Department of Cardiology, School of Medicine, International University of Health and Welfare.
Tohoku J Exp Med. 2021 Jun;254(2):81-87. doi: 10.1620/tjem.254.81.
Heart failure increases among the elderly; however, the influence of ambient temperature on cardiorenal function has not been well investigated. Patients (n = 110, mean age 82.9 years, 43 males) with stable heart failure and creatinine < 3.0 mg/dl were studied. Medical records, such as ejection fraction, B-type natriuretic peptide (BNP), and estimated glomerular filtration rate (eGFR) at each visit every 1-3 months were collected by the end-point for death, additional prescription to treat heart failure, or heart failure hospitalization. The ambient temperatures at each visit were obtained from the Japan Meteorological Agency. During the follow-up period (median 399 days and 7 visits), follow-up BNP showed a trend toward a positive correlation with the diurnal temperature range. After dividing into two groups by median baseline eGFR, follow-up BNP was positively correlated with minimum temperature (p = 0.039) and the diurnal temperature range (p = 0.007) in the Low-eGFR group but not in the High-eGFR group. Follow-up eGFR was negatively correlated with the ambient day temperature in both groups (p ≤ 0.002). Follow-up BNP was positively correlated with follow-up eGFR (p < 0.0001) only in the Low-eGFR group and not in the High-eGFR group, suggesting that BNP and eGFR increase in winter and BNP and eGFR decrease in summer in the Low-eGFR group. In conclusions, heart failure may be worsened by larger diurnal temperature range or in winter in patients with renal impairment. This population should be carefully managed in the clinic according to the ambient temperature.
心力衰竭在老年人中增加；然而，环境温度对心肾功能的影响尚未得到很好的研究。研究了 110 例稳定心力衰竭且肌酐<3.0mg/dl 的患者（平均年龄 82.9 岁，男性 43 例）。通过终点（死亡、治疗心力衰竭的额外处方或心力衰竭住院）收集了每次就诊的医疗记录，如射血分数、B 型利钠肽（BNP）和估计肾小球滤过率（eGFR）。每次就诊的环境温度均从日本气象厅获得。在随访期间（中位数 399 天，共 7 次就诊），随访 BNP 与日间温度范围呈正相关趋势。按中位数基线 eGFR 分为两组后，在低 eGFR 组中，随访 BNP 与最低温度（p=0.039）和日间温度范围（p=0.007）呈正相关，但在高 eGFR 组中无相关性。在两组中，随访 eGFR 与环境日温度呈负相关（p≤0.002）。仅在低 eGFR 组中，随访 BNP 与随访 eGFR 呈正相关（p<0.0001），而在高 eGFR 组中无相关性，表明低 eGFR 组中 BNP 和 eGFR 在冬季增加，而在夏季减少。总之，在肾功能受损的患者中，较大的日间温度范围或冬季可能使心力衰竭恶化。该人群应根据环境温度在临床中进行谨慎管理。
