Association between nutritional status and heart failure with improved ejection fraction

A proportion of patients with heart failure with reduced ejection fraction (HFrEF) may experience an improvement in ejection fraction, termed HFimpEF. Malnutrition is a common condition associated with adverse prognosis in HF patients. However, the association between nutritional status and HFimpEF remains unclear.

A total of 1057 hospitalized patients with HFrEF were retrospectively enrolled. Patients were grouped into HFimpEF (defined as follow-up EF>40 % and ≥10 % absolute increase) or persistent HFrEF. Nutritional status was assessed by prognostic nutritional index (PNI), geriatric nutritional risk index (GNRI) and controlling nutritional status index (CONUT). Logistic regression and restricted cubic splines were conducted to assess the association between nutritional status and HFimpEF. Among 1057 patients (mean age 64.00 years, 72.94 % male), 418 (39.55 %) developed HFimpEF. After multivariate adjustment, a per-score increase of nutritional indices was associated with HFimpEF [PNI, OR (95 % CI): 1.03 (1.01-1.06); GNRI, OR (95 % CI): 1.02 (1.01-1.04); CONUT, OR (95 % CI): 0.89 (0.83-0.96)]. The restricted cubic splines revealed linear associations between nutritional indices and HFimpEF (P for non-linearity >0.05). The addition of the CONUT score to the basic model had the most significant incremental effect on the prediction for HFimpEF [area under the curve = 0.698; continuous net reclassification improvement: 0.191 (0.068-0.313); integrated discrimination improvement: 0.009 (0.004-0.015)].

Malnutrition is associated with the development of HFimpEF. Assessment of nutritional status may provide incremental value for the prediction of HFimpEF.