Department of Cardiology, DRK Kliniken Berlin Köpenick, S.-Allende-Str. 2-8, 12559, Berlin, Germany,
J Cachexia Sarcopenia Muscle. 2013 Dec;4(4):277-85. doi: 10.1007/s13539-013-0109-7. Epub 2013 Jun 21.
Respiratory muscle (RM) function predicts prognosis in non-cachectic patients with chronic heart failure (CHF). We hypothesized that weakness of RM (maximum inspiratory mouth occlusion pressure, Pimax) is a function of body mass index, and that outcome is more a function of BMI than of Pimax or ventilatory drive (P0.1).
We enrolled 249 CHF patients (11.2 % female, median age 54.2 years) at the German Heart Institute Berlin. Patients were in NYHA classes I/II/III/IV by n = 16/90/108/35. All patients underwent tests of pulmonary function, RM (Pimax, P0.1), cardiopulmonary exercise testing (peakVO2, VE/VCO2-slope), and right heart catheterization.
Mean follow-up time was 18 (1-36) months, 47 patients (18.9 %) died or underwent cardiac assist implantation. Pimax correlated weakly with BMI (r = 0.19), peakVO2 (r = 0.15), and FEV1 (r = 0.34, all p < 0.02), and was lower in females compared to males (3.9 ± 1.7 vs. 6.6 ± 2.7 kPa; p < 0.001). P0.1 correlated with pulmonary pressure (rho = 0.2; p < 0.01) and peakVO2 (rho = -0.14; p < 0.02). Neither Pimax [hazard ratio (HR) 0.98; confidence interval (CI) 0.88-1.08] nor P0.1 (HR 0.52; 0.06-4.6) predicted survival. Multivariate regression analysis revealed gender, BMI, and FEV1 as cofactors of Pimax, with only BMI (HR 0.87; CI 0.80-0.95) predicting survival independently. The lowest quintile in BMI had the worst outcome (log-rank χ² = 13.5, p = 0.009). In CHF patients including cachexia and NYHA IV, Pimax does not predict survival. Pimax depends on gender, BMI, FEV1, and peakVO2, with only BMI and peakVO2 predicting survival. The impaired Pimax in CHF might be a result of catabolism and weight loss and is not a predictive factor in itself.
呼吸肌（RM）功能可预测非恶病质慢性心力衰竭（CHF）患者的预后。我们假设 RM 无力（最大口腔吸气阻断压，Pimax）是体重指数的函数，并且结局更多地是 BMI 的函数，而不是 Pimax 或通气驱动（P0.1）的函数。
我们招募了德国柏林心脏研究所的 249 名 CHF 患者（女性占 11.2%，中位年龄 54.2 岁）。根据 NYHA 分级，患者为 I/II/III/IV 级，分别为 16/90/108/35 例。所有患者均接受了肺功能、RM（Pimax、P0.1）、心肺运动试验（峰值 VO2、VE/VCO2 斜率）和右心导管检查。
中位随访时间为 18（1-36）个月，47 例患者（18.9%）死亡或接受心脏辅助植入。Pimax 与 BMI（r=0.19）、峰值 VO2（r=0.15）和 FEV1（r=0.34，均 p<0.02）呈弱相关，且女性低于男性（3.9±1.7 比 6.6±2.7kPa；p<0.001）。P0.1 与肺压（rho=0.2；p<0.01）和峰值 VO2（rho=-0.14；p<0.02）相关。Pimax[风险比（HR）0.98；置信区间（CI）0.88-1.08]和 P0.1（HR 0.52；0.06-4.6）均不能预测生存。多变量回归分析显示，性别、BMI 和 FEV1 是 Pimax 的共同因素，只有 BMI（HR 0.87；CI 0.80-0.95）独立预测生存。BMI 最低五分位数的结局最差（对数秩 χ²=13.5，p=0.009）。在包括恶病质和 NYHA IV 的 CHF 患者中，Pimax 不能预测生存。Pimax 取决于性别、BMI、FEV1 和峰值 VO2，只有 BMI 和峰值 VO2 预测生存。CHF 中 Pimax 的受损可能是代谢和体重减轻的结果，本身不是预测因素。
