心力衰竭患者脱水及体重指数与心房颤动发生的关系
The Relationship of Dehydration and Body Mass Index With the Occurrence of Atrial Fibrillation in Heart Failure Patients.
作者信息
Chuda Anna, Kaszkowiak Marcin, Banach Maciej, Maciejewski Marek, Bielecka-Dabrowa Agata
机构信息
Heart Failure Unit, Department of Cardiology and Congenital Diseases of Adults, Polish Mother's Memorial Hospital Research Institute, Łódz, Poland.
Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Łódz, Poland.
出版信息
Front Cardiovasc Med. 2021 May 20;8:668653. doi: 10.3389/fcvm.2021.668653. eCollection 2021.
The aim of the study was to assess the relationship of dehydration, body mass index (BMI) and other indices with the occurrence of atrial fibrillation (AF) in heart failure (HF) patients. The study included 113 patients [median age 64 years; 57.52% male] hospitalized due to HF. Baseline demographics, body mass analysis, echocardiographic results, key cardiopulmonary exercise test (CPET) parameters, 6 min walk distance (6MWD) and Kansas City Cardiomyopathy Questionnaire (KCCQ) score were assessed. Of all patients, 23 (20.35%) had AF, and 90 (79.65%) had sinus rhythm (SR). Patients with AF were older (med. 66 vs. 64 years; = 0.039), with higher BMI (32.02 vs. 28.51 kg/m; = 0.017) and percentage of fat content (37.0 vs. 27.9%, = 0.014). They were more dehydrated, with a lower percentage of total body water (TBW%) (45.7 vs. 50.0%; = 0.022). Clinically, patients with AF had more often higher New York Heart Association (NYHA) class (III vs. II; < 0.001), shorter 6MWD (median 292.35 vs. 378.4 m; = 0.001) and a lower KCCQ overall summary score (52.60 vs. 73.96 points; = 0.002). Patients with AF had significantly lower exercise capacity as measured by peak oxygen consumption (peak VO2) (0.92 vs. 1.26 mL/min, = 0.016), peak VO2/kg (11 vs. 15 mL/kg/min; < 0.001), and percentage of predicted VO2max (pp-peak VO2) (62.5 vs 70.0; p=0.010). We also found VE/VCO2 (med. 33.85 vs. 32.20; = 0.049) to be higher and peak oxygen pulse (8.5 vs. 11 mL/beat; = 0.038) to be lower in patients with AF than in patients without AF. In a multiple logistic regression model higher BMI (OR 1.23 per unit increase, < 0.001) and higher left atrial volume index (LAVI) (OR 1.07 per unit increase, = 0.03), lower tricuspid annular plane systolic excursion (TAPSE) (OR 0.74 per unit increase, =0.03) and lower TBW% in body mass analysis (OR 0.90 per unit increase, =0.03) were independently related to AF in patients with HF. Increased volume of left atrium and right ventricular systolic dysfunction are well-known predictors of AF occurrence in patients with HF, but hydration status and increased body mass also seem to be important factors of AF in HF patients.
本研究的目的是评估心力衰竭（HF）患者脱水、体重指数（BMI）及其他指标与心房颤动（AF）发生之间的关系。该研究纳入了113例因HF住院的患者[中位年龄64岁；男性占57.52%]。评估了基线人口统计学资料、身体质量分析、超声心动图结果、关键心肺运动试验（CPET）参数、6分钟步行距离（6MWD）以及堪萨斯城心肌病问卷（KCCQ）评分。在所有患者中，23例（20.35%）患有AF，90例（79.65%）为窦性心律（SR）。AF患者年龄更大（中位年龄66岁对64岁；P = 0.039），BMI更高（32.02对28.51kg/m²；P = 0.017），脂肪含量百分比更高（37.0%对27.9%，P = 0.014）。他们脱水更严重总身体水分（TBW%）百分比更低（45.7%对50.0%；P = 0.022）。临床上，AF患者纽约心脏协会（NYHA）分级更高（III级对II级；P < 0.001），6MWD更短（中位值292.35对378.4m；P = 0.001），KCCQ总体总结评分更低（52.60对73.96分；P = 0.002）。通过峰值耗氧量（peak VO₂）（0.92对1.26mL/min，P = 0.016）、峰值VO₂/kg（11对15mL/kg/min；P < 0.001）以及预测VO₂max百分比（pp - peak VO₂）（62.5对70.0；P = 0.010）测量，AF患者的运动能力显著更低。我们还发现AF患者的VE/VCO₂（中位值33.85对32.20；P = 0.049）更高，峰值氧脉搏（8.5对11mL/次心跳；P = 0.038）更低。在多因素逻辑回归模型中，更高的BMI（每单位增加OR 1.23，P < 0.001）、更高的左心房容积指数（LAVI）（每单位增加OR 1.07，P = 0.03）、更低的三尖瓣环平面收缩期位移（TAPSE）（每单位增加OR 0.74，P = 0.03）以及身体质量分析中更低的TBW%（每单位增加OR 0.90，P = 0.03）与HF患者的AF独立相关。左心房容积增加和右心室收缩功能障碍是HF患者AF发生的众所周知的预测因素，但水化状态和体重增加似乎也是HF患者AF的重要因素。
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