Abstract Body (Do not enter title and authors here): Introduction

Growing evidence has highlighted the detrimental impact of malnutrition on outcomes among patients undergoing structural heart interventions. However, there is still a paucity of data on patients with heart failure with reduced ejection fraction (HFrEF) who undergo transcatheter edge-to-edge repair with the MitraClip device for the treatment of mitral regurgitation (MR). Therefore, we aimed to investigate this association using a national-level database.

Method

Data from the U.S. Collaborative Network–TriNetX were used to evaluate the impact of malnutrition on patients with HFrEF (defined as LVEF <40%) and MR who underwent MitraClip implantation. Patients were classified into two cohorts: those with malnutrition identified by the relevant ICD-10 code and those without. The malnutrition cohort was propensity score matched to a control group based on age, sex, race, and various comorbidities to ensure balanced comparison. Patients were followed for 3 years after MitraClip implantation to evaluate clinical outcomes, including all-cause mortality, worsening HF, incidence of atrial fibrillation (AF) or atrial flutter (AFL), stroke, pulmonary embolism (PE), and deep vein thrombosis (DVT).

Results

After propensity score matching, each cohort included 594 patients with comparable baseline characteristics. The mean age was 72.3 years in the malnutrition group compared to 73.0 years in the non-malnutrition group, with males comprising 53.5% and 52.7% of each group, respectively. Within 3 years post-MitraClip placement, patients with malnutrition had a significantly higher risk of adverse outcomes, including mortality (HR: 1.68, 95% CI: 1.36–2.08, P<0.05), worsening HF (HR: 1.47, 95% CI: 1.30–1.66, P<0.05), AF/AFL (HR: 1.22, 95% CI: 1.06–1.41, P<0.05), stroke (HR: 1.62, 95% CI: 1.09–2.42, P<0.05), PE (HR: 2.03, 95% CI: 1.16–3.54, P<0.05), and DVT (HR: 2.37, 95% CI: 1.19–4.71, P<0.05).

Conclusion

Patients with HFrEF and comorbid malnutrition are at increased risk of adverse outcomes following MitraClip placement, including higher rates of mortality, worsening HF, AF/AFL, stroke, PE, and DVT. Addressing nutritional deficiencies prior to MitraClip implantation may be essential for optimizing clinical outcomes and warrants further investigation.