Abstract
BACKGROUND: In this study we sought to characterize the prevalence, clinical characteristics, and outcomes of malnutrition in patients with atrial functional mitral regurgitation (AFMR). METHODS: This multicentre, observational study included 802 patients diagnosed with AFMR. The Geriatric Nutritional Risk Index (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. RESULTS: 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; P < 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; P < 0.01). CONCLUSIONS: Patients with AFMR and malnutrition represent a vulnerable population with worse clinical outcomes.