Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
JACC Cardiovasc Imaging. 2021 Jan;14(1):203-215. doi: 10.1016/j.jcmg.2020.07.022. Epub 2020 Sep 16.
The purpose of this study was to determine the relationship between body composition, N-terminal B-type natriuretic peptide (NT-proBNP) levels, and heart failure (HF) phenotypes and outcomes.
Abnormalities in body composition can influence metabolic dysfunction and HF severity; however, data assessing fat distribution and skeletal muscle (SM) size in HF with reduced (HFrEF) and preserved EF (HFpEF) are limited. Further, whether NPs relate more closely to axial muscle mass than measures of adiposity is not well studied.
We studied 572 adults without HF (n = 367), with HFrEF (n = 113), or with HFpEF (n = 92). Cardiac magnetic resonance was used to assess subcutaneous and visceral abdominal fat, paracardial fat, and axial SM size. We measured NT-proBNP in 334 participants. We used Cox regression to analyze the relationship between body composition and mortality.
Compared with controls, pericardial and subcutaneous fat thickness were significantly increased in HFpEF, whereas patients with HFrEF had reduced axial SM size after adjusting for age, sex, race, and body height (p < 0.05 for comparisons). Lower axial SM size, but not fat, was significantly predictive of death in unadjusted (standardized hazard ratio: 0.63; p < 0.0001) and multivariable-adjusted analyses (standardized hazard ratio = 0.72; p = 0.0007). NT-proBNP levels more closely related to lower axial SM rather than fat distribution or body mass index (BMI) in network analysis, and when simultaneously assessed, only SM (p = 0.0002) but not BMI (p = 0.18) was associated with NT-proBNP. However, both NT-proBNP and axial SM mass were independently predictive of death (p < 0.05).
HFpEF and HFrEF have distinct abnormalities in body composition. Reduced axial SM, but not fat, independently predicts mortality. Greater axial SM more closely associates with lower NT-proBNP rather than adiposity. Lower NT-proBNP levels in HFpEF compared with HFrEF relate more closely to muscle mass rather than obesity.
本研究旨在确定身体成分、N 末端 B 型利钠肽（NT-proBNP）水平与心力衰竭（HF）表型和结局之间的关系。
身体成分的异常会影响代谢功能障碍和 HF 的严重程度；然而，关于 HF 射血分数降低（HFrEF）和射血分数保留（HFpEF）患者中脂肪分布和骨骼肌（SM）大小的数据有限。此外，NP 是否与轴向肌肉质量的相关性比肥胖程度的相关性更密切，这一点尚未得到很好的研究。
我们研究了 572 名无 HF（n=367）、HFrEF（n=113）或 HFpEF（n=92）的成年人。心脏磁共振用于评估皮下和内脏腹部脂肪、心包脂肪和轴向 SM 大小。我们在 334 名参与者中测量了 NT-proBNP。我们使用 Cox 回归分析身体成分与死亡率之间的关系。
与对照组相比，HFpEF 患者的心包和皮下脂肪厚度明显增加，而 HFrEF 患者在调整年龄、性别、种族和身高后，轴向 SM 大小减小（比较时 p<0.05）。未经调整（标准化风险比：0.63；p<0.0001）和多变量调整分析（标准化风险比=0.72；p=0.0007）中，较低的轴向 SM 大小而非脂肪与死亡显著相关。在网络分析中，NT-proBNP 水平与较低的轴向 SM 更密切相关，而不是与脂肪分布或体重指数（BMI）相关，当同时评估时，只有 SM（p=0.0002）而不是 BMI（p=0.18）与 NT-proBNP 相关。然而，NT-proBNP 和轴向 SM 质量均独立预测死亡（p<0.05）。
HFpEF 和 HFrEF 存在不同的身体成分异常。减少的轴向 SM，而不是脂肪，独立预测死亡率。更大的轴向 SM 与较低的 NT-proBNP 更密切相关，而不是肥胖。与 HFrEF 相比，HFpEF 中较低的 NT-proBNP 水平与肌肉质量的相关性更密切，而不是肥胖。
