Palmieri Vittorio, Roman Mary J, Bella Jonathan N, Liu Jennifer E, Best Lyle G, Lee Elisa T, Howard Barbara V, Devereux Richard B
Weill Medical College of Cornell University, New York, New York 10021, USA.
J Am Soc Echocardiogr. 2008 Jan;21(1):66-71. doi: 10.1016/j.echo.2007.05.008. Epub 2007 Jul 12.
We sought to investigate prognostic implications of the relationships of estimated left ventricular (LV) myocardial energy expenditure (MEE) with LV systolic dysfunction, body composition, and inflammation in a population-based sample of adults without overt congestive heart failure.
Echocardiography was used to assess LV ejection fraction (EF) and MEE. Body composition was evaluated by bioelectric impedance. Dietary recall was used to assess 24-hour calorie intake. Participants in the Strong Heart Study without prior congestive heart failure and with all needed data available (n = 3087) were divided based on LV EF (>55%, 54%-45%, or <45%).
Participants with EF less than 45% were older and they had lower body mass index, adipose mass, fat-free mass, and 24-hour calorie intake than participants with normal EF (>/=55%), and had greatest reductions of body mass index and physical activity in a time interval of 3.5 years, on average, elapsed between an initial clinical assessment and the evaluation at the time of the echocardiographic examination (P < .01). Lower EF was associated with male sex, hypertension, diabetes, coronary heart disease, and higher fibrinogen, C-reactive protein, and plasma creatinine levels (all P < .01). MEE was higher with lower EF (all P < .001). In Cox regression models, during approximately 8 years of observation, MEE comprised between 97 and 123 cal/min and MEE greater than 123 cal/min were associated with 2.5-fold and additional 3.3-fold higher rates of cardiac death, respectively, compared with MEE less than 97 cal/min, independently of EF, body composition, and other covariates. However, lower adipose mass predicted increased risk of cardiac death independent of MEE and EF.
In a population-based sample of adults including ambulatory individuals with depressed LV systolic function but without overt congestive heart failure, depressed EF was associated independently with higher MEE, lower adipose mass, and higher fibrinogen. However, increased MEE and lower adipose mass predicted cardiac death independently of EF and other covariates.
我们试图在一个无明显充血性心力衰竭的成年人群样本中，研究估计的左心室（LV）心肌能量消耗（MEE）与LV收缩功能障碍、身体成分和炎症之间关系的预后意义。
采用超声心动图评估LV射血分数（EF）和MEE。通过生物电阻抗评估身体成分。采用饮食回忆法评估24小时卡路里摄入量。将无既往充血性心力衰竭且有所有所需数据的强心脏研究参与者（n = 3087）根据LV EF（>55%、54%-45%或<45%）进行分组。
EF低于45%的参与者年龄较大，与EF正常（≥55%）的参与者相比，他们的体重指数、脂肪量、去脂体重和24小时卡路里摄入量更低，并且在初始临床评估与超声心动图检查时的评估之间平均3.5年的时间间隔内，体重指数和体力活动下降幅度最大（P <.01）。较低的EF与男性、高血压、糖尿病、冠心病以及较高的纤维蛋白原、C反应蛋白和血浆肌酐水平相关（均P <.01）。EF越低，MEE越高（均P <.001）。在Cox回归模型中，在大约8年的观察期内，MEE介于97至123卡/分钟之间，与MEE低于97卡/分钟相比，MEE大于123卡/分钟分别与心脏死亡风险高2.5倍和额外高3.3倍相关，独立于EF、身体成分和其他协变量。然而，较低的脂肪量独立于MEE和EF预测心脏死亡风险增加。
在一个包括LV收缩功能降低但无明显充血性心力衰竭的门诊成年人群样本中，EF降低独立于较高的MEE、较低的脂肪量和较高的纤维蛋白原。然而，MEE增加和脂肪量降低独立于EF和其他协变量预测心脏死亡。
