A New Insight into Prognostic Factors in Heart Failure with Preserved Ejection Fraction -Prognostic Significance of Nutritional Assessment-

Abstract

Background: Clinical significance of nutritional assessment in heart failure with preserved ejection fraction (HFPEF) remains undefined. Geriatric nutritional risk index (GNRI) is a simple nutritional assessment tool for hospitalized elderly patients. We evaluated its clinical usefulness in patients with HFPEF who were predominantly prevalent in the elderly population.Methods: The present study enrolled 135 patients who were hospitalized with HFPEF (LVEF$40%) from January 2004 to December 2010. GNRI on admission was calculated as follows; 14.893(serum albumin) (g/dl)+41.73(body mass index/22), Low GNRI (#88) was defined by cutoff value that predicts all-cause mortality in this population. Results: Mean age was 76611 years, and 52.6% was male. During mean follow-up of 2.461.3 years, 49 patients died. Low GNRI (36.3%) was associated with lower levels of hemoglobin and sodium, and higher levels of BUN, creatinine, and BNP compared to high GNRI (p!0.05, respectively). The incidence of malnutrition-related complications, including infection and reduced physical activity (Barthel index #60), was significantly higher in low GNRI group than high GNRI group (p!0.05, respectively). On stepwise cox hazard analysis, lower GNRI was an independent predictor of all-cause mortality as well as advanced age, previous histrory of HF hospitalization, and higher levels of BUN and BNP (HR:0.943 (0.914-0.974), p!0.001). Conclusions: GNRI is a simple index for predicting malnutrition-related complications and mortality in patients with HFPEF.