Comparison of Nutritional Status in Elderly Patients with Low-pressure Gradient and High-pressure Gradient Severe Aortic Stenosis

Background: Assessment of nutrition status is important among elderly patients with severe aortic stenosis (SAS) when considering treatment or its prognosis. Although low pressure gradient (PG) SAS with preserved ejection fraction (EF) have been recently identified, it remains unclear whether the nutritional status is different between patients with high-PG SAS and low-PG SAS. Methods: We retrospectively enrolled 200 consecutive patients (mean age 81 ± 8 years) with SAS (aortic valve area <1.0 cm²) and preserved EF (≥50%). Patients were divided into paradoxical low-PG (mean PG <40 mmHg) and high-PG (mean PG ≥40 mmHg) SAS. Geriatric nutritional risk index (GNRI) as a marker of nutrition status was calculated as follows; 14.89 × serum albumin (g/dl) + 41.7 × body mass index (BMI)/22. Results: Compared with high-PG SAS, low-PG SAS patients were older (86 ± 7 vs. 80 ± 7 years, P < .001), lower BMI (1.41 ± 0.15 vs. 1.48 ± 0.15 kg/m², P < .05), and smaller LV end-diastolic volume index (43 ± 12 vs. 47 ± 12 ml/m², P < .05) and stroke volume index (33 ± 13 vs. 38 ± 13 ml/m², P < .01). Serum albumin was significantly lower in low-PG SAS patients than high-PG SAS patients, resulting in lower GNRI (91.8 ± 9.7 vs. 97.6 ± 9.0, P < .01). Multivariate analysis identified an age (Odds ratio 1.08, 95% CI 1.024–1.158, P = .0045) and GNRI (Odds ratio 0.95, 95% CI 0.911–0.995, P = .03) were independent predictor for low-PG SAS. Conclusions: Low-PG SAS patients presents a lower nutrition status assessed by the GNRI.