心力衰竭合并肌肉疏松症患者的预后因素:一项观察性回顾研究

Yasutaka Imamura, Atsushi Suzuki, Kazuho Kamishima, Kazuhito Suzuki, Junichi Yamaguchi
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摘要

心力衰竭(HF)的发病率随着年龄的增长而增加,而肌肉疏松症是心力衰竭患者预后不良的一个因素。我们旨在评估心力衰竭合并肌肉疏松症患者的特征和预后因素。我们回顾性研究了2018年5月至2021年5月期间因心房颤动入院、接受双能X射线吸收测定并被确诊为肌肉疏松症的256名连续患者。主要终点为全因死亡率。对左室射血分数(LVEF)<50%(LVEF降低,射血分数降低型心房颤动[HFrEF])和LVEF≥50%(LVEF保留,射血分数保留型心房颤动[HFpEF])患者的预后和特征进行了评估和比较。HFrEF和HFpEF患者分别为83人(32%)和173人(68%)。与 HFpEF 组相比,HFrEF 组女性人数较少,高血压发病率较低,缺血性心脏病发病率较高,脑钠肽 (BNP) 水平较高。全因死亡的 Kaplan-Meier 分析显示,HFrEF 组的预后明显差于 HFpEF 组 [log-rank p = 0.002]。在心房颤动和肌肉疏松症患者中,年龄较大、纽约心脏协会(NYHA)分级较高、BNP 水平较高和 LVEF 降低是评估后死亡的独立预测因素。在治疗房颤合并肌肉疏松症患者的过程中,有必要密切关注 BNP 和 LVEF。
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Prognostic factors in patients with heart failure and sarcopenia: an observational retrospective study
Heart failure (HF) prevalence increases with age, and sarcopenia is a poor prognostic factor in patients with HF. We aimed to evaluate the characteristics and prognostic factors in patients with HF and sarcopenia. We retrospectively reviewed 256 consecutive patients admitted to our hospital for HF between May 2018 and May 2021, underwent dual-energy X-ray absorptiometry, and were diagnosed with sarcopenia. The primary endpoint was all-cause mortality. The prognoses and characteristics were evaluated and compared between patients with left ventricular ejection fraction (LVEF) < 50% (reduced LVEF, HF with reduced ejection fraction [HFrEF]) and those with LVEF ≥ 50% (preserved LVEF, HF with preserved ejection fraction [HFpEF]). 83 (32%) and 173 (68%) patients had HFrEF and HFpEF, respectively. The HFrEF group had fewer women, lower hypertension rates, higher ischemic heart disease rates, and brain natriuretic peptide (BNP) levels than did the HFpEF group. Kaplan–Meier analysis for all-cause death showed that the HFrEF group had a significantly worse prognosis than the HFpEF group [log-rank p = 0.002]. In patients with HF and sarcopenia, older age, higher New York Heart Association (NYHA) class, BNP levels, and reduced LVEF were independent predictors of death after evaluation. During the treatment of patients with HF and sarcopenia, it is necessary to manage treatment with close attention to BNP and LVEF.
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