Prognostic impact of muscle and fat mass in patients with heart failure.
Prognostic impact of muscle and fat mass in patients with heart failure.
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肌肉和脂肪量对心力衰竭患者预后的影响。
DOI：
10.1002/jcsm.12702
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发表时间：
2021-06
期刊：
影响因子：
--
通讯作者：
Kimura K
中科院分区：
文献类型：
--
作者：
Konishi M;Akiyama E;Matsuzawa Y;Sato R;Kikuchi S;Nakahashi H;Maejima N;Iwahashi N;Kosuge M;Ebina T;Hibi K;Misumi T;von Haehling S;Anker SD;Tamura K;Kimura K
恶病质是心力衰竭(HF)患者预后较差的因素，其特征是伴有或不伴有脂肪块丢失的肌肉丧失。然而，关于肌肉和脂肪质量分别对心衰患者预后的影响的研究有限。我们假设肌肉和脂肪质量对心衰的预后有不同的影响。这是一项观察性队列研究，纳入了418名确诊为心衰的患者(59%为男性)，平均年龄为71岁±13岁，左心室射血分数为39±0.16%，其中左心室射血分数保留(≥=50%)、中度左心室射血分数(40%~50%)和左心室射血分数降低(40%)分别占31.3%、14.8%和53.8%。采用双能X线骨密度仪对经过减充血治疗后处于稳定状态的患者进行骨密度测定。患者平均体重指数为22.1±24.6 kg/m2，平均附件骨质量指数(ASM)为6.88±1.23 kg/m2，女性为5.59±0.92 kg/m2，54.1%的患者出现国际标准定义的肌肉质量下降(男性7.0 kg/m2，女性5.4 kg/m2)。平均脂肪质量男性为20.4±77.2%，女性为27.2%±28.6%。在中位随访37个月期间，418例心衰患者中92例(22.0%)死亡(1年和3年死亡率分别为8.4%和17.3%)。根据年龄、性别、血红蛋白、纽约心脏协会功能分级和身高平方调整后，骨骼肌和脂肪质量的较低值与死亡风险的增加独立相关(风险比，95%可信区间为每1公斤脂肪质量增加0.825[0.747-0.908]，P=0.001和0.954[0.916-0.993]，P=0.018)。超过一半的心力衰竭患者的肌肉质量减少。肌肉和脂肪质量较低与心衰患者死亡率较高相关。
Cachexia, characterized by loss of muscle with or without loss of fat mass, is a poor prognostic factor in patients with heart failure (HF). However, there is limited investigation on the prognostic impact of muscle and fat mass separately in HF. We hypothesized that muscle and fat mass have different effects on the prognosis of HF. This was an observational cohort study of 418 patients (59% were men) admitted with a diagnosis of HF (71 ± 13 years [mean ± standard deviation]), with left ventricular ejection fraction (LVEF) of 39 ± 16%, including 31.3%, 14.8%, and 53.8% of patients with preserved LVEF (LVEF ≥ 50%), mid‐range LVEF (40–50%), and reduced (<40%) LVEF, respectively. Dual‐energy X‐ray absorptiometry was performed with the patients in the stable state after decongestion therapy. The mean body mass index of patients was 22.1 ± 4.6 kg/m2, and the mean appendicular skeletal mass (ASM) index was 6.88 ± 1.23 kg/m2 in men and 5.59 ± 0.92 in women; 54.1% of the patients showed reduced muscle mass defined by the international cut‐off value (7.0 kg/m2 for men and 5.4 for women). The mean fat mass was 20.4 ± 7.2% in men and 27.2 ± 8.6% in women. During a median follow‐up of 37 months, 92 (22.0%) of 418 patients with HF died (1 and 3 year mortality: 8.4% and 17.3%, respectively). Lower values of both skeletal muscle and fat mass were independently associated with increased risk of mortality adjusted for age, sex, haemoglobin, New York Heart Association functional class, and height squared (hazard ratio with 95% confidence interval of 0.825 [0.747–0.908] per 1 kg increase of ASM, P < 0.001, and 0.954 [0.916–0.993] per 1 kg increase of fat mass, P = 0.018, respectively). More than half of the patients with HF showed reduced muscle mass. Lower values of both muscle and fat mass were associated with higher mortality in HF.
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影响因子：
39.3
作者：
Fuelster, Susann;Tacke, Matthias;von Haehling, Stephan
通讯作者：
von Haehling, Stephan
影响因子：
2.8
作者：
Haykowsky, Mark J.;Kouba, Erik J.;Brubaker, Peter H.;Nicklas, Barbara J.;Eggebeen, Joel;Kitzman, Dalane W.
通讯作者：
Kitzman, Dalane W.
影响因子：
8.9
作者：
Cederholm, T.;Jensen, G. L.;Compher, C.
通讯作者：
Compher, C.
影响因子：
13
作者：
Lavie, Carl J.;Alpert, Martin A.;Ventura, Hector O.
通讯作者：
Ventura, Hector O.
影响因子：
158.5
作者：
MCKEE, PA;CASTELLI, WP;KANNEL, WB
通讯作者：
KANNEL, WB