心房功能性二尖瓣反流营养不良的特点

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open Pub Date : 2025-08-01 DOI:10.1016/j.cjco.2025.05.007

Tsukasa Murakami MD, PhD , Nobuyuki Kagiyama MD, PhD , Tomohiro Kaneko MD, PhD , Kazuki Kagami MD, PhD , Masashi Amano MD, PhD , Taiji Okada MD, PhD , Yukio Sato MD, PhD , Yohei Ohno MD, PhD , Kimi Sato MD, PhD , Kojiro Morita MPH, PhD, RN, PHN , Tomoko Machino-Ohtsuka MD, PhD , Yukio Abe MD, PhD , Hideki Ishii MD, PhD , Masaru Obokata MD, PhD

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引用次数: 0

摘要

在本研究中，我们试图描述心房功能性二尖瓣反流（AFMR）患者营养不良的患病率、临床特征和结局。方法本多中心观察性研究纳入802例诊断为AFMR的患者。采用老年营养风险指数（GNRI）作为营养风险指标。根据GNRI将患者分为4组：正常组(>；98年;N = 342)，轻度营养风险(92-98；N = 196)，中度风险(82至<；92年;N = 166)，严重风险(<；82年;N = 98)。主要转归是心力衰竭入院和全因死亡的综合转归。结果57%的AFMR患者存在最小轻度营养风险（GNRI≤98）。GNRI较低的患者年龄较大，身体质量指数、血红蛋白水平和肾功能较低，纽约心脏协会III类或IV类、痴呆和日常生活活动受损的患病率较高。中位随访时间为978天（四分位数间距为492-1141天），共观察到254个主要结局。营养不良风险类别的严重程度增加与主要结局的高发生率相关。多变量分析显示，调整多个混杂因素后，GNRI的连续指标与主要结局相关(调整风险比，0.76 / 1标准差增量；95%置信区间为0.66-0.87；P & lt;0.01)。234例（29.2%）患者可获得随访GNRI值。随着时间的推移，GNRI下降的患者比GNRI保持不变的患者具有更高的复合结局发生率(校正风险比，3.83；95%置信区间为1.97-7.43；P & lt;0.01)。结论AFMR合并营养不良患者是临床预后较差的弱势人群。

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Characterization of Malnutrition in Atrial Functional Mitral Regurgitation

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).