Mai Ziling, Huang Zhidong, Lai Wenguang, Li Huanqiang, Wang Bo, Huang Sumei, Shi Yingming, Yu Sijia, Hu Qizheng, Liu Jin, Zhang Lingyu, Liu Yong, Chen Jiyan, Liang Yan, Zhong Shilong, Chen Shiqun
Guangdong Provincial People's Hospital, School of Biology and Biological Engineering, South China University of Technology, Guangzhou, China.
Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Front Nutr. 2021 Sep 16;8:740746. doi: 10.3389/fnut.2021.740746. eCollection 2021.
The regulatory effect of the left ventricular ejection fraction (LVEF) categories on the association of malnutrition and all-cause mortality in patients undergoing coronary angiography (CAG) have not been adequately addressed. Forty-five thousand eight hundred and twenty-six patients consecutively enrolled in the Cardiorenal ImprovemeNt (CIN) study (ClinicalTrials.gov NCT04407936) from January 2008 to July 2018 who underwent coronary angiography (CAG). The Controlling Nutritional Status (CONUT) score was applied to 45,826 CAG patients. The hazard ratios of mortality across combined LVEF and/or malnutrition categories were estimated by Cox regression models. Variables adjusted for in the Cox regression models included: age, gender, hypertension (HT), DM, PCI, coronary artery disease (CAD), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride (TRIG), chronic kidney disease (CKD), statins, atrial fibrillation (AF), anemia, and stroke. Population attributable risk (PAR) was estimated for eight groups stratified by nutritional status and LVEF categories. In our study, 42,181(92%) of patients were LVEF ≥ 40%, of whom, 41.55 and 9.34% were in mild and moderate or severe malnutrition status, respectively, while 46.53 and 22.28% in mild and moderate or severe malnutritional status among patients with LVEF < 40%. During a median follow-up time of 4.5 years (percentile 2.8-7.1), 5,350 (11.7%) patients died. After fully adjustment, there is no difference of mortality on malnutrition in LVEF < 40% group (mild, moderate and severe vs. normal, HR (95%CI): [1.00 (0.83-0.98)], [1.20 (0.95-1.51)], [1.41 (0.87-2.29)], respectively, for trend =0.068), but malnutrition was related to markedly increased risk of mortality in LVEF ≥ 40% group (mild, moderate, and severe vs. normal, HR (95%CI): [1.21 (1.12-1.31)], [1.56 (1.40-1.74)], and [2.20(1.67-2.90)], respectively, for trend < 0.001, and p for interaction < 0.001). Patients with LVEF ≥ 40% had a higher malnutrition-associated risk of mortality and a higher PAR than those with LVEF < 40%. Malnutrition is common in CAG patients and it has a greater effect on all-cause mortality and a higher PAR in patients with LVEF ≥ 40% than LVEF < 40%.
左心室射血分数（LVEF）类别对接受冠状动脉造影（CAG）患者的营养不良与全因死亡率之间关联的调节作用尚未得到充分探讨。2008年1月至2018年7月期间，连续纳入心脏肾脏改善（CIN）研究（ClinicalTrials.gov NCT04407936）的45826例接受冠状动脉造影（CAG）的患者。对45826例CAG患者应用控制营养状况（CONUT）评分。通过Cox回归模型估计联合LVEF和/或营养不良类别下的死亡风险比。Cox回归模型中调整的变量包括：年龄、性别、高血压（HT）、糖尿病（DM）、经皮冠状动脉介入治疗（PCI）、冠状动脉疾病（CAD）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、甘油三酯（TRIG）、慢性肾脏病（CKD）、他汀类药物、心房颤动（AF）、贫血和中风。对按营养状况和LVEF类别分层的八组人群估计人群归因风险（PAR）。在我们的研究中，42181例（92%）患者的LVEF≥40%，其中分别有41.55%和9.34%处于轻度和中度或重度营养不良状态，而LVEF<40%的患者中分别有46.53%和22.28%处于轻度和中度或重度营养不良状态。在中位随访时间4.5年（百分位数2.8 - 7.1）期间，5350例（11.7%）患者死亡。经过充分调整后，LVEF<40%组中营养不良患者的死亡率无差异（轻度、中度和重度与正常相比，HR（95%CI）：[1.00（0.83 - 0.98）]，[1.20（0.95 - 1.51）]，[1.41（0.87 - 2.29）]，趋势p = 0.068），但在LVEF≥40%组中，营养不良与死亡率显著增加相关（轻度、中度和重度与正常相比，HR（95%CI）：[1.21（1.12 - 1.31）]，[1.56（1.40 - 1.74）]，和[2.20（1.67 - 2.90）]，趋势p<0.001，交互作用p<0.001）。LVEF≥40%的患者与LVEF<40%的患者相比，营养不良相关的死亡风险更高且PAR更高。营养不良在CAG患者中很常见，并且与LVEF≥40%的患者相比，它对LVEF<40%的患者全因死亡率的影响更大且PAR更高。
