Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w
Disentangling heart failure and frailty: A prospective study of patients undergoing percutaneous mitral valve repair
C. Metze1, C. Iliadis1, M. I. Körber1, J. Von Stein1, M. Halbach1, S. Baldus1, R. Pfister1
1Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Herzzentrum der Universität zu Köln, Köln;

Objectives: Aim of this study was to analyse the contribution of heart failure to the frailty phenotype by examining heart failure patients prior and post percutaneous mitral valve repair (PMVR).

Background: Frailty and heart failure share pathophysiology and clinical characteristics.

Methods: Frailty according to Fried criteria (weight loss, weakness, exhaustion, slowness, and low activity) was assessed in consecutive patients admitted for PMVR before and 6 weeks after the procedure.

Results: 118 (45.7%) of 258 patients (mean [SD] age 78 [9] years, 42% female, 55% secondary mitral regurgitation) were classified as frail at baseline which significantly decreased to 74 (28.7%) patients at follow-up (p<0.001). Frequency of individual frailty domains slowness, exhaustion and inactivity significantly decreased whereas weakness remained unchanged. Baseline frailty was significantly associated with comorbidities, NT-proBNP levels and functional capacity whereas frailty after PMVR was not associated with NT-proBNP levels. Predictors of postprocedural reversibility of frailty were NYHA class < IV, absence of weakness and lower frailty score. When compared to patients who were persistently non-frail (reference) risk of mortality continuously increased for patients who developed new frailty (HR 1.41 95% CI 0.41-4.86), who had reversal of frailty (HR 2.17 95% CI 1.03-4.57) and who were persistently frail (HR 3.26 95% CI 1.62-6.57, p=0.006 for trend).

Conclusion: Treatment of mitral regurgitation in heart failure patients can halve the burden of physical frailty particular in patients with a less advanced phenotype. Considering the prognostic relevance of frailty reversibility our data support the concept of frailty as a primary treatment target. 

Keywords: heart failure, frailty, percutaneous mitral valve repair

Baseline
non-frail
(n=140, 54.3%)

Baseline frail (n=118, 45.7%)

p-value

Follow-up
non-frail (n=184, 71.3%)

Follow-up frail (n=74,
28.7%)

p-value

Logistic EuroSCORE, %

19 (15)

23 (17)

0.02

20 (15)

24 (19)

0.27

NYHA class        III/IV, %

86

95

0.01

22

69

<0.001

NT-proBNP, pg/ml

2,105
(1,239; 4,019)

3,275
(1,796; 6,478)

<0.001

2,206
(1,176; 3,870)

2,857
(1,390; 5,425)

0.13

MLwHFQ score

27 (16)

39 (15)

<0.001

17 (11)

29 (18)

<0.001

Persistent non-frail   
(n=123)

New frail
(n=17)

New non-frail (n=61)

Persistent frail (n=57)

p-value for comparison of all groups

p-value for comparison of new non-frail vs persistent frail

NYHA class
IV, %

4

0

8

28

<0.001

0.005

Weakness, %

33

71

70

89

<0.001

0.01
 
Exhaustion, %		  
43		  
41		  
92		  
86		  
<0.001
 0.31
 
Slowness, %
 8		  
24		  
67
 68
 <0.001
 0.89
 
Inactivity, %
 15
 0
 79
 75
 <0.001
 0.68

Number of        positive Fried    frailty domains

1.3 (0.7)

1.7 (0.6)

3.6 (0.6)

3.8 (0.7)

<0.001

0.04
NYHA: New York Heart Association, MLwHFQ: Minnesota Living with heart failure
https://dgk.org/kongress_programme/jt2023/aP1783.html