Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
Clin Res Cardiol. 2024 Jan;113(1):58-67. doi: 10.1007/s00392-023-02220-5. Epub 2023 May 13.
Malnutrition is associated with adverse outcomes in patients with aortic stenosis. The Triglycerides × Total Cholesterol × Body Weight Index (TCBI) is a simple scoring model to evaluate the status of nutrition. However, the prognostic relevance of this index in patients undergoing transcatheter aortic valve replacement (TAVR) is unknown. This study aimed to evaluate the association of the TCBI with clinical outcomes in patients undergoing TAVR.
A total of 1377 patients undergoing TAVR were evaluated in this study. The TCBI was calculated by the formula; triglyceride (mg/dL) × total cholesterol (mg/dL) × body weight (kg)/1000. The primary outcome was all-cause mortality within 3 years.
Patients with a low TCBI, based on a cut-off value of 985.3, were more likely to have elevated right atrial pressure (p = 0.04), elevated right ventricular pressure (p < 0.01), right ventricular systolic dysfunction (p < 0.01), tricuspid regurgitation ≥ moderate (p < 0.01). Patients with a low TCBI had a higher cumulative 3-year all-cause (42.3% vs. 31.6%, p < 0.01; adjusted HR 1.36, 95% CI 1.05-1.77, p = 0.02) and non-cardiovascular mortality (15.5% vs. 9.1%, p < 0.01; adjusted HR 1.95, 95% CI 1.22-3.13, p < 0.01) compared to those with a high TCBI. Adding a low TCBI to EuroSCORE II improved the predictive value for 3-year all-cause mortality (net reclassification improvement, 0.179, p < 0.01; integrated discrimination improvement, 0.005, p = 0.01).
Patients with a low TCBI were more likely to have right-sided heart overload and exhibited an increased risk of 3-year mortality. The TCBI may provide additional information for risk stratification in patients undergoing TAVR.
营养不良与主动脉瓣狭窄患者的不良结局相关。三酰甘油×总胆固醇×体重指数（TCBI）是一种简单的评分模型，用于评估营养状况。然而，该指数在接受经导管主动脉瓣置换术（TAVR）的患者中的预后相关性尚不清楚。本研究旨在评估 TCBI 与接受 TAVR 治疗的患者临床结局的相关性。
本研究共评估了 1377 名接受 TAVR 的患者。TCBI 通过公式计算得出：三酰甘油（mg/dL）×总胆固醇（mg/dL）×体重（kg）/1000。主要结局为 3 年内全因死亡率。
基于截断值 985.3，TCBI 低的患者更有可能出现右心房压升高（p=0.04）、右心室压升高（p<0.01）、右心室收缩功能障碍（p<0.01）、三尖瓣反流≥中度（p<0.01）。TCBI 低的患者 3 年全因（42.3%比 31.6%，p<0.01；调整后 HR 1.36，95%CI 1.05-1.77，p=0.02）和非心血管死亡率（15.5%比 9.1%，p<0.01；调整后 HR 1.95，95%CI 1.22-3.13，p<0.01）均高于 TCBI 高的患者。将 TCBI 加入到 EuroSCORE II 中可以提高 3 年全因死亡率的预测价值（净重新分类改善，0.179，p<0.01；综合区分改善，0.005，p=0.01）。
TCBI 低的患者更有可能出现右侧心脏负荷过重，并表现出 3 年死亡率升高的风险。TCBI 可能为接受 TAVR 的患者提供风险分层的额外信息。
