Abstract 15431: Impact of Malnutrition as a Key Prognostic Factor in Patients With Heart Failure With Preserved Ejection Fraction

Abstract

Background: Malnutrition is one of the unfavorable prognostic factors in patients with heart failure (HF). Prevalence of HF with preserved ejection fraction (PEF) (defined as left ventricular ejection fraction >50%) has been increased and there is an obvious association between HF-PEF and hypertension, diabetes mellitus, and insulin resistance. However, association between malnutrition and clinical outcomes in patients with HFPEF remains to be elucidated. Methods and Results: We evaluated controlling nutritional status score (CONUT), prognostic nutritional index (PNI), and geriatric nutritional risk index (GNRI) in 190 patients with HFPEF (mean 69.9 ± 11.6 years) admitted to our hospital. Patients were prospectively followed with the endpoints being cardiovascular death or rehospitalization. There were 56 events including 14 deaths and 42 rehospitalizations during a median follow-up of 14.0 months. Patients with cardiac events showed more severe New York Heart Association (NYHA) functional class and lower left ventricular ejection fraction (LVEF) compared with those without. Total lymphocyte count, serum albumin, and total cholesterol level were lower in patients with cardiac events. Patients with cardiac events showed higher CONUT score (6 vs 2, P<0.001), lower PNI (30.4 vs 38.9, P<0.001), and lower GNRI (84.9 vs 96.3, P<0.001) compared with those who without. The correlations between each nutritional index and clinical parameters were examined. CONUT score, PNI, and GNRI correlated with age, LVEF, and serum brain natriuretic peptide (BNP) level. In Cox proportional hazards analysis, higher CONUT score (adjusted hazard ratio 9.0, 95% confidence interval (CI) 3.2-25.2), lower PNI (3.6, 1.7-7.7), and lower GNRI (6.3, 2.7-14.9) were independently associated with cardiac events after adjustment of age, gender, NYHA functional class, and serum BNP level. Kaplan-Meier analysis revealed that significantly higher cardiac event rate was observed in the patients with malnutrition (log-rank test, P<0.001). Conclusion: Malnutrition was associated with unfavorable outcomes in patients with HFPEF. Evaluating nutritional status may provide valuable prognostic information in patients with HFPEF.