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Malnutrition, hemodynamics and inflammation in heart failure with reduced, mildly reduced and preserved ejection fraction

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Abstract

In patients with heart failure (HF) with reduced ejection fraction (HFrEF), malnutrition can be associated with intestinal congestion and systemic inflammation. These relationships have not been fully investigated in HF with mildly reduced EF (HFmrEF) and with preserved EF (HFpEF). We analyzed 420 patients with HF who underwent right heart catheterization. The relationships between hemodynamic parameters, C-reactive protein, and the controlling nutritional (CONUT) score were investigated in HFrEF, HFmrEF and HFpEF. The CONUT score of all patients was 2 [1, 4] (median [interquartile range]), and was not significantly different between the left ventricular EF (LVEF) categories (2 [1, 3] for HFrEF, 2 [1, 3] for HFmrEF, and 3 [1, 4] for HFpEF, p = 0.279). In multivariate linear regression analyses, there was a significant association between CRP and the CONUT score in HFmrEF and HFpEF, while brain natriuretic peptide and right atrial pressure were significantly associated with the CONUT score in HFrEF. Higher CONUT scores predicted a higher incidence of the composite endpoint of death or HF hospitalization within 12 months without an interaction with LVEF (p = 0.980). The CONUT score was an independent predictor of the composite endpoint, death, and HF hospitalization after adjustment for confounders in the multivariate analysis. In conclusion, inflammation was associated with malnutrition in HFmrEF and HFpEF, while congestion was an independent predictor of malnutrition in HFrEF. Malnutrition predicted worse outcomes regardless of LVEF.

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References

  1. Anker SD, Negassa A, Coats AJ, Afzal R, Poole-Wilson PA, Cohn JN, Yusuf S (2003) Prognostic importance of weight loss in chronic heart failure and the effect of treatment with angiotensin-converting-enzyme inhibitors: an observational study. Lancet 361(9363):1077–1083

    Article  CAS  Google Scholar 

  2. Horiuchi Y, Tanimoto S, Okuno T, Aoki J, Yahagi K, Sato Y, Tanaka T, Koseki K, Komiyama K, Nakajima H, Hara K, Tanabe K (2018) Hemodynamic correlates of nutritional indexes in heart failure. J Cardiol 71(6):557–563

    Article  Google Scholar 

  3. Santos NFD, Pinho CPS, Cardoso A, Mendes RML (2018) Cachexia in hospitalized patients with heart failure. Nutr Hosp 35(3):669–676

    PubMed  Google Scholar 

  4. Valentova M, Anker SD, von Haehling S (2020) Cardiac cachexia revisited: the role of wasting in heart failure. Heart Fail Clin 16(1):61–69

    Article  Google Scholar 

  5. Carr JG, Stevenson LW, Walden JA, Heber D (1989) Prevalence and hemodynamic correlates of malnutrition in severe congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol 63(11):709–713

    Article  CAS  Google Scholar 

  6. Krack A, Sharma R, Figulla HR, Anker SD (2005) The importance of the gastrointestinal system in the pathogenesis of heart failure. Eur Heart J 26(22):2368–2374

    Article  CAS  Google Scholar 

  7. Pasini E, Aquilani R, Testa C, Baiardi P, Angioletti S, Boschi F, Verri M, Dioguardi F (2016) Pathogenic gut flora in patients with chronic heart failure. JACC Heart Fail 4(3):220–227

    Article  Google Scholar 

  8. Horwich TB, Kalantar-Zadeh K, MacLellan RW, Fonarow GC (2008) Albumin levels predict survival in patients with systolic heart failure. Am Heart J 155(5):883–889

    Article  CAS  Google Scholar 

  9. Ignacio de Ulibarri J, Gonzalez-Madrono A, de Villar NG, Gonzalez P, Gonzalez B, Mancha A, Rodriguez F, Fernandez G (2005) CONUT: a tool for controlling nutritional status. First validation in a hospital population. Nutr Hosp 20(1):38–45

    CAS  PubMed  Google Scholar 

  10. Ommen SR, Hodge DO, Rodeheffer RJ, McGregor CG, Thomson SP, Gibbons RJ (1998) Predictive power of the relative lymphocyte concentration in patients with advanced heart failure. Circulation 97(1):19–22

    Article  CAS  Google Scholar 

  11. Rauchhaus M, Clark AL, Doehner W, Davos C, Bolger A, Sharma R, Coats AJ, Anker SD (2003) The relationship between cholesterol and survival in patients with chronic heart failure. J Am Coll Cardiol 42(11):1933–1940

    Article  CAS  Google Scholar 

  12. Ferrari R, Fucili A, Rapezzi C (2020) Understanding the results of the PARAGON-HF trial. Eur J Heart Fail 22(9):1531–1535

    Article  Google Scholar 

  13. Paulus WJ, Tschope C (2013) A novel paradigm for heart failure with preserved ejection fraction: comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation. J Am Coll Cardiol 62(4):263–271

    Article  Google Scholar 

  14. Peterson PN, Rumsfeld JS, Liang L et al (2010) A validated risk score for in-hospital mortality in patients with heart failure from the American Heart Association get with the guidelines program. Circ Cardiovasc Qual Outcomes 3:25–32

    Article  Google Scholar 

  15. Pocock SJ, Ariti CA, McMurray JJV et al (2013) Predicting survival in heart failure: a risk score based on 39 372 patients from 30 studies. Eur Heart J 34:1404–1413

    Article  Google Scholar 

  16. Alibay Y, Schmitt C, Beauchet A, Dubourg O, Alexandre JA, Boileau C, Jondeau G, Puy H (2005) Non-radioimmunometric NT-ProBNP and BNP assays: impact of diluent, age, gender, BMI. Ann Biol Clin (Paris) 63(1):43–49

    CAS  Google Scholar 

  17. Chien SC, Lo CI, Lin CF, Sung KT, Tsai JP, Huang WH, Yun CH, Hung TC, Lin JL, Liu CY, Hou CJ, Tsai IH, Su CH, Yeh HI, Hung CL (2019) Malnutrition in acute heart failure with preserved ejection fraction: clinical correlates and prognostic implications. ESC Heart Fail 6(5):953–964

    Article  Google Scholar 

  18. Komorita T, Yamamoto E, Sueta D, Tokitsu T, Fujisue K, Usuku H, Nishihara T, Oike F, Takae M, Egashira K, Takashio S, Ito M, Yamanaga K, Arima Y, Sakamoto K, Suzuki S, Kaikita K, Tsujita K (2020) The controlling nutritional status score predicts outcomes of cardiovascular events in patients with heart failure with preserved ejection fraction. Int J Cardiol Heart Vasc 29:100563

    PubMed  PubMed Central  Google Scholar 

  19. Minamisawa M, Seidelmann SB, Claggett B, Hegde SM, Shah AM, Desai AS, Lewis EF, Shah SJ, Sweitzer NK, Fang JC, Anand IS, O’Meara E, Rouleau JL, Pitt B, Solomon SD (2019) Impact of malnutrition using geriatric nutritional risk index in heart failure with preserved ejection fraction. JACC Heart Fail 7(8):664–675

    Article  Google Scholar 

  20. Glezeva N, Baugh JA (2014) Role of inflammation in the pathogenesis of heart failure with preserved ejection fraction and its potential as a therapeutic target. Heart Fail Rev 19(5):681–694

    Article  CAS  Google Scholar 

  21. Anand IS, Latini R, Florea VG, Kuskowski MA, Rector T, Masson S, Signorini S, Mocarelli P, Hester A, Glazer R, Cohn JN, Val-He FTI (2005) C-reactive protein in heart failure: prognostic value and the effect of valsartan. Circulation 112(10):1428–1434

    Article  CAS  Google Scholar 

  22. Iwanaga Y, Nishi I, Furuichi S, Noguchi T, Sase K, Kihara Y, Goto Y, Nonogi H (2006) B-type natriuretic peptide strongly reflects diastolic wall stress in patients with chronic heart failure: comparison between systolic and diastolic heart failure. J Am Coll Cardiol 47(4):742–748

    Article  CAS  Google Scholar 

  23. Joaquin C, Alonso N, Lupon J, de Antonio M, Domingo M, Moliner P, Zamora E, Codina P, Ramos A, Gonzalez B, Rivas C, Cachero M, Puig-Domingo M, Bayes-Genis A (2020) Mini Nutritional Assessment Short Form is a morbi-mortality predictor in outpatients with heart failure and mid-range left ventricular ejection fraction. Clin Nutr 39(11):3395–3401

    Article  Google Scholar 

  24. Agra Bermejo RM, Gonzalez Ferreiro R, Varela Roman A, Gomez Otero I, Kreidieh O, Conde Sabaris P, Rodriguez-Manero M, Moure Gonzalez M, Seoane Blanco A, Virgos Lamela A, Garcia Castelo A, Gonzalez Juanatey JR (2017) Nutritional status is related to heart failure severity and hospital readmissions in acute heart failure. Int J Cardiol 230:108–114

    Article  Google Scholar 

  25. Iwakami N, Nagai T, Furukawa TA, Sugano Y, Honda S, Okada A, Asaumi Y, Aiba T, Noguchi T, Kusano K, Ogawa H, Yasuda S, Anzai T, Defi N (2017) Prognostic value of malnutrition assessed by controlling nutritional status score for long-term mortality in patients with acute heart failure. Int J Cardiol 230:529–536

    Article  Google Scholar 

  26. Kato T, Yaku H, Morimoto T, Inuzuka Y, Tamaki Y, Yamamoto E, Yoshikawa Y, Kitai T, Taniguchi R, Iguchi M, Kato M, Takahashi M, Jinnai T, Ikeda T, Nagao K, Kawai T, Komasa A, Nishikawa R, Kawase Y, Morinaga T, Su K, Kawato M, Seko Y, Inoko M, Toyofuku M, Furukawa Y, Nakagawa Y, Ando K, Kadota K, Shizuta S, Ono K, Sato Y, Kuwahara K, Ozasa N, Kimura T (2020) Association with Controlling Nutritional Status (CONUT) score and in-hospital mortality and infection in acute heart failure. Sci Rep 10(1):3320

    Article  CAS  Google Scholar 

  27. Narumi T, Arimoto T, Funayama A, Kadowaki S, Otaki Y, Nishiyama S, Takahashi H, Shishido T, Miyashita T, Miyamoto T, Watanabe T, Kubota I (2013) Prognostic importance of objective nutritional indexes in patients with chronic heart failure. J Cardiol 62(5):307–313

    Article  Google Scholar 

  28. Nochioka K, Sakata Y, Takahashi J, Miyata S, Miura M, Takada T, Fukumoto Y, Shiba N, Shimokawa H, Investigators C (2013) Prognostic impact of nutritional status in asymptomatic patients with cardiac diseases: a report from the CHART-2 Study. Circ J 77(9):2318–2326

    Article  Google Scholar 

  29. Dorsheimer L, Assmus B, Rasper T, Ortmann CA, Ecke A, Abou-El-Ardat K, Schmid T, Brune B, Wagner S, Serve H, Hoffmann J, Seeger F, Dimmeler S, Zeiher AM, Rieger MA (2019) Association of mutations contributing to clonal hematopoiesis with prognosis in chronic ischemic heart failure. JAMA Cardiol 4(1):25–33

    Article  Google Scholar 

  30. Lee MS, Duan L, Clare R, Hekimian A, Spencer H, Chen W (2018) Comparison of effects of statin use on mortality in patients with heart failure and preserved versus reduced left ventricular ejection fraction. Am J Cardiol 122(3):405–412

    Article  CAS  Google Scholar 

  31. Preiss D, Campbell RT, Murray HM, Ford I, Packard CJ, Sattar N, Rahimi K, Colhoun HM, Waters DD, LaRosa JC, Amarenco P, Pedersen TR, Tikkanen MJ, Koren MJ, Poulter NR, Sever PS, Ridker PM, MacFadyen JG, Solomon SD, Davis BR, Simpson LM, Nakamura H, Mizuno K, Marfisi RM, Marchioli R, Tognoni G, Athyros VG, Ray KK, Gotto AM, Clearfield MB, Downs JR, McMurray JJ (2015) The effect of statin therapy on heart failure events: a collaborative meta-analysis of unpublished data from major randomized trials. Eur Heart J 36(24):1536–1546

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumi-cho 1, Chiyoda-ku, Tokyo, 101-8643, Japan

    Yusuke Watanabe, Yu Horiuchi, Masaaki Nakase, Naoto Setoguchi, Taiki Ishizawa, Masahiro Sekiguchi, Hideaki Nonaka, Momoka Nakajima, Masahiko Asami, Kazuyuki Yahagi, Kota Komiyama, Hitomi Yuzawa, Jun Tanaka, Jiro Aoki & Kengo Tanabe

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  1. Yusuke Watanabe
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  2. Yu Horiuchi
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  3. Masaaki Nakase
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  4. Naoto Setoguchi
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Correspondence to Yu Horiuchi.

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Conflict of interest

Dr. Horiuchi received an honorarium from Otsuka Pharmaceutical, Novartis, Ono Pharmaceutical and AstraZeneca. Other authors have nothing to disclose.

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Watanabe, Y., Horiuchi, Y., Nakase, M. et al. Malnutrition, hemodynamics and inflammation in heart failure with reduced, mildly reduced and preserved ejection fraction. Heart Vessels 37, 1841–1849 (2022). https://doi.org/10.1007/s00380-022-02090-3

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  • DOI: https://doi.org/10.1007/s00380-022-02090-3

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