Low prognostic nutritional index is associated with adverse outcomes in patients with hypertrophic cardiomyopathy

Abstract

Aim: The aim of the study was to investigate poor nutritional status assessed by prognostic nutritional index (PNI) on the prognosis of patients with hypertrophic cardiomyopathy(HCM).
Material and Methods: A total of 420 patients with HCM were assessed. The primary end point was defined as the occurrence of CV death that included sudden cardiac death (SCD), death due to HF and cardioembolic stroke-related death.
Results: During the follow-up, primary end point was developed in 25 (6.0%) patients. Receiver operating characteristic (ROC) analysis showed that using a cut-off level of 40, PNI predicted the occurrence of primary end point with a sensitivity of 76% and specificity of 76.7%. In the multivariate model, low PNI was significant predictor of the primary end point.
Conclusion: This study showed that lowerPNI level is an independent predictor of CV death in patients with HCM.

Keywords

• cardiovascular death,hypertrophic cardiomyopathy,prognostic nutritional index

Düşük prognostik nütrisyonel indeks hipertrofik kardiyomiyopatili hastalarda kötü sonuçlar ile ilişkilidir

Abstract

Amaç: Çalışmanın amacı prognostik beslenme indeksi (PNI) ile değerlendirilen zayıf beslenme durumunun, hipertrofik kardiyomiyopatili (HKMP) hastaların prognozu üzerine etkisini araştırmaktır.
Gereç ve Yöntemler: Toplam 420 HKMP hastası değerlendirildi. Çalışmanın birincil sonlanım noktası, ani kardiyak ölüm (AKÖ), kalp yetmezliği (KY) nedenli ölüm ve kardiyo embolik inme ilişkili ölümü içeren kardiyovasküler ölüm saptanması olarak tanımlandı.
Bulgular: Takip süresi boyunca 25 (% 6.0) hastada birincil sonlanım noktası saptandı. ROC (Receiver operating characteristic curve) analizi, PNİ kesme seviyesi 40 kullanarak PNİ’nin % 76 hassasiyet ve% 76.7 özgüllük ile birincil son nokta oluşumunu öngördüğünü gösterdi. Tek değişkenli ve çok değişkenli modelde düşük PNİ değeri, primer sonlanım noktası için önemli bir belirleyici olarak saptandı.
Sonuç: Bu çalışma, düşük PNİ düzeyinin HKMP hastalarında KV ölümün bağımsız bir öngördürücüsü olduğunu göstermiştir.

Keywords

• kardiyovasküler ölüm,hipertrofik kardiyomiyopati,prognostik nütrisyonel indeks

References

1. 1. Maron BJ, Towbin JA, Thiene G et al. Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation 2006; 113: 1807-16.
2. 2. Maron BJ. Hypertrophic cardiomyopathy: a systematic review. Jama 2002; 287: 1308-20.
3. 3. Elliott PM, Poloniecki J, Dickie S, Sharma S, Monserrat L, Varnava A, Mahon NG, McKenna WJ. Sudden death in hypertrophic cardiomyopathy: identification of high risk patients. Journal of the American College of Cardiology 2000; 36: 2212-8.
4. 4. Spirito P, Bellone P, Harris KM, Bernabo P, Bruzzi P, Maron BJ. Magnitude of left ventricular hypertrophy and risk of sudden death in hypertrophic cardiomyopathy. The New England journal of medicine 2000; 342: 1778-85.
5. 5. Harris KM, Spirito P, Maron MS et al. Prevalence, clinical profile, and significance of left ventricular remodeling in the end-stage phase of hypertrophic cardiomyopathy. Circulation 2006; 114: 216-25.
6. 6. Ekizler FA, Cay S, Acar B et al. Monocyte to high-density lipoprotein cholesterol ratio predicts adverse cardiac events in patients with hypertrophic cardiomyopathy. Biomarkers in medicine 2019; 13: 1175-86.
7. 7. Matsumori A, Yamada T, Suzuki H, Matoba Y, Sasayama S. Increased circulating cytokines in patients with myocarditis and cardiomyopathy. British heart journal 1994; 72: 561-6.
8. 8. Zen K, Irie H, Doue T, Takamiya M, Yamano T, Sawada T, Azuma A, Matsubara H. Analysis of circulating apoptosis mediators and proinflammatory cytokines in patients with idiopathic hypertrophic cardiomyopathy: comparison between nonobstructive and dilated-phase hypertrophic cardiomyopathy. International heart journal 2005; 46: 231-44.

9. 9. Ozyilmaz S, Akgul O, Uyarel H et al. The importance of the neutrophil-to-lymphocyte ratio in patients with hypertrophic cardiomyopathy. Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology 2017; 36: 239-46.
10. 10. Pocock SJ, Ariti CA, McMurray JJ et al. Predicting survival in heart failure: a risk score based on 39 372 patients from 30 studies. Eur Heart J 2013; 34: 1404-13.
11. 11. Oreopoulos A, Padwal R, Kalantar-Zadeh K, Fonarow GC, Norris CM, McAlister FA. Body mass index and mortality in heart failure: a meta-analysis. Am Heart J 2008; 156: 13-22.
12. 12. Jeon HG, Choi DK, Sung HH, Jeong BC, Seo SI, Jeon SS, Choi HY, Lee HM. Preoperative Prognostic Nutritional Index is a Significant Predictor of Survival in Renal Cell Carcinoma Patients Undergoing Nephrectomy. Ann Surg Oncol 2016; 23: 321-7.
13. 13. Zhu L, Zou Y, Wang Y et al. Prognostic Significance of Plasma High-Sensitivity C-Reactive Protein in Patients With Hypertrophic Cardiomyopathy. Journal of the American Heart Association 2017; 6: 4529
14. 14. Pasqualucci D, Fornaro A, Castelli G et al. Clinical Spectrum, Therapeutic Options, and Outcome of Advanced Heart Failure in Hypertrophic Cardiomyopathy. Circulation Heart failure 2015; 8: 1014-21.
15. 15. Maron BJ, Maron MS. Contemporary strategies for risk stratification and prevention of sudden death with the implantable defibrillator in hypertrophic cardiomyopathy. Heart rhythm 2016; 13: 1155-65.
16. 16. Mutlu B, Bayrak F, Kahveci G, Degertekin M, Eroglu E, Basaran Y. Usefulness of N-terminal pro-B-type natriuretic peptide to predict clinical course in patients with hypertrophic cardiomyopathy. The American journal of cardiology 2006; 98: 1504-6.
17. 17. Hogye M, Mandi Y, Csanady M, Sepp R, Buzas K. Comparison of circulating levels of interleukin-6 and tumor necrosis factor-alpha in hypertrophic cardiomyopathy and in idiopathic dilated cardiomyopathy. The American journal of cardiology 2004; 94: 249-51.
18. 18. Iwasaki J, Nakamura K, Matsubara H et al. Relationship between circulating levels of monocyte chemoattractant protein-1 and systolic dysfunction in patients with hypertrophic cardiomyopathy. Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology 2009; 18: 317-22.
19. 19. Nishioka S, Okamoto T, Takayama M, Urushihara M, Watanabe M, Kiriya Y, Shintani K, Nakagomi H, Kageyama N. Malnutrition risk predicts recovery of full oral intake among older adult stroke patients undergoing enteral nutrition: Secondary analysis of a multicentre survey (the APPLE study). Clin Nutr 2017; 36: 1089-96.
20. 20. Buzby GP, Mullen JL, Matthews DC, Hobbs CL, Rosato EF. Prognostic nutritional index in gastrointestinal surgery. Am J Surg 1980; 139: 160-7.
21. 21. Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi 1984; 85: 1001-5.
22. 22. He Q, Huang Y, Wan G et al. A novel prognostic marker based on risk stratification with prognostic nutritional index and age for nasopharyngeal carcinoma patients who received neoadjuvant chemotherapy. Biomarkers in medicine 2019; 13: 1013-23.
23. 23. Honda Y, Nagai T, Iwakami N et al. Usefulness of Geriatric Nutritional Risk Index for Assessing Nutritional Status and Its Prognostic Impact in Patients Aged >/=65 Years With Acute Heart Failure. The American journal of cardiology 2016; 118: 550-5.
24. 24. Cheng YL, Sung SH, Cheng HM, Hsu PF, Guo CY, Yu WC, Chen CH. Prognostic Nutritional Index and the Risk of Mortality in Patients With Acute Heart Failure. Journal of the American Heart Association 2017; 6: 4876
25. 25. Zencirkiran Agus H, Kahraman S. Prognostic nutritional index predicts one-year outcome in heart failure with preserved ejection fraction. Acta cardiologica 2019:1-6.
26. 26. Hayiroglu MI, Keskin M, Keskin T, Uzun AO, Altay S, Kaya A, Oz A, Cinier G, Guvenc TS, Kozan O. A Novel Independent Survival Predictor in Pulmonary Embolism: Prognostic Nutritional Index. Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis 2018; 24: 633-9.
27. 27. Wada H, Dohi T, Miyauchi K et al. Relationship between the prognostic nutritional index and long-term clinical outcomes in patients with stable coronary artery disease. Journal of cardiology 2018; 72: 155-61.
28. 28. Keskin M, Hayiroglu MI, Keskin T et al. A novel and useful predictive indicator of prognosis in ST-segment elevation myocardial infarction, the prognostic nutritional index. Nutrition, metabolism, and cardiovascular diseases : NMCD 2017; 27: 438-46.
29. 29. Ancion A, Allepaerts S, Robinet S, Oury C, Pierard LA, Lancellotti P. Serum albumin level and long-term outcome in acute heart failure. Acta cardiologica 2019; 74: 465-71.
30. 30. Polat N, Aydin M, Yildiz A, Acet H, Akil MA, Bilik MZ, Demir M, Isik MA, Kaya H, Alan S. The prognostic significance of serum albumin in patients with acute decompensated systolic heart failure. Acta cardiologica 2014; 69: 648-54.
31. 31. Melacini P, Basso C, Angelini A et al. Clinicopathological profiles of progressive heart failure in hypertrophic cardiomyopathy. Eur Heart J 2010; 31: 2111-23.
32. 32. Nagai T, Yoshikawa T, Saito Y, Takeishi Y, Yamamoto K, Ogawa H, Anzai T, Investigators J. Clinical Characteristics, Management, and Outcomes of Japanese Patients Hospitalized for Heart Failure With Preserved Ejection Fraction- A Report From the Japanese Heart Failure Syndrome With Preserved Ejection Fraction (JASPER) Registry. Circulation journal : official journal of the Japanese Circulation Society 2018; 82: 1534-45.
33. 33. Ommen SR, Hodge DO, Rodeheffer RJ, McGregor CG, Thomson SP, Gibbons RJ. Predictive power of the relative lymphocyte concentration in patients with advanced heart failure. Circulation 1998; 97: 19-22.