Department of Internal Medicine/Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany.
Department of Heart Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany.
Eur J Heart Fail. 2020 Oct;22(10):1826-1836. doi: 10.1002/ejhf.1752. Epub 2020 Feb 26.
To characterize the prevalence and clinical relevance of malnutrition in patients undergoing transcatheter tricuspid valve edge-to-edge repair (TTVR).
Overall, 86 consecutive patients (mean age 78 ± 7 years) with moderate-to-severe tricuspid regurgitation (TR) at prohibitive surgical risk were analysed. Mini Nutritional Assessment (MNA), quality of life assessment, 6-min walk test distance and laboratory analyses were performed before and 1 month after TTVR. A total of 43 patients (50%) underwent concomitant transcatheter mitral valve repair. According to MNA, 81 patients (94%) were malnourished or at risk of malnutrition before TTVR. Following TTVR, MNA improved in 64 patients (74%). As compared to patients without MNA improvement, patients with increased MNA score had greater reductions in TR [regurgitation volume -17.0 (interquartile range, IQR -25.0; -7.0) mL vs. -26.4 (IQR -40.3; -14.5) mL, P < 0.001] and inferior vena cava diameter. Only patients with increased MNA score displayed a decrease in N-terminal pro-brain natriuretic peptide levels [-320 (IQR -1294; 105) pg/mL vs. +708 (IQR -342; 2708) pg/mL, P = 0.009], improvements in cholinesterase levels (0.0 ± 11.9 μmoL/L vs. +10.9 ± 16.7 μmoL/L, P < 0.001) and renal function during follow-up. Beneficial effects on quality of life scores and 6-min walk test distance following TTVR were observed exclusively in patients with improvement in MNA. During a median follow-up of 6 months, patients with worsened MNA had an increased risk of death and rehospitalization for heart failure.
Nutritional impairment is common and of prognostic importance in patients undergoing TTVR. Hepatorenal function modestly improves after successful TTVR. Further study of extracardiac implications of TR-associated right heart failure is warranted to improve care in this vulnerable patient population.
描述行经导管三尖瓣缘对缘修复术（TTVR）的患者中营养不良的流行程度和临床相关性。
共分析了 86 例因手术风险高而患有中重度三尖瓣反流（TR）的连续患者（平均年龄 78±7 岁）。在 TTVR 前后进行了迷你营养评估（MNA）、生活质量评估、6 分钟步行测试距离和实验室分析。共有 43 例（50%）患者同时进行了经导管二尖瓣修复。根据 MNA，81 例（94%）患者在 TTVR 前存在营养不良或有营养不良风险。TTVR 后，64 例（74%）患者的 MNA 得到改善。与 MNA 无改善的患者相比，MNA 评分增加的患者 TR 减少更多[反流量 -17.0（四分位距 IQR -25.0；-7.0）mL 比 -26.4（IQR -40.3；-14.5）mL，P<0.001]，下腔静脉直径减小。只有 MNA 评分增加的患者显示 N 端脑利钠肽前体水平降低[-320（IQR -1294；105）pg/mL 比 +708（IQR -342；2708）pg/mL，P=0.009]，胆碱酯酶水平改善（0.0±11.9μmol/L 比 +10.9±16.7μmol/L，P<0.001）和肾功能随访期间。TTVR 后，生活质量评分和 6 分钟步行测试距离的有益影响仅在 MNA 改善的患者中观察到。在中位随访 6 个月期间，MNA 恶化的患者死亡和因心力衰竭再住院的风险增加。
在接受 TTVR 的患者中，营养损害很常见，且具有预后意义。成功的 TTVR 后肝肾功能略有改善。需要进一步研究 TR 相关右心衰竭的心脏外影响，以改善这一脆弱患者群体的治疗。
