Malnutrition, congestion and mortality in ambulatory patients with heart failure

Sze, Shirley and Pellicori, Pierpaolo and Zhang, Jufen and Clark, Andrew L. (2019) Malnutrition, congestion and mortality in ambulatory patients with heart failure. Heart, 105 (4). pp. 297-306. ISSN 1468-201X

[img] Text
Accepted Version
Available under the following license: Creative Commons Attribution Non-commercial No Derivatives.

Download (176kB)
[img] Other (Acceptance)
Other
Restricted to Repository staff only

Download (114kB)
Official URL: http://dx.doi.org/10.1136/heartjnl-2018-313312

Abstract

Background: In patients with chronic heart failure (CHF), malnutrition might be related to right heart dysfunction and venous congestion, which predispose to bowel oedema and malabsorption, thereby leading to malnutrition. We explored the relation between congestion, malnutrition and mortality in a large cohort of ambulatory patients with CHF. Methods: We assessed malnutrition using the Geriatric Nutritional Risk Index (GNRI). Congestion was defined by echocardiography (raised right atrial pressure (RAP)=dilated inferior vena cava≥21 mm/raised pulmonary artery systolic pressure (PAsP)=transtricuspid gradient of ≥36 mm Hg/right ventricular systolic dysfunction (RVSD)=tricuspid annular plane systolic excursion <17 mm). Results: Of the 1058 patients enrolled, CHF was confirmed in 952 (69% males, median age 75 (IQR: 67–81) years, median N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) 1141 (IQR: 465–2562) ng/L). 39% had HF with -reduced ejection fraction (left ventricular ejection fraction, LVEF <40%) and 61% had HF with normal (HeFNEF, LVEF ≥40% and NT-pro-BNP >125 ng/L) ejection fraction. Overall, 14% of patients were malnourished (GNRI ≤98). 35% had raised RAP, 23% had raised PAsP and 38% had RVSD. Congestion was associated with malnutrition. During a median follow-up of 1683 days (IQR: 1096–2230 days), 461 (44%) patients died. Malnutrition was an independent predictor of mortality. Patients who were malnourished with both RVSD and increased RAP had much worse outcome compared with non-malnourished patients without RVSD who had normal RAP. Conclusion: Malnutrition and congestion are modestly correlated and each is independently associated with increased mortality in patients with CHF. Patients with HF with both malnutrition and congestion as evidenced by right heart dysfunction should be managed with additional vigilance.

Item Type: Journal Article
Keywords: echocardiography, heart failure
Faculty: Faculty of Medical Science
SWORD Depositor: Symplectic User
Depositing User: Symplectic User
Date Deposited: 10 Sep 2018 14:33
Last Modified: 11 Feb 2019 14:26
URI: http://arro.anglia.ac.uk/id/eprint/703555

Actions (login required)

Edit Item Edit Item