Background: The relationship between changes in nutritional status after cardiac resynchronization therapy (CRT) and clinical outcomes has not been fully studied.
Objective: We aimed to evaluate changes in nutritional status, assessed by prognostic nutritional index (PNI), and their association with improvement of cardiac function and prognosis.
Methods: This study was consisted of 119 consecutive patients with a CRT-device. Patients were divided into two groups based on whether PNI had increased at 6 months after CRT-device implantation (increased PNI group, n=73) or not (decreased PNI group, n=46). PNI was calculated as 10×serum albumin (g/dL)+0.005×total lymphocyte count (per mm³). Plasma BNP level, left ventricular (LV) end-diastolic volume (LVEDV), LV end-systolic volume (LVESV) and LV ejection fraction (LVEF) were measured before and 6 months after CRT-device implantation. We assessed the effect of changes in PNI after CRT-device implantation on LV remodeling and adverse events (all cause death or left ventricular assist device implantation).
Results: At baseline, there were no significant differences between the two groups in age, gender, body mass index, NYHA functional class or comorbidities. In increased PNI group, BNP (442±347 pg/ml vs. 278±431 pg/ml, P<0.05), LVEDV (186±93 ml vs. 149±71 ml, P<0.05) and LVESV (134±75 ml vs. 98±62 ml, P<0.05) were significantly decreased 6 months after CRT-device implantation. In addition, LVEF (31±11% vs. 37±12%, P<0.05) was significantly increased after CRT-device implantation. In decreased PNI group, no significant changes were detected in any parameters. During a median follow-up period of 1593 days, there were 47 (39.4%) adverse events. The incidence of adverse events was 32.8% and 50.0% in increased and decreased PNI groups, respectively. In the Kaplan-Meier analysis, decreased PNI group was associated with a higher risk of adverse events than increased PNI group during the follow-up period (log-rank P=0.024).
Conclusion: These data suggested that changes in nutritional status, indexed by PNI, reflected LV remodeling in response to CRT. Increases in PNI were associated with a reduction in the rate of adverse events after CRT-device implantation.