, Cohen DJ, O'Brien SM, Peterson ED, Mack MJ, Shahian DM, et al. Development and Validation of a Risk Prediction Model for In-Hospital Mortality After Transcatheter Aortic Valve Replacement. JAMA cardiology. 2016;1(1):46-52. DOI: https://doi.org/10.1001/jamacardio.2015.0326
Hermiller JB, Jr., Yakubov SJ, Reardon MJ, Deeb GM, Adams DH, Afilalo J, et al. Predicting Early and Late Mortality After Transcatheter Aortic Valve Replacement. Journal of the American College of Cardiology. 2016;68(4):343-52. DOI: https://doi.org/10.1016/j.jacc.2016.04.057
Forcillo J, Condado JF, Ko YA, Yuan M, Binongo JN, Ndubisi NM, et al. Assessment of Commonly Used Frailty Markers for High- and Extreme-Risk Patients Undergoing Transcatheter Aortic Valve Replacement. The Annals of thoracic surgery. 2017;104(6):1939-46. DOI: https://doi.org/10.1016/j.athoracsur.2017.05.067
Hebeler KR, Baumgarten H, Squiers JJ, Wooley J, Pollock BD, Mahoney C, et al. Albumin Is Predictive of 1-Year Mortality After Transcatheter Aortic Valve Replacement. The Annals of thoracic surgery. 2018;106(5):1302-7. DOI: https://doi.org/10.1016/j.athoracsur.2018.06.024
Condado JF, Junpaparp P, Binongo JN, Lasanajak Y, Witzke-Sanz CF, Devireddy C, et al. Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) can risk stratify patients in transcatheter aortic-valve replacement (TAVR). International journal of cardiology. 2016; 223: 444-9. DOI: https://doi.org/10.1016/j.ijcard.2016.08.260
Mas-Peiro S, Hoffmann J, Seppelt PC, De Rosa R, Murray MI, Walther T, et al. Value of prognostic nutritional index for survival prediction in trans-catheter aortic valve replacement compared to other common nutritional indexes. Acta cardiologica. 2021;76(6):615-22. DOI: https://doi.org/10.1080/00015385.2020.1757854
Okuno T, Koseki K, Nakanishi T, Sato K, Ninomiya K, Tomii D, et al. Evaluation of objective nutritional indexes as predictors of one-year outcomes after transcatheter aortic valve implantation. Journal of cardiology. 2019;74(1):34-9. DOI: https://doi.org/10.1016/j.jjcc.2019.02.017
Shibata K, Yamamoto M, Kano S, Koyama Y, Shimura T, Kagase A, et al. Importance of Geriatric Nutritional Risk Index assessment in patients undergoing transcatheter aortic valve replacement. American heart journal. 2018; 202: 68-75. DOI: https://doi.org/10.1016/j.ahj.2018.04.021
Goldfarb M, Lauck S, Webb JG, Asgar AW, Perrault LP, Piazza N, et al. Malnutrition and Mortality in Frail and Non-Frail Older Adults Undergoing Aortic Valve Replacement. Circulation. 2018; 138(20): 2202-11. DOI: https://doi.org/10.1161/CIRCULATIONAHA.118.033887