Zhang Yingyue, Zhang Yan, Shi Yajun, Dong Wei, Mu Yang, Wang Jing, Gao Yifan, Hu Rong, Xu Yong, Chen Yundai, Ma Jing
Department of Cardiology, Chinese PLA General Hospital, Beijing, China.
Medical School of Chinese PLA, Beijing, China.
Front Cardiovasc Med. 2021 Oct 1;8:732200. doi: 10.3389/fcvm.2021.732200. eCollection 2021.
Heart failure (HF) is considered one of the most common complications of coronary heart disease (CHD), with a higher incidence of readmission and mortality. Thus, exploring the risk factors related to the prognosis is necessary. Moreover, the effect of the waist-to-hip ratio (WHR) on HF patients with revascularized CHD is still unclear. Thus, we aimed to assess the influence of WHR on the prognosis of HF patients with revascularized CHD. We collected data of HF patients with revascularized CHD who were referred to the Cardiac Rehabilitation Clinic of PLA Hospital from June 30, 2015, to June 30, 2019. Cox proportional hazard regression analysis was used to determine the relationship between WHR and prognosis of HF patients with revascularized CHD. Patients were divided into higher and lower WHR groups based on the cutoff WHR value calculated by the X-tile software. Cox regression analysis was used to analysis the two groups. We drew the receiver operating characteristic curve (ROC) of WHR and analyzed the differences between the two groups. Endpoints were defined as major adverse cardiac events (MACE) (including all-cause mortality, non-fatal myocardial infarction, unscheduled revascularization, and stroke). During the median follow-up of 39 months and maximum follow-up of 54 months, 109 patients were enrolled, of which 91.7% were males, and the mean age was 56.0 ± 10.4 years. WHR was associated with the incidence of MACE in the Cox regression analysis ( = 0.001); an increase in WHR of 0.01 unit had a hazard ratio (HR) of 1.134 (95%CI: 1.057-1.216). The WHR cutoff value was 0.93. Patients in the higher WHR group had a significantly higher risk of MACE than those in the lower WHR group (HR = 7.037, 95%CI: 1.758-28.168). The ROC area under the curve was 0.733 at 4 years. Patients in the higher WHR group had a higher body mass index (BMI; 26.7 ± 3.5 vs. 25.4 ± 2.4, = 0.033) than patients in the lower WHR group. WHR is an independent risk factor of the long-term prognosis of Chinese HF patients with revascularized CHD. Patients with WHR ≥ 0.93 require intensified treatment. Higher WHR is related to higher BMI and ΔVO2/ΔWR.
心力衰竭（HF）被认为是冠心病（CHD）最常见的并发症之一，再入院率和死亡率较高。因此，探索与预后相关的危险因素很有必要。此外，腰臀比（WHR）对接受血运重建的冠心病HF患者的影响仍不清楚。因此，我们旨在评估WHR对接受血运重建的冠心病HF患者预后的影响。我们收集了2015年6月30日至2019年6月30日转诊至解放军总医院心脏康复门诊的接受血运重建的冠心病HF患者的数据。采用Cox比例风险回归分析来确定WHR与接受血运重建的冠心病HF患者预后之间的关系。根据X-tile软件计算出的WHR临界值，将患者分为WHR较高组和较低组。采用Cox回归分析对两组进行分析。我们绘制了WHR的受试者工作特征曲线（ROC），并分析了两组之间的差异。终点定义为主要不良心脏事件（MACE）（包括全因死亡率、非致命性心肌梗死、非计划血运重建和中风）。在中位随访39个月、最长随访54个月期间，共纳入109例患者，其中男性占91.7%，平均年龄为56.0±10.4岁。在Cox回归分析中，WHR与MACE的发生率相关（P = 0.001）；WHR每增加0.01个单位，风险比（HR）为1.134（95%CI：1.057 - 1.216）。WHR临界值为0.93。WHR较高组患者发生MACE的风险显著高于WHR较低组（HR = 7.037，95%CI：1.758 - 28.168）。4年时ROC曲线下面积为0.733。WHR较高组患者的体重指数（BMI；26.7±3.5 vs. 25.4±2.4，P = 0.033）高于WHR较低组。WHR是中国接受血运重建的冠心病HF患者长期预后的独立危险因素。WHR≥0.93的患者需要强化治疗。较高的WHR与较高BMI以及ΔVO2/ΔWR相关。
