Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan.
Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan; Department of Cardiology, Nagoya Heart Center, Nagoya, Japan.
Cardiovasc Revasc Med. 2021 Feb;23:68-76. doi: 10.1016/j.carrev.2020.08.031. Epub 2020 Aug 26.
Little 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.
Changes 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.
The 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).
Serial albumin assessment may identify poor prognostic subsets in patients with persistent and late acquired malnutrition after TAVR.
经导管主动脉瓣置换术（TAVR）后，作为衰弱指标的营养状况变化对临床结局的影响知之甚少。本研究旨在评估 TAVR 后血清白蛋白变化对临床的影响。
本研究纳入了 1524 名患者，根据基线和 TAVR 后 1 年时的白蛋白水平将患者分为低白蛋白血症（<3.5 g/dl）和正常白蛋白血症（≥3.5 g/dl），分别评估两组患者的血清白蛋白水平变化。患者被分为 4 组：NN 组（基线正常白蛋白血症，1 年时正常白蛋白血症：n=1119）、HN 组（基线低白蛋白血症，1 年时正常白蛋白血症：n=202）、NH 组（基线正常白蛋白血症，1 年时低白蛋白血症：n=121）和 HH 组（基线低白蛋白血症，1 年时低白蛋白血症：n=82）。我们还将迟发性低白蛋白血症定义为在 1 年评估时发现的低白蛋白血症。比较了 4 组之间的临床结局。多变量分析旨在评估与迟发性低白蛋白血症和长期死亡率相关的变量。
4 组患者的 3 年累积死亡率存在显著差异（NN 组：11.4%，HN 组：10.7%，NH 组：25.4%，HH 组：44.4%，p<0.001）。多变量 Cox 回归分析显示，NH 组的死亡率更高（风险比[HR]；2.80 和 3.53，95%置信区间[CI]；1.71-4.57 和 2.06-6.06，p<0.001 和 p<0.001），而 HN 组与 NN 组的风险相似（HR；1.16，95%CI；0.66-2.06，p=0.61）。基线低白蛋白血症、低体重指数、肝病、外周动脉疾病和 1 年内再次住院是迟发性低白蛋白血症的预测因素（均 p<0.05）。
连续白蛋白评估可能有助于识别 TAVR 后持续性和迟发性获得性营养不良患者的预后亚组。
