Muscle wasting in patients with chronic heart failure: results from the studies investigating co-morbidities aggravating heart failure (SICA-HF)
Muscle wasting in patients with chronic heart failure: results from the studies investigating co-morbidities aggravating heart failure (SICA-HF)
复制标题
DOI：
10.1093/eurheartj/ehs381
复制
发表时间：
2013-02-01
影响因子：
39.3
通讯作者：
von Haehling, Stephan
中科院分区：
文献类型：
--
作者：
Fuelster, Susann;Tacke, Matthias;von Haehling, Stephan
目的：评估慢性心力衰竭（HF）患者骨骼肌质量减少的患病率及其临床影响。慢性心力衰竭伴有影响生活质量和预后的合并症。
方法与结果：我们前瞻性地招募了200例慢性心力衰竭患者。通过双能X线吸收法评估上肢和下肢的四肢骨骼肌质量。我们分析了上肢和下肢的肌肉力量，并且所有患者都进行了6分钟步行试验、4米步行试验以及心肺运动试验。肌肉萎缩定义为四肢肌肉质量比18 - 40岁健康参考成人组的平均值低2个标准差，这是针对健康老龄化中肌肉萎缩（肌肉减少症）的诊断建议。在39例（19.5%）受试者中检测到肌肉萎缩。与无肌肉萎缩的患者相比，有肌肉萎缩的患者握力和股四头肌力量的值明显更低，总峰值耗氧量（peakVO₂，1173 ± 433比1622 ± 456 mL/min）更低，运动时间（7.7 ± 3.8比10.22 ± 3.0 min，两者P < 0.001）更短，左心室射血分数（LVEF，P = 0.05）更低。有肌肉萎缩的患者在6分钟内行走的距离和4米步行时的步态速度更低（两者P < 0.05）。有肌肉萎缩的患者血清白细胞介素 - 6水平显著升高（P = 0.001）。逻辑回归分析显示，在调整年龄、性别、纽约心脏协会心功能分级、血红蛋白、LVEF、6分钟步行距离以及合并症数量后，肌肉萎缩与峰值VO₂降低独立相关（优势比6.53，p = 0.01）。
结论：肌肉萎缩是慢性心力衰竭患者中常见的一种合并症。有肌肉萎缩的患者表现出运动能力和肌肉力量下降，以及病情进展。
Aims To assess the prevalence and clinical impact of reductions in the skeletal muscle mass of patients with chronic heart failure (HF). Chronic HF is accompanied by co-morbidities that influence the quality of life and outcomes.Methods and results We prospectively enrolled 200 patients with chronic HF. The appendicular skeletal muscle mass of the arms and the legs combined, was assessed by dual energy X-ray absorptiometry. We analysed the muscle strength in arms and legs, and all patients underwent a 6-min walk test, a 4-m walk test, and spiroergometry testing. Muscle wasting was defined as the appendicular muscle mass 2 SD below the mean of a healthy reference group of adults aged 18-40 years, as suggested for the diagnosis of muscle wasting in healthy ageing (sarcopenia). Muscle wasting was detected in 39 (19.5%) subjects. Patients with muscle wasting had significantly lower values for handgrip and quadriceps strength as well as lower total peak oxygen consumption (peakVO(2), 1173 +/- 433 vs. 1622 +/- 456 mL/min), lower exercise time (7.7 +/- 3.8 vs. 10.22 +/- 3.0 min, both P < 0.001), and lower left ventricular ejection fraction (LVEF, P = 0.05) than patients without. The distance walked during 6 min and the gait speed during the 4-m walk were lower in patients with muscle wasting (both P < 0.05). Serum levels of interleukin-6 were significantly elevated in patients with muscle wasting (P = 0.001). Logistic regression showed muscle wasting to be independently associated with reduced peak VO2 adjusted for age, sex, New York Heart Association class, haemoglobin, LVEF, distance walked in 6 minutes, and the number of co-morbidities (odds ratio 6.53, p = 0.01).Conclusion Muscle wasting is a frequent co-morbidity among patients with chronic HF. Patients with muscle wasting present with reduced exercise capacity and muscle strength, and advanced disease.