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Impact of nutritional status as an independent predictor of the major cardiovascular events after the completion of comprehensive cardiac rehabilitation: estimation by geriatric nutritional risk index

Session Poster session 3

Speaker Mariko Ehara

Event : ESC Congress 2016

  • Topic : preventive cardiology
  • Sub-topic : Rehabilitation: Outcomes
  • Session type : Poster Session

Authors : M Ehara (Nagoya,JP), K Shibata (Nagoya,JP), N Iritani (Toyohashi,JP), T Kameshima (Nagoya,JP), M Konaka (Nagoya,JP), K Murase (Toyohashi,JP), T Ohtani (Nagoya,JP), Y Higashida (Nagoya,JP), A Segi (Nagoya,JP), Y Ohkawa (Nagoya,JP), S Yamada (Nagoya,JP), T Suzuki (Toyohashi,JP)

Authors:
M. Ehara1 , K. Shibata2 , N. Iritani3 , T. Kameshima2 , M. Konaka2 , K. Murase3 , T. Ohtani2 , Y. Higashida4 , A. Segi4 , Y. Ohkawa4 , S. Yamada5 , T. Suzuki3 , 1Nagoya Heart Center, Cardiology - Nagoya - Japan , 2Nagoya Heart Center, Rehabilitation - Nagoya - Japan , 3Toyohashi Heart Center - Toyohashi - Japan , 4Nagoya Heart Center - Nagoya - Japan , 5Nagoya University - Nagoya - Japan ,

Citation:
European Heart Journal ( 2016 ) 37 ( Abstract Supplement ), 541

Background: For cardiovascular patients the importance of keeping good fitness has been noticed, however, the association of nutritional status with future cardiovascular events is still unclear. Geriatric nutritional risk index (GNRI) is a simple nutritional assessment tool to evaluate nutritional status for patients. Recovery phase comprehensive cardiac rehabilitation (CCR), which consists not only of physical training but also counseling and guidance concerning diet, lifestyle and physical activity, is a feasible program to prevent major adverse cardiac events (MACE).

Purpose: To evaluate the impact of GNRI at the completion phase of CCR to predict future MACE (including death, readmission and myocardial infarction).

Methods: We studied 248 consecutive patients (average age 68, range 25–88) who participated in CCR program at least for 3 month (median 217 days), whose peak oxygen consumption per weight (PVO2) at both the initial and completion phase of the program by cardiopulmonary exercise test were available. Cases with the initial PVO2 <16 ml/kg/min were defined as “poor fitness”. Left ventricular ejection fraction on echocardiography (LVEF), blood hemoglobin level (Hb), estimated glomerular filtration rate (eGFR), handgrip force (HG) and daily step number were measured. GNRI was calculated as follows: 14.89 × serum albumin level (g/dl) + 41.7 × body mass index / 22. Incidence of MACE was compared between 2 groups divided by the median of the completion phase GNRI: “low-GNRI (<95.3, with moderate to severe nutritional risk)” and “normal-GNRI (≥95.3, with no or low nutritional risk)”. The Cox proportional hazards regression analysis was used to assess the independent predictors of MACE.

Results: At the observation period (median 553 days), low-GNRI group had significantly higher incidence of MACE compared with normal-GNRI group (19.3% vs. 3.7%, p<0.001). According to the fitness level, poor fitness population showed MACE significantly more in low-GNRI group (25.0% vs. 9.8%, p=0.006), whereas normal fitness population showed no significant difference between 2 GNRI groups. Multivariate analysis showed that lower GNRI predicted increased incidence of MACE independent of age, LVEF, HG, step number and PVO2 (hazard ratio 1.10, 95% confidence interval 1.02–1.14, p=0.006).

Conclusion: Low GNRI at the completion phase of CCR may be useful for predicting future cardiac events, especially among poor fitness patients. During CCR session, we should further focus on nutritional improvement as well as physical fitness.

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