Relationship between malnutrition and coronary microvascular dysfunction in patients with nonischemic dilated cardiomyopathy

Tolga Sinan Güvenç,Mustafa Çalişkan,Şeref Kul

doi:10.3906/sag-2003-239

Tolga Sinan Güvenç, Mustafa Çalişkan + Show 1 more

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https://doi.org/10.3906/sag-2003-239

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Abstract

Background/ aimMalnutrition is common in patients with nonischemic dilated cardiomyopathy (DCM), especially in the end stages of the disease where heart failure symptoms predominate. Malnutrition has been associated with atherosclerosis in patients with chronic kidney disease, but it is unknown whether a similar relationship exists between malnutrition and coronary microvascular dysfunction (CMD). In the present study, we aimed to analyse whether indices of malnutrition were associated with coronary flow reserve (CFR) in patients with DCM.Materials and methodsA total of 33 cases who were prospectively followed up with by institutional DCM registry were found eligible for inclusion. Coronary flow reserve was measured with transthoracic echocardiography from the left anterior descending artery. The study sample was divided into 2 groups using a CFR cut-off value of 2.0. Geriatric nutritional index (GNI), prognostic nutritional index (PNI), and C-reactive protein/albumin ratio (CAR) were calculated.ResultsA total of 17 out of 33 cases (51.5%) had a low (<2.0) CFR. Both GNI and PNI were similar between the 2 groups, but the inflammatory–nutritional parameter CAR was significantly higher in those with a low CFR (1.18 ± 0.64 vs. 0.54 ± 0.28, P < 0.001). CA remained an independent predictor of CFR on multivariate regression (β = 0.65, P < 0.001) after adjustment for demographic (age, sex, body mass index), nutritional (GNI, PNI, albumin), and inflammatory (C-reactive protein) parameters. For a cut-off value of 0.80, CAR had a sensitivity of 85.7% and specificity of 73.6% to predict a CFR <2.0 (AUC: 0.835, 95%CI: 0.693–0.976, P = 0.001).ConclusionsOur findings indicate that not malnutrition per se but a combination of inflammation activation and malnutrition is predictive of CMD in patients with DCM.

Highlights

Nonischemic dilated cardiomyopathy (DCM) is the final consequence of various pathologic processes that cause myocardial damage and is a common cause of heart failure (HF) syndrome
C-reactive protein/albumin ratio (CAR) remained an independent predictor of coronary flow reserve (CFR) on multivariate regression (β = 0.65, P < 0.001) after adjustment for demographic, nutritional (GNI, prognostic nutritional index (PNI), albumin), and inflammatory (C-reactive protein) parameters
For a cut-off value of 0.80, CAR had a sensitivity of 85.7% and specificity of 73.6% to predict a CFR

Summary

Introduction

Nonischemic dilated cardiomyopathy (DCM) is the final consequence of various pathologic processes that cause myocardial damage and is a common cause of heart failure (HF) syndrome. DCM excludes significant epicardial coronary disease or previous myocardial infarction as the cause of initial myocardial insult, but a reduced coronary flow reserve (CFR) is observed in a fraction of DCM patients [1,2]. This reduction in coronary flow reserve (CFR) is explained by coronary microvascular dysfunction (CMD), which is secondary to structural alterations, elevated left ventricular end-diastolic pressure externally compressing intramyocardial arterioles and capillaries, and endothelial dysfunction (ED) due to reduced bioavailability of nitric oxide and formation of free radicals [3]. Data in patients with chronic kidney disease (CKD) undergoing dialysis suggest such an association, which is

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