{"id":"21132825f84b","type":"article","url":"https://hartvaat.nl/2023/07/11/ondervoeding-verslechtert-prognose-bij-hartfalen-en-mr-coapt-analyse/","title":"Ondervoeding verslechtert prognose bij hartfalen en MR: COAPT-analyse","title_en":"Impact of Malnutrition in Patients With Heart Failure and Secondary Mitral Regurgitation: The COAPT Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["nt-probnp"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2023.04.047","source_url":"https://doi.org/10.1016/j.jacc.2023.04.047","authors":["Andrea Scotti","Augustin Coisne","Juan F Granada","Elissa Driggin","Mahesh V Madhavan","Zhipeng Zhou","Björn Redfors","Saibal Kar","D Scott Lim","David J Cohen","JoAnn Lindenfeld","William T Abraham","Michael J Mack","Federico M Asch","Gregg W Stone"],"significance":6,"published":"2023-07-11","source_date":"2023-07-11","image":"","kennis":[],"congress":"","summary_en":"This COAPT analysis showed that malnutrition independently predicts worse outcomes in heart failure with secondary MR, highlighting the importance of nutritional assessment in the MitraClip decision-making process.","created":"2026-07-03T10:30:28Z","updated":"2026-07-03T13:29:32Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"COAPT-analyse toonde dat ondervoeding een onafhankelijke voorspeller is van slechtere uitkomsten bij hartfalen met secundaire MR. Ondanks de slechte prognose profiteerden ondervoed patiënten evenzeer van MitraClip.","abstract_original":"BACKGROUND: Although malnutrition is associated with poor prognosis in several diseases, its prognostic impact in patients with heart failure (HF) and secondary mitral regurgitation (SMR) is not understood. OBJECTIVES: The purpose of this study was to assess the prevalence and impact of malnutrition in HF patients with severe SMR randomized to transcatheter edge-to-edge repair (TEER) with the MitraClip plus guideline-directed medical therapy (GDMT) vs GDMT alone in the COAPT trial. METHODS: Baseline malnutrition risk was calculated using the validated geriatric nutritional risk index (GNRI) score. Patients were categorized as having \"malnutrition\" (GNRI ≤98) vs \"no malnutrition\" (GNRI >98). Outcomes were assessed through 4 years. The primary endpoint of interest was all-cause mortality. RESULTS: Among 552 patients, median baseline GNRI was 109 (IQR: 101-116); 94 (17.0%) had malnutrition. All-cause mortality at 4 years was greater in patients with vs those without malnutrition (68.3% vs 52.8%; P = 0.001). Using multivariable analysis, both baseline malnutrition (adjusted-HR [adj-HR]: 1.37; 95% CI: 1.03-1.82; P = 0.03) and randomization to TEER plus GDMT compared with GDMT alone (adj-HR: 0.65; 95% CI: 0.51-0.82; P = 0.0003) were independent predictors of 4-year mortality. In contrast, GNRI was unrelated to the 4-year rate of heart failure hospitalization (HFH), although TEER treatment reduced HFH (adj-HR: 0.46; 95% CI: 0.36-0.56). The reductions in death (adj-Pinteraction = 0.46) and HFH (adj-Pinteraction = 0.67) with TEER were consistent in patients with and without malnutrition. CONCLUSIONS: Malnutrition was present in 1 of 6 patients with HF and severe SMR enrolled in COAPT and was independently associated with increased 4-year mortality (but not HFH). TEER reduced mortality and HFH in patients with and without malnutrition. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation [The COAPT Trial] and COAPT CAS [COAPT]; NCT01626079)."}