Background/Aim: Metabolic derangements due to increased nutritional risk lead to catabolism and loss of proteins, muscle tissue and eventually mass of parenchymatous organs. The aim of our study was to assess whether transitory nutritional risk after heart surgery influences on the left ventricle myocardial mass (LVMM), assessed by echocardiography. Methods: Consecutive sample of patients scheduled for cardiovascular rehabilitation, in period 0-3 months after surgery. Nutritional risk screening (NRS) was analyzed using the NRS-2002 tool. Results: Study sample included 330 patients after heart surgery for ischemic 186 (56.4%); valvular 91 (27.6%) and valvular plus ischemic 53 (16.1%) heart disease. Age was 65.5 ± 10.6 (range 23-84) and there were more male patients than female - 240 (72.7%) and 90 (27.3%), respectively. The percentage of unintentional loss of weight was 10.8 ± 3.4%, in range 0-23.81%, whereas NRS-2002 was 4.4 ± 1.1. LVMM was 218.7 ± 65.9 g vs. 252.3 ± 51.7 (p = 0.015); for patients with increased nutritional risk and controls, respectively. There was no significant correlation of LVMM with NRS-2002, while the percentage of unintentional loss of weight displayed only weakly inverse correlation (Rho CC = -0.197; p = 0.007). LVMM also correlated significantly with body mass index (Rho CC = 0.247; p < 0.001) and waist-to-hip ratio (Rho CC = 0.291; p < 0.001). In conclusion, LVMM was found to decrease slightly in the period of increased nutritional risk, following heart surgery. Changes in LVMM are partially consequences of systemic catabolic response, as well as anthropometric changes due to unintentional loss of weight.

Yusuf S, Rangarajan S, Teo K, Islam S, Li W, Liu L, Bo J, Lou Q, Lu F, Liu T, Yu L, Zhang S, Mony P, Swaminathan S, Mohan V, Gupta R, Kumar R, Vijayakumar K, Lear S, Anand S, Wielgosz A, Diaz R, Avezum A, Lopez-Jaramillo P, Lanas F, Yusoff K, Ismail N, Iqbal R, Rahman O, Rosengren A, Yusufali A, Kelishadi R, Kruger A, Puoane T, Szuba A, Chifamba J, Oguz A, McQueen M, McKee M, Dagenais G; PURE Investigators: Cardiovascular risk and events in 17 low-, middle-, and high-income countries. N Engl J Med 2014;371:818-827.
Mack M, Gopal A: Epidemiology, traditional and novel risk factors in coronary artery disease. Cardiol Clin 2014;32:323-332.
Cochrane T, Davey R, Iqbal Z, Gidlow C, Kumar J, Chambers R, Mawby Y: NHS health checks through general practice: randomised trial of population cardiovascular risk reduction. BMC Public Health 2012;12:944.
Fitchett D: The metabolic syndrome is an important concept in therapeutic decision-making. Can J Cardiol 2015;31:596-600.
Jahangir E, De Schutter A, Lavie CJ: The relationship between obesity and coronary artery disease. Transl Res 2014;164:336-344.
Agarwal E, Ferguson M, Banks M, Batterham M, Bauer J, Capra S, Isenring E: Malnutrition and poor food intake are associated with prolonged hospital stay, frequent readmissions, and greater in-hospital mortality: results from the nutrition care day survey 2010. Clin Nutr 2013;32:737-745.
Sorensen J, Kondrup J, Prokopowicz J, Schiesser M, Krähenbühl L, Meier R, Liberda M; EuroOOPS Study Group: EuroOOPS: an international, multicentre study to implement nutritional risk screening and evaluate clinical outcome. Clin Nutr 2008;27:340-349.
McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, Falk V, Filippatos G, Fonseca C, Gomez-Sanchez MA, Jaarsma T, Køber L, Lip GY, Maggioni AP, Parkhomenko A, Pieske BM, Popescu BA, Rønnevik PK, Rutten FH, Schwitter J, Seferovic P, Stepinska J, Trindade PT, Voors AA, Zannad F, Zeiher A; Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology, Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, McDonagh T, Sechtem U, Bonet LA, Avraamides P, Ben Lamin HA, Brignole M, Coca A, Cowburn P, Dargie H, Elliott P, Flachskampf FA, Guida GF, Hardman S, Iung B, Merkely B, Mueller C, Nanas JN, Nielsen OW, Orn S, Parissis JT, Ponikowski P; ESC Committee for Practice Guidelines: ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European society of cardiology. Developed in collaboration with the heart failure association (HFA) of the ESC. Eur J Heart Fail 2012;14:803-869.
Boban M, Persic V, Miletic B, Kovacicek K, Madzar Z: Heart surgery stems increased nutritional risk, expressed during the course of stationary rehabilitation. Ann Nutr Metab 2013;63:17-24.
Boban M, Laviano A, Persic V, Rotim A, Jovanovic Z, Vcev A: Characteristics of NRS-2002 nutritional risk screening in patients hospitalized for secondary cardiovascular prevention and rehabilitation. J Am Coll Nutr 2014;33:466-473.
Devereux RB, Reichek N: Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation 1977;55:613-618.
Kondrup J, Rasmussen HH, Hamberg O, Stanga Z; Ad Hoc ESPEN Working Group: Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 2003;22:321-336.
Korfali G, Gündoğdu H, Aydintuğ S, Bahar M, Besler T, Moral AR, Oğuz M, Sakarya M, Uyar M, Kiliçturgay S: Nutritional risk of hospitalized patients in Turkey. Clin Nutr 2009;28:533-537.
Lomivorotov VV, Efremov SM, Boboshko VA, Nikolaev DA, Vedernikov PE, Deryagin MN, Lomivorotov VN, Karaskov AM: Prognostic value of nutritional screening tools for patients scheduled for cardiac surgery. Interact Cardiovasc Thorac Surg 2013;16:612-618.
Florea VG, Moon J, Pennell DJ, Doehner W, Coats AJ, Anker SD: Wasting of the left ventricle in patients with cardiac cachexia: a cardiovascular magnetic resonance study. Int J Cardiol 2004;97:15-20.
Cuspidi C, Rescaldani M, Tadic M, Sala C, Grassi G: Effects of bariatric surgery on cardiac structure and function: a systematic review and meta-analysis. Am J Hypertens 2014;27:146-156.
Anker SD, Negassa A, Coats AJ, Afzal R, Poole-Wilson PA, Cohn JN, Yusuf S: Prognostic importance of weight loss in chronic heart failure and the effect of treatment with angiotensin-converting-enzyme inhibitors: an observational study. Lancet 2003;361:1077-1083.
Gaasch WH, Zile MR: Left ventricular structural remodeling in health and disease: with special emphasis on volume, mass, and geometry. J Am Coll Cardiol 2011;58:1733-1740.
Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP: Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med 1990;322:1561-1566.
Anker MS, von Haehling S, Springer J, Banach M, Anker SD: Highlights of mechanistic and therapeutic cachexia and sarcopenia research 2010 to 2012 and their relevance for cardiology. Arch Med Sci 2013;9:166-171.
Skipper A, Ferguson M, Thompson K, Castellanos VH, Porcari J: Nutrition screening tools: an analysis of the evidence. JPEN J Parenter Enteral Nutr 2012;36:292-298.
Papavassiliou DP, Treiber FA, Strong WB, Malpass MD, Davis H: Anthropometric, demographic, and cardiovascular predictors of left ventricular mass in young children. Am J Cardiol 1996;78:323-326.
Carlsson AC, Risérus U, Engström G, Ärnlöv J, Melander O, Leander K, Gigante B, Hellénius ML, de Faire U: Novel and established anthropometric measures and the prediction of incident cardiovascular disease: a cohort study. Int J Obes (Lond) 2013;37:1579-1585.
Jie B, Jiang ZM, Nolan MT, Zhu SN, Yu K, Kondrup J: Impact of preoperative nutritional support on clinical outcome in abdominal surgical patients at nutritional risk. Nutrition 2012;28:1022-1027.
Almeida AI, Correia M, Camilo M, Ravasco P: Nutritional risk screening in surgery: valid, feasible, easy! Clin Nutr 2012;31:206-211.
Reid CL: Nutritional requirements of surgical and critically-ill patients: do we really know what they need? Proc Nutr Soc 2004;63:467-472.
Rasmussen HH, Kondrup J, Staun M, Ladefoged K, Lindorff K, Jørgensen LM, Jakobsen J, Kristensen H, Wengler A: A method for implementation of nutritional therapy in hospitals. Clin Nutr 2006;25:515-523.
Rasmussen HH, Holst M, Kondrup J: Measuring nutritional risk in hospitals. Clin Epidemiol 2010;2:209-216.
Reiner Z, Mihatov S, Milicić D, Bergovec M, Planinc D; TASPIC-CRO Study Group Investigators: Treatment and secondary prevention of ischemic coronary events in Croatia (TASPIC-CRO study). Eur J Cardiovasc Prev Rehabil 2006;13:646-654.
Racca V, Castiglioni P, Ripamonti V, Bertoli S, Calvo MG, Ferratini M: Nutrition markers in patients after heart surgery. JPEN J Parenter Enteral Nutr 2010;34:143-150.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.