Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004 Yokohama, Japan.
Eur J Prev Cardiol. 2021 Aug 9;28(9):1022-1029. doi: 10.1093/eurjpc/zwaa117.
Sarcopenia, one of the extracardiac factors for reduced functional capacity and poor outcome in heart failure (HF), may act differently between HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF). We sought to investigate the impact of sarcopenia on mortality in HFpEF and HFrEF.
We performed a post hoc analysis of a multicentre prospective cohort study, including 942 consecutive older (age ≥65 years) hospitalized patients: 475 with HFpEF (ejection fraction ≥45%, age 81 ± 7 years, 48.8% men) and 467 with HFrEF (ejection fraction <45%, age 78 ± 8 years, 68.1% men). Sarcopenia was diagnosed according to the international criteria incorporating muscle strength (handgrip strength), physical performance (gait speed), and skeletal muscle mass (appendicular skeletal mass). The HFpEF group consisted of fewer patients with low appendicular skeletal muscle mass index measured using bioelectrical impedance analysis [<7.0 kg/m2 (men) and <5.7 (women); 22.1% vs. 31.0%, P = 0.003], and more patients with low handgrip strength [<26 kg (men) and <18 (women); 67.8% vs. 55.5%, P < 0.001], and slow gait speed [<0.8 m/s (both sexes); 54.5% vs. 41.1%, P < 0.001] than the HFrEF group, resulting in a similar sarcopenia prevalence in the two groups (18.1% vs. 21.6%, P = 0.191). Sarcopenia was an independent predictor of 1-year mortality in both HFpEF and HFrEF [hazard ratio (95% confidence interval) 2.42 (1.36-4.32), P = 0.003 in HFpEF and 2.02 (1.08-3.75), P = 0.027 in HFrEF; P for interaction = 0.666] after adjustment for other predictors.
In older patients with HF, sarcopenia contributes to mortality similarly in HFpEF and HFrEF.
肌肉减少症是心功能降低和心力衰竭（HF）预后不良的心脏外因素之一，其在射血分数保留型心力衰竭（HFpEF）和射血分数降低型心力衰竭（HFrEF）中的作用可能不同。我们旨在研究肌肉减少症对 HFpEF 和 HFrEF 患者死亡率的影响。
我们对一项多中心前瞻性队列研究进行了事后分析，纳入了 942 例连续住院的老年（年龄≥65 岁）患者：475 例 HFpEF（射血分数≥45%，年龄 81±7 岁，48.8%为男性）和 467 例 HFrEF（射血分数<45%，年龄 78±8 岁，68.1%为男性）。根据包含肌肉力量（握力）、身体表现（步速）和骨骼肌质量（四肢骨骼肌质量）的国际标准诊断肌肉减少症。HFpEF 组中使用生物电阻抗分析测量的低四肢骨骼肌质量指数的患者较少 [<7.0kg/m2（男性）和<5.7kg/m2（女性）；22.1%比 31.0%，P=0.003]，而握力较低的患者较多 [<26kg（男性）和<18kg（女性）；67.8%比 55.5%，P<0.001]，以及步速较慢的患者较多 [<0.8m/s（两性）；54.5%比 41.1%，P<0.001]，这导致两组的肌肉减少症患病率相似（18.1%比 21.6%，P=0.191）。肌肉减少症是 HFpEF 和 HFrEF 患者 1 年死亡率的独立预测因素[风险比（95%置信区间）分别为 2.42（1.36-4.32），P=0.003 和 2.02（1.08-3.75），P=0.027；调整其他预测因素后 P 交互=0.666]。
在老年 HF 患者中，肌肉减少症对 HFpEF 和 HFrEF 患者的死亡率有相似的影响。
