The association between malnutrition and adverse outcome in patients with chronic heart failure who underwent cardiac resynchronization therapy

Abstract Introduction Malnutrition is frequently observed in patients with heart failure. It has been reported to be associated with poor clinical outcomes in patients with chronic heart failure (CHF). Previous studies demonstrated that patients with lower left ventricular ejection fraction (LVEF) were at increased absolute risk of death due to arrhythmia and worsening heart failure. However, the study investigating the association between malnutrition and adverse outcome including ventricular arrhythmia events is limited. Purpose This study aimed to investigate the association between malnutrition and adverse outcome in patients with CHF after cardiac resynchronization therapy (CRT). Methods This retrospective study evaluated 167 patients (112 male, mean age 70.9 ± 9.5 years; 32 (19.2%) ischemic cardiomyopathy, 70 (41.9%) dilated cardiomyopathy, 5 (3.0%) hypertrophic cardiomyopathy, 28 (16.8%) sarcoidosis, 10 (6.0%) valvular disease, 22 others) who underwent CRT implantation between 2004 and 2023. Mean follow-up period was 1310 ± 561 days. Nutritional status was assessed using the Geriatric Nutritional Risk Index (GNRI) and Controlling Nutritional Status (CONUT) score before the CRT implantation. Patients were divided into two groups as preserved nutrition (CONUT 0 - 4, n = 141; GNRI ≥ 92, n = 130) or malnutrition (CONUT 5 - 12, n = 26; GNRI 92, n = 37) groups. Ventricular arrhythmia was defined as ventricular tachycardia or ventricular fibrillation requiring anti-tachycardia pacing or shock. The primary endpoint was a composite of ventricular arrhythmias and all-cause mortality. Secondary endpoints were ventricular arrhythmias and all-cause mortality. Results Ventricular arrhythmias occurred in 36 patients (21.6%), and all-cause mortality occurred in 38 patients (22.8%). Kaplan-Meier survival analyses revealed that malnutrition groups defined by both CONUT score and GNRI had a higher incidence of the primary composite endpoint (log-rank, p = 0.001 and p = 0.03, respectively). Regarding secondary endpoints, all-cause mortality was significantly higher in both malnutrition groups (p = 0.0005 and p = 0.008, respectively), while ventricular arrhythmias were significantly more frequent only in the CONUT-defined malnutrition group (p = 0.02) but not in the GNRI-defined group (p = 0.24). Cox proportional hazards regression analysis showed that malnutrition defined by CONUT score (hazard ratio 1.87, 95% CI: 1.01-3.45, p = 0.047), history of ventricular arrhythmias (hazard ratio 2.72, 95% CI: 1.59 – 4.65, p = 0.0003), and left bundle branch block (hazard ratio 0.54, 95% CI: 0.31 - 0.93, p = 0.03) were independent predictors of the primary endpoint, while malnutrition defined by GNRI was not significantly associated with the primary endpoint (hazard ratio 1.70, 95% CI: 0.99-2.92, p = 0.053). Conclusion Malnutrition defined by CONUT score could predict ventricular arrhythmias and all-cause mortality in patients with CHF who underwent CRT.