Characterization of Malnutrition in Atrial Functional Mitral Regurgitation

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 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.

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).

Patients with AFMR and malnutrition represent a vulnerable population with worse clinical outcomes.