Department of Pediatric Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
Department of Pediatric Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
J Cardiol. 2020 Oct;76(4):413-419. doi: 10.1016/j.jjcc.2020.04.011. Epub 2020 May 18.
Patients with congenital heart disease (CHD) reportedly have reduced exercise capacity. Underlying cardiac anatomy and a sedentary lifestyle are thought to be associated with exercise impairment. However, little has been reported regarding the relationship between quantitative body composition and exercise capacity. Bioelectrical impedance analysis (BIA) is a rapid and safe assessment method that has been widely used in clinical research. We hypothesized that bioelectrical impedance parameters are determinants of exercise capacity, and the skeletal muscle index (SMI) determined by BIA is a prognostic predictor in patients with CHD.
We conducted a retrospective single-center study of 305 consecutive patients with CHD [median age, 26 years (range 12-60]; 48% males] admitted between 2014 and 2017. The BIA parameters were reviewed, including the edema index (EI, extracellular water to total body water ratio), SMI (skeletal muscle mass/height), mineral index (MI, mineral mass/height), percent body fat (%BF), and exercise capacity [peak oxygen uptake (peakVO)] via a cardiopulmonary exercise test.
The multivariate analysis revealed a significant correlation between peakVO and EI (r=0.55) and peakVO and SMI (r=0.49). The receiver operating characteristic curve analysis showed that the EI cut-off for peakVO<20ml/kg/min was 0.386 [area under the curve (AUC), 0.77; sensitivity, 0.67; specificity 0.76], and the SMI cut-off was 7.6kg/m (AUC, 0.78; sensitivity, 0.76; specificity 0.75). Compared with patients who had biventricular morphology, patients with single ventricular morphology had a higher EI (mean, 0.381 vs. 0.387, respectively) and lower SMI (8.5 vs. 7.7, respectively), resulting in a lower peakVO (27.1 vs. 20.8, respectively). The Kaplan-Meier analysis showed that a low SMI was associated with an increased risk of future heart failure-related admissions.
SMI determined by BIA is a determinant of exercise capacity and can be used as a prognostic predictor in patients with CHD.
据报道，患有先天性心脏病 (CHD) 的患者运动能力下降。心脏解剖结构和久坐的生活方式被认为与运动能力受损有关。然而，关于定量身体成分与运动能力之间的关系，报道甚少。生物电阻抗分析 (BIA) 是一种快速且安全的评估方法，已广泛应用于临床研究。我们假设生物电阻抗参数是运动能力的决定因素，并且 BIA 确定的骨骼肌指数 (SMI) 是 CHD 患者的预后预测指标。
我们进行了一项回顾性单中心研究，纳入了 2014 年至 2017 年间连续收治的 305 例 CHD 患者（中位年龄 26 岁[范围 12-60]；48%为男性）。回顾了 BIA 参数，包括水肿指数 (EI，细胞外水与总体液比)、SMI（骨骼肌质量/身高）、矿物质指数 (MI，矿物质质量/身高)、体脂百分比 (%BF) 和心肺运动试验测定的运动能力（峰值摄氧量[peakVO]）。
多元分析显示，peakVO 与 EI(r=0.55) 和 peakVO 与 SMI(r=0.49) 之间存在显著相关性。受试者工作特征曲线分析显示，EI 预测 peakVO<20ml/kg/min 的截断值为 0.386[曲线下面积 (AUC) 为 0.77；灵敏度为 0.67；特异性为 0.76]，SMI 截断值为 7.6kg/m(AUC 为 0.78；灵敏度为 0.76；特异性为 0.75)。与双心室形态的患者相比，单心室形态的患者 EI 更高（均值分别为 0.381 和 0.387），SMI 更低（分别为 8.5 和 7.7），导致 peakVO 更低（分别为 27.1 和 20.8）。Kaplan-Meier 分析显示，低 SMI 与未来心力衰竭相关入院的风险增加相关。
BIA 确定的 SMI 是运动能力的决定因素，可作为 CHD 患者的预后预测指标。
