Loss in body weight is an independent prognostic factor for mortality in chronic heart failure: insights from the GISSI-HF and Val-HeFT trials
Loss in body weight is an independent prognostic factor for mortality in chronic heart failure: insights from the GISSI-HF and Val-HeFT trials
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DOI：
10.1002/ejhf.240
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发表时间：
2015-04-01
影响因子：
18.2
通讯作者：
Latini, Roberto
中科院分区：
文献类型：
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作者：
Rossignol, Patrick;Masson, Serge;Latini, Roberto
慢性心力衰竭（HF）患者体重减轻（W-LOSS）的生物学和预后意义以及治疗意义尚不明确。我们在两个独立的大型慢性心衰患者队列中评估了W-LOSS是否为经典临床危险因素增加了额外的预后价值。研究了与W-LOSS相关的因素。方法和结果在GISSI-HF （n = 6820）和Val-HeFT试验（n = 4892）中连续测量了sw - loss和估计的血浆体积变化。在这两项研究中，在随访的第一年经历至少一次5% W-LOSS被认为是消瘦的迹象。在gisi - hf中，在1年内连续两次临床就诊期间自报无意W-LOSS 2 kg也被认为是消瘦的迹象。在gisi - hf和Val-HeFT组中，分别有16.4%和15.7%的患者发生W-LOSS（在gisi - hf组中，18.9%的患者发生2 kg W-LOSS）。在调整了一些基线协变量和血浆容量变化的多变量分析中，发现W-LOSS与死亡率和不良心血管和非心血管结局独立相关，具有显著的净重分类改善（cfNRI）和综合判别改善（IDI）的增加。W-LOSS与代表HF严重程度的几个特征独立相关，包括基线NT-proBNP和Val-HeFT的高灵敏度c反应蛋白（hsCRP）。结论：sw - loss是gisi -HF和Val-HeFT试验中常见的发现，与患者的多种特征相关，除了HF严重程度的临床变量（包括估计的血浆容量变化）之外，还增加了额外的预后信息。
AimsUncertainties remain on the biological and prognostic significance and therapeutic implications of loss in body weight (W-LOSS) in chronic heart failure (HF) patients. We assessed whether W-LOSS added additional prognostic value to classical clinical risk factors in two separate and large cohorts of patients with chronic HF. The factors associated with W-LOSS were studied.Methods and resultsW-LOSS and estimated plasma volume changes were measured serially in the GISSI-HF (n = 6820) and Val-HeFT trials (n = 4892). In both studies, experiencing at least one episode of 5% W-LOSS during the first year of follow-up was considered a sign of wasting. In GISSI-HF, self-reported unintentional W-LOSS 2 kg between two consecutive clinical visits within 1 year was also considered a sign of wasting. W-LOSS occurred in 16.4% and 15.7% of the patients enrolled in GISSI-HF and Val-HeFT, respectively (unintentional 2 kg W-LOSS occurred in 18.9% in GISSI-HF). In multivariable analyses adjusting for a number of baseline covariates as well as for plasma volume changes, W-LOSS was found to be independently associated with mortality and adverse cardiovascular and non-cardiovascular outcomes, with a significant net reclassification improvement (cfNRI) and an increase in integrated discrimination improvement (IDI). W-LOSS was independently associated with several features representing the severity of HF, including baseline NT-proBNP and high sensitivity C-reactive protein (hsCRP) in Val-HeFT.ConclusionsW-LOSS was a frequent finding in the GISSI-HF and Val-HeFT trials, associated with multiple patient features, and added additional prognostic information beyond clinical variables of HF severity, including estimated plasma volume changes.