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Am J Cardiol. 2017 Mar 1;119(5):770-777. doi: 10.1016/j.amjcard.2016.11.019. Epub 2016 Dec 2.

Prognostic Value of Hypoalbuminemia After Transcatheter Aortic Valve Implantation (from the Japanese Multicenter OCEAN-TAVI Registry).

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Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan. Electronic address:
Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan.
Department of Cardiology, Nagoya Heart Center, Nagoya, Japan.
Department of Cardiology, Sendai Kousei Hospital, Sendai, Japan.
Department of Cardiology, Syonan Kamakura Hospital, Shonan, Japan.
Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan.
Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan.
Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.
Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.


Hypoalbuminemia, a frailty criterion, belongs to a group of co-morbidities not captured as a traditional risk factor. We assessed its prognostic value in patients who underwent transcatheter aortic valve implantation (TAVI). The study included 1,215 consecutive patients from the Optimized Catheter Valvular Intervention -TAVI Japanese multicenter registry. Hypoalbuminemia was defined as serum albumin level <3.5 g/dl. Baseline characteristics, procedural outcomes, and all-cause, cardiovascular and noncardiovascular mortality rates after TAVI were compared between patients with albumin level <3.5 g/dl (hypo[h]-ALB group, n = 284) and those with albumin level >3.5 g/dl (nonhypo[nh]-ALB group, n = 931). Several baseline characteristics differed significantly between both groups, including age (85.1 ± 5.1 vs 84.2 ± 4.9 years, p = 0.012), ejection fraction (58.5 ± 14.3% vs 62.9 ± 12.4%, p <0.001), baseline kidney function, or liver disease. The 30-day mortality rate in all patients showed significant differences between the 2 groups (3.9% vs 1.3%, p = 0.005). During a mean follow-up of 330 days, cumulative all-cause, cardiovascular, and noncardiovascular mortality rates were significantly higher in the hALB group than in the nhALB group (log-rank test, p <0.001, p = 0.0021, and p <0.001, respectively). The groups were also analyzed using a propensity matching model for adjusting the baseline differences. The analysis revealed that the poorer prognosis of the hALB group in terms of cumulative all-cause and noncardiovascular mortality was retained (p = 0.038, and p = 0.0068, respectively); however, differences in cardiovascular mortality rates in the 2 groups were attenuated (p = 0.93). In conclusion, hypoalbuminemia was associated with poor prognosis, highlighted by the increase in noncardiovascular mortality. Baseline albumin level could be a useful marker for risk stratification before TAVI.

[Indexed for MEDLINE]

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