Relationships Between Right Ventricular Function, Body Composition, and Prognosis in Advanced Heart Failure
Relationships Between Right Ventricular Function, Body Composition, and Prognosis in Advanced Heart Failure
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DOI：
10.1016/j.jacc.2013.06.046
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发表时间：
2013-10-29
影响因子：
24
通讯作者：
Kautzner, Josef
中科院分区：
文献类型：
--
作者：
Melenovsky, Vojtech;Kotrc, Martin;Kautzner, Josef
目的 本研究旨在探讨晚期心力衰竭 (HF) 患者的右心室 (RV) 功能、身体成分和预后之间的关系。背景 之前调查 HF 相关恶病质的研究并未探讨 RV 功能对身体成分的影响。我们假设右心室功能障碍与晚期心力衰竭患者的体重减轻、身体成分异常和预后恶化有关。方法对晚期心力衰竭受试者 (n = 408) 进行前瞻性身体成分评估（皮褶厚度、双能 X 射线吸收测定法）、综合超声心动图和血液检测。对受试者进行不良事件（定义为死亡、移植或循环辅助装置）的随访。结果 患有右心室功能障碍的受试者 (51%) 体重指数较低，脂肪质量指数较低，并且更有可能出现恶病质 (19%)。右心室功能障碍的程度与之前较大的体重减轻和较低的脂肪/瘦体重比相关。在中位随访 541 天中，发生了 150 起事件 (37%)。在单变量和多变量分析中，右心室功能障碍（风险比：3.09 [95% 置信区间 (CI)：2.18 至 4.45]）和恶病质（风险比：2.90 [95% CI：2.00 至 4.12]）受试者的事件风险更大。体重指数增加与较低的事件发生率相关（HR/kg/m(2)：0.92 [95% CI：0.88 - 0.96]），这种保护作用是由较高的脂肪量（0.91 [95% CI：0.87 - 0.96]）介导的，而不是无脂肪质量指数（0.97 [95% CI：0.92 - 1.03]）介导的。 结论右心室功能障碍和心脏恶病质经常共存，具有附加的不利影响，并且可能在机制上相互关联。脂肪消耗而不是瘦体重消耗预示着不良后果，这表明脂肪减少要么是分解代谢增强的替代品，要么脂肪组织在心力衰竭的情况下具有心脏保护作用。
Objectives This study sought to examine the relationships between right ventricular (RV) function, body composition, and prognosis in patients with advanced heart failure (HF).Background Previous studies investigating HF-related cachexia have not examined the impact of RV function on body composition. We hypothesized that RV dysfunction is linked to weight loss, abnormal body composition, and worsened prognosis in advanced HF.Methods Subjects with advanced HF (n = 408) underwent prospective assessment of body composition (skinfold thickness, dual-energy X-ray absorptiometry), comprehensive echocardiography, and blood testing. Subjects were followed up for adverse events (defined as death, transplantation, or circulatory assist device).Results Subjects with RV dysfunction (51%) had lower body mass index, lower fat mass index, and were more likely to display cachexia (19%). The extent of RV dysfunction correlated with greater antecedent weight loss and a lower fat/ lean body mass ratio. Over a median follow-up of 541 days, there were 150 events (37%). Risk of event was greater in subjects with RV dysfunction (hazard ratio: 3.09 [95% confidence interval (CI): 2.18 to 4.45]) and cachexia (hazard ratio: 2.90 [95% CI: 2.00 to 4.12]) in univariate and multivariate analyses. Increased body mass index was associated with a lower event rate (HR per kg/m(2): 0.92 [95% CI: 0.88 to 0.96]), and this protection was mediated by a higher fat mass (0.91 [95% CI: 0.87 to 0.96]) but not a fat-free mass index (0.97 [95% CI: 0.92 to 1.03]).Conclusions RV dysfunction and cardiac cachexia often coexist, have additive adverse impact, and might be mechanistically interrelated. Wasting of fat but not of lean mass was predictive of adverse outcome, suggesting that fat loss is either a surrogate of enhanced catabolism or adipose tissue is cardioprotective in the context of HF.