Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
J Cardiol. 2020 Jul;76(1):109-114. doi: 10.1016/j.jjcc.2020.01.003. Epub 2020 Jan 28.
Loop diuretics are widely used for the management of fluid retention in patients with heart failure (HF). Sarcopenia, defined as decreased skeletal muscle mass, is frequently present in patients with HF and is associated with poor prognosis. The effects of loop diuretics on skeletal muscle in HF patients have not been fully elucidated. Here, we investigated the impact of loop diuretics on the skeletal muscle mass in patients with HF.
We conducted a subanalysis of a cross-sectional study from 10 hospitals evaluating 155 patients with HF (age 67 ± 13 yrs, 69% men).
We compared the HF patients who were treated with loop diuretics (n = 120) with the patients who were not (n = 35). The thigh and arm circumferences were significantly small in the group treated with loop diuretics compared to those not so treated (39.9 ± 4.8 vs. 43.5 ± 6.9 cm, p < 0.001 and 26.7 ± 3.5 vs. 28.9 ± 6.2 cm, p < 0.001, respectively). In a univariate analysis, higher age, lower body mass index, lower hemoglobin, and loop diuretic use were significantly associated with smaller thigh circumference. In a multivariable analysis, the use of loop diuretics was independently associated with smaller thigh circumference (β = -0.51, 95% confidence interval -0.98 to -0.046, p = 0.032).
Loop diuretics are associated with decreased thigh and arm circumferences in patients with HF, independent of the severity of HF. Our findings revealed for the first time the adverse effects of loop diuretics on skeletal muscle wasting. These findings will have a significant impact in clinical practice regarding the frequent use of loop diuretics in HF patients.
在心力衰竭（HF）患者中，广泛使用袢利尿剂来管理液体潴留。肌少症定义为骨骼肌量减少，常存在于 HF 患者中，并与预后不良相关。袢利尿剂对 HF 患者骨骼肌的影响尚未完全阐明。在这里，我们研究了袢利尿剂对 HF 患者骨骼肌量的影响。
我们对来自 10 家医院的评估 155 例 HF 患者的横断面研究进行了亚分析（年龄 67±13 岁，69%为男性）。
我们比较了接受袢利尿剂治疗的 HF 患者（n=120）与未接受治疗的患者（n=35）。与未接受治疗的患者相比，接受袢利尿剂治疗的患者大腿和手臂周长明显较小（39.9±4.8 vs. 43.5±6.9cm，p<0.001和 26.7±3.5 vs. 28.9±6.2cm，p<0.001）。在单变量分析中，年龄较大、体重指数较低、血红蛋白较低和使用袢利尿剂与大腿周长较小显著相关。在多变量分析中，袢利尿剂的使用与大腿周长较小独立相关（β=-0.51，95%置信区间-0.98 至-0.046，p=0.032）。
袢利尿剂与 HF 患者大腿和手臂周长减小相关，与 HF 严重程度无关。我们的发现首次揭示了袢利尿剂对骨骼肌消耗的不良影响。这些发现将对 HF 患者频繁使用袢利尿剂的临床实践产生重大影响。
