Prevalence and Prognostic Significance of Malnutrition Risk in Patients With Valvular Heart Disease

Previous studies on the prevalence and prognosis of nutritional status in valvular heart disease (VHD) were primarily limited to aortic stenosis. The nutritional status of other types of VHDs remained an underexplored area.

This study aimed to evaluate the prevalence of malnutrition risk in different types of VHD and investigate the association between malnutrition risk and adverse clinical events.

A total of 8,908 patients with moderate or severe VHD in the China-VHD Study underwent echocardiography and malnutrition risk assessment using the geriatric nutritional risk index (GNRI). The primary outcome was 2-year all-cause mortality, while the secondary outcome was 2-year major adverse cardiovascular events (MACEs).

Among 8,908 patients (mean age 61.8 ± 13.4 years; 56% male), approximately half were at risk for malnutrition. Patients with moderate or severe malnutrition risk had significantly higher risks of all-cause death and MACEs in various VHDs than those without malnutrition risk (all P < 0.02). The strongest association was detected in patients with tricuspid regurgitation (mortality, HR: 3.18, 95% CI: 1.99 to 5.10, P < 0.001; MACEs, HR: 2.33, 95% CI: 1.58 to 3.44, P < 0.001). Adding GNRI score to the European System for Cardiac Operative Risk Evaluation improved risk stratification and outcome prediction (C-statistic P < 0.001; likelihood ratio test P < 0.001).

Malnutrition risk was prevalent in various VHDs and was strongly associated with increased mortality and MACEs. The GNRI score provided incremental prognostic information for clinical outcomes. Future research is needed to evaluate the impact of nutritional interventions on outcomes in these vulnerable patients.