Murakami Tsukasa, Kagiyama Nobuyuki, Kaneko Tomohiro, Kagami Kazuki, Amano Masashi, Okada Taiji, Sato Yukio, Ohno Yohei, Sato Kimi, Morita Kojiro, Machino-Ohtsuka Tomoko, Abe Yukio, Ishii Hideki, Obokata Masaru
Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan.
Department of Cardiology, Japanese Red Cross Ogawa Hospital, Saitama, Japan.
CJC Open. 2025 May 21;7(8):1038-1047. doi: 10.1016/j.cjco.2025.05.007. eCollection 2025 Aug.
In this study we sought to characterize the prevalence, clinical characteristics, and outcomes of malnutrition in patients with atrial functional mitral regurgitation (AFMR).
This multicentre, observational study included 802 patients diagnosed with AFMR. The eriatric utritional isk ndex (GNRI) was used as a nutritional risk metric. Patients were divided into 4 groups on the basis of the GNRI: normal (> 98; n = 342), mild nutritional risk (92-98; n = 196), moderate risk (82 to < 92; n = 166), and severe risk (< 82; n = 98). The primary outcome was a composite of heart failure admission and all-cause death.
At least mild nutrition risk (GNRI ≤ 98) was present in 57% of patients with AFMR. Patients with lower GNRI were older, had lower body mass index, hemoglobin levels, and renal function, and had a higher prevalence of New York Heart Association class III or IV, dementia, and impaired activities of daily living. During the median follow-up duration of 978 (interquartile range, 492-1141) days, 254 primary outcomes were observed. Increasing severity of malnutrition risk categories was associated with higher rates of the primary outcome. Multivariable analysis revealed that a continuous metric of GNRI was associated with the primary outcome after adjusting for multiple confounders (adjusted hazard ratio, 0.76 per 1 standard deviation increment; 95% confidence interval, 0.66-0.87; < 0.01). Follow-up GNRI values were available in 234 patients (29.2%). Patients with a decreased GNRI over time had higher rates of the composite outcome than those with preserved GNRI (adjusted hazard ratio, 3.83; 95% confidence interval, 1.97-7.43; < 0.01).
Patients with AFMR and malnutrition represent a vulnerable population with worse clinical outcomes.
在本研究中，我们试图描述心房功能性二尖瓣反流（AFMR）患者营养不良的患病率、临床特征和结局。
这项多中心观察性研究纳入了802例诊断为AFMR的患者。老年营养风险指数（GNRI）被用作营养风险指标。根据GNRI将患者分为4组：正常（>98；n = 342）、轻度营养风险（92 - 98；n = 196）、中度风险（82至<92；n = 166）和重度风险（<82；n = 98）。主要结局是心力衰竭入院和全因死亡的复合结局。
57%的AFMR患者存在至少轻度营养风险（GNRI≤98）。GNRI较低的患者年龄较大，体重指数、血红蛋白水平和肾功能较低，纽约心脏协会III或IV级、痴呆和日常生活活动受损的患病率较高。在978天（四分位间距，492 - 1141天）的中位随访期内，观察到254例主要结局。营养不良风险类别严重程度增加与主要结局发生率较高相关。多变量分析显示，在调整多个混杂因素后，GNRI的连续指标与主要结局相关（调整后风险比，每增加1个标准差为0.76；95%置信区间，0.66 - 0.87；P<0.01）。234例患者（29.2%）有随访GNRI值。随时间GNRI降低的患者复合结局发生率高于GNRI保持不变的患者（调整后风险比，3.83；95%置信区间，1.97 - 7.43；P<0.01）。
AFMR和营养不良患者是临床结局较差的脆弱人群。
