CardioVascular Center, Tufts Medical Center, Boston, MA (A.R.V., L.T., M.L., D.C., M.S.K., G.C., M.K.).
Department of Pediatrics, US Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX (W.W.W.).
Circ Heart Fail. 2022 May;15(5):e009012. doi: 10.1161/CIRCHEARTFAILURE.121.009012. Epub 2022 Apr 5.
Patients with advanced systolic heart failure are at risk of unintentional weight loss and muscle wasting. It has been observed that left ventricular assist device (LVAD) recipients gain weight after device implantation, although it is unknown whether this represents skeletal muscle mass gains. We aimed to determine whether skeletal muscle mass increases early during LVAD support.
We prospectively recruited 30 adults with systolic heart failure ±21 days from LVAD implantation. Participants underwent whole-body dual X-ray absorptiometry to measure fat free mass, appendicular lean mass (ALM, lean mass in the arms and legs) and fat mass. Dual X-ray absorptiometry imaging was repeated at 3 and 6 months after LVAD implantation, with participation ending after the 6-month visit or heart transplantation, whichever occurred first. Changes in body composition were evaluated using mixed effects linear regression models.
The cohort was 87% male, with mean age 56±12 (SD) years, and mean body mass index 26.4±5.4 kg/m. Per sarcopenia ALM criteria, 52% of participants had muscle wasting at baseline. At baseline, mean fat free mass and ALM were 56.4±11.7 and 21.0±5.3 kg, respectively. Both measures increased significantly (<0.001) over 6 months of LVAD support: mean fat free mass change at 3 and 6 months: 2.3 kg (95% CI, 1.0-3.5) and 4.2 kg (95% CI, 2.2-6.1); mean ALM change at 3 and 6 months: 1.5 kg (95% CI, 0.7-2.3) and 2.3 kg (95% CI, 0.9-3.6).
Among LVAD recipients with advanced systolic heart failure and high baseline prevalence of muscle wasting, there were significant gains in skeletal muscle mass, as represented by dual X-ray absorptiometry fat free mass and ALM, over the first 6 months of LVAD support.
患有晚期收缩性心力衰竭的患者存在非故意体重减轻和肌肉消耗的风险。人们观察到左心室辅助装置（LVAD）植入后接受者会增加体重，尽管尚不清楚这是否代表骨骼肌质量增加。我们旨在确定 LVAD 支持早期是否会增加骨骼肌质量。
我们前瞻性招募了 30 名接受 LVAD 植入后 21 天内的收缩性心力衰竭患者±。参与者接受全身双能 X 线吸收法测量去脂体重、四肢瘦体重（ALM，手臂和腿部的瘦体重）和脂肪量。在 LVAD 植入后 3 个月和 6 个月重复双能 X 线吸收法成像，以 6 个月就诊或心脏移植后的第一次就诊结束。使用混合效应线性回归模型评估身体成分的变化。
队列中 87%为男性，平均年龄 56±12（SD）岁，平均体重指数 26.4±5.4 kg/m²。根据肌少症 ALM 标准，基线时有 52%的参与者存在肌肉消耗。基线时，平均去脂体重和 ALM 分别为 56.4±11.7 和 21.0±5.3 kg。在 LVAD 支持的 6 个月内，这两个指标均显著增加（<0.001）：3 个月和 6 个月时的平均去脂体重变化分别为 2.3 kg（95%CI，1.0-3.5）和 4.2 kg（95%CI，2.2-6.1）；3 个月和 6 个月时的平均 ALM 变化分别为 1.5 kg（95%CI，0.7-2.3）和 2.3 kg（95%CI，0.9-3.6）。
在接受 LVAD 治疗的晚期收缩性心力衰竭患者中，基线时肌肉消耗的患病率较高，在 LVAD 支持的最初 6 个月内，通过双能 X 线吸收法去脂体重和 ALM 均明显增加了骨骼肌质量。
