Clinical Impact of Early Nutritional Reversibility After Mitral Valve Transcatheter Edge-to-Edge Repair

Background

Mitral valve transcatheter edge-to-edge repair (M-TEER) is an established effective treatment for patients with mitral regurgitation. The Geriatric Nutritional Risk Index (GNRI) is a well-known nutritional marker that predicts mortality risk; however, no reports clarify the clinical impact of GNRI reversibility after M-TEER.

Objectives

The purpose of this study was to investigate the association between GNRI reversibility and clinical outcomes after M-TEER and identify factors predicting early GNRI improvement.

Methods

Data from 1,909 patients enrolled in the Japanese multicenter registry whose GNRI values were measured before and 1 month after undergoing M-TEER were retrospectively reviewed. Changes in GNRI (Δ-GNRI) were calculated and divided into two groups, namely improved GNRI (Δ-GNRI >0) and worsening GNRI (Δ-GNRI ≤0) groups. Multivariate logistic regression analysis was performed to explore factors associated with improvement in Δ-GNRI. Cox regression analysis was used to examine associations with long-term all-cause mortality or composite outcome.

Results

Among the 1,909 patients, GNRI improved in 54.8% of patients. The median follow-up period was 1.3 years; 433 patients died during the follow-up period. The Δ-GNRI improvement was significantly associated with younger age, achievement of acute procedural success, lower high-sensitivity C-reactive protein, and preprocedural high GNRI value (all P < 0.05), and was significantly associated with a lower risk of death and composite outcome.

Conclusions

The Δ-GNRI is a useful predictor of long-term prognosis, with reversibility observed in half of patients after M-TEER. Improvement in Δ-GNRI is associated with acute procedural success, underscoring the importance of assessing the potential for procedural success before M-TEER.