目的:老年营养风险指数(GNRI)是评估老年人营养状况的简单工具。本研究旨在探讨GNRI对接受心脏再同步化治疗(CRT)的心力衰竭(HF)患者的治疗反应和长期临床结局的临床意义。
方法:回顾性纳入我院接受CRT植入或升级的患者。GNRI及其三元与超声心动图反应的关联,全因死亡率或心脏移植,并调查了因HF而首次住院的情况。
结果:完全,纳入647例患者,年龄中位数为60[四分位距(IQR):52-67]岁,GNRI平均得分为107.9±23.7。GNRIT1,T2和T3组的超应答率显着增加(25.1%,29.8%与41.1%,P=0.002)。经多次调整后,GNRI较高的患者更有可能获得更好的LVEF改善(OR=1.13,95%CI:1.04-1.23,P=0.010)。较高的GNRI与全因死亡率或心脏植入风险较低(HR=0.95,95%CI:0.93-0.96,P<0.001)和HF住院风险较低(HR=0.96,95%CI:0.95-0.98,P<0.001)独立相关。纳入GNRI提高了基于传统模型的全因死亡率的可预测性,包括性,纽约心脏协会功能班,左束支传导阻滞,QRS减少,和N末端B型利钠肽前体水平(C统计学从0.785提高到0.813,P=0.007)。
结论:在接受CRT的HF患者中,较高的GNRI与较好的治疗反应和长期预后相关。评估CRT人群的营养状况对于潜在反应者的个性化选择是必要的。
OBJECTIVE: Geriatric Nutritional Risk Index (GNRI) is a simple tool for assessing the nutritional status of the aging population. This study aims to explore the clinical implication of GNRI on treatment response and long-term clinical outcomes in heart failure (HF) patients receiving cardiac resynchronization therapy (CRT).
METHODS: Patients who underwent CRT implantation or upgrade at our hospital were retrospectively included. The association of GNRI and its tertiles with the echocardiographic response, all-cause mortality or heart transplantation, and the first hospitalization due to HF were investigated.
RESULTS: Totally, 647 patients were enrolled, with a median age of 60 [Interquartile Range (IQR): 52-67] years and mean score of GNRI at 107.9 ± 23.7. Super-response rates increased significantly among the GNRI T1, T2, and T3 groups (25.1%, 29.8% vs. 41.1%, P = 0.002). Patients with higher GNRI were more likely to have better LVEF improvement after multiple adjustments (OR = 1.13, 95% CI: 1.04-1.23, P = 0.010). Higher GNRI was independently associated with a lower risk of all-cause mortality or heart implantation (HR = 0.95, 95% CI: 0.93-0.96, P < 0.001) and HF hospitalization (HR = 0.96, 95% CI: 0.95-0.98, P < 0.001). The inclusion of GNRI enhanced the predictability of all-cause mortality based on traditional model, including sex, New York Heart Association functional class, left bundle branch block, QRS reduction, and N-terminal pro-B-type natriuretic peptide level (C statistics improved from 0.785 to 0.813, P = 0.007).
CONCLUSIONS: Higher GNRI was associated with better treatment response and long-term prognosis in HF patients with CRT. Evaluation of nutritional status among CRT population is necessary for individualized choice of potential responders.