Prevalence and Prognostic Significance of Malnutrition Risk in Patients with Valvular Heart disease: Insight from the China-VHD Study

Background Previous studies on the prevalence and prognosis of nutritional status in valvular heart disease (VHD) were primarily limited to aortic valve stenosis. The nutritional status of other types of VHDs remained an underexplored area. This study aimed to evaluate the prevalence of malnutrition risk in different types of VHD and investigate the association between malnutrition risk and adverse clinical events. Methods A total of 8,908 patients with moderate or severe VHD in the China-VHD Study underwent echocardiography and malnutrition risk assessment using the geriatric nutritional risk index (GNRI). The primary outcome was 2-year all-cause mortality, while the secondary outcome was 2-year major adverse cardiovascular events (MACEs). Results Among 8,908 patients (mean age 61.8±13.4 years; 56% male), approximately half were at risk for malnutrition. Patients with moderate or severe malnutrition risk had significantly higher risks of all-cause death and MACEs in various VHDs compared to those without malnutrition risk (all p<0.02). The strongest association was detected in patients with tricuspid regurgitation (mortality: hazard ratio [HR], 3.18, 95% confidence interval (CI), 1.99-5.10, p<0.001; MACEs: HR, 2.33, 95% CI, 1.58-3.44, p<0.001). Adding GNRI score to the European System for Cardiac Operative Risk Evaluation improved risk stratification and outcome prediction (C-statistic p<0.001; likelihood ratio test p<0.001). Conclusion Malnutrition risk was prevalent in various VHDs and was strongly associated with increased mortality and MACEs. The GNRI score provided incremental prognostic information for clinical outcomes. Future research is needed to evaluate the impact of nutritional interventions on outcomes in these vulnerable patients. What is known - Malnutrition is a prevalent condition among patients with aortic valve stenosis, and it represents a significant modifiable factor associated with adverse clinical outcomes. - Nutritional screening tools is effective in identifying malnutrition in patients with aortic valve stenosis, but its usefulness for other types of valvular heart disease (VHD) is still unclear. What the study adds -Malnutrition risk, as determined by geriatric nutritional risk index (GNRI), was prevalent in patients with all types of VHD. - Compared with patients without malnutritional risk, those with moderate or severe malnutritional risk had a significantly increased risk of all-cause death and major adverse cardiovascular events (MACEs) in various types of VHDs, irrespective of body mass index and cardiac function. - The addition of GNRI to the European System for Cardiac Operative Risk Evaluation (EuroSCORE II) amplified the stratification of patients at risk and improved outcome prediction.