Ito Ryota, Hiraiwa Hiroaki, Araki Takashi, Mizutani Takashi, Kazama Shingo, Kimura Yuki, Oishi Hideo, Kuwayama Tasuku, Kondo Toru, Morimoto Ryota, Okumura Takahiro, Murohara Toyoaki
Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
Heart Vessels. 2022 Dec;37(12):2002-2012. doi: 10.1007/s00380-022-02113-z. Epub 2022 Jun 14.
Heart failure (HF) is a systemic inflammatory disease that causes hypotrophy and skeletal muscle loss. The Global Leadership Initiative on Malnutrition (GLIM) criteria have been developed as a novel evaluation index for malnutrition, with reported usefulness in HF caused by ischemic heart disease. However, reports on the usefulness of malnutrition evaluated by the GLIM criteria in non-ischemic dilated cardiomyopathy (NIDCM) and its relationship with psoas muscle volume are lacking. We investigated the prognostic value of malnutrition evaluated using the GLIM criteria and its association with psoas muscle volume in patients with NIDCM. We enrolled 139 consecutive patients with NIDCM between December 2000 and June 2020. Malnutrition was evaluated using the GLIM criteria on admission. The median follow-up period was 4.7 years. Cardiac events were defined as a composite of cardiac death, hospitalization for worsening HF, and lethal arrhythmia. Furthermore, we measured the psoas muscle volume using computed tomography volumetry in 48 patients. At baseline, the median age was 50 years, and 132 patients (95.0%) had New York Heart Association functional class I or II HF. The median psoas muscle volume was 460.8 cm. A total of 26 patients (18.7%) were malnourished according to the GLIM criteria. The Kaplan-Meier survival analysis showed that malnourished patients had more cardiac events than non-malnourished patients (log-rank, P < 0.001). The multivariate Cox proportional hazards regression analysis revealed that GLIM criteria-based malnutrition was an independent determinant of cardiac events (hazard ratio, 2.065; 95% confidence interval, 1.166-3.656; P = 0.014). Psoas muscle volume, which was assessed in a total of 48 patients, was lower in malnourished than in non-malnourished patients (median, 369.0 vs. 502.3 cm; P = 0.035) and correlated with body mass index (r = 0.441; P = 0.002). Nutritional screening using the GLIM criteria may be useful in predicting future cardiac events in patients with NIDCM, reflecting a potential relationship between malnutrition and a low psoas muscle volume.
心力衰竭（HF）是一种全身性炎症性疾病，可导致心肌肥厚和骨骼肌丢失。全球营养不良领导倡议（GLIM）标准已被开发为一种新的营养不良评估指标，据报道在缺血性心脏病引起的HF中具有实用性。然而，关于GLIM标准评估的营养不良在非缺血性扩张型心肌病（NIDCM）中的实用性及其与腰大肌体积的关系的报道尚缺乏。我们研究了使用GLIM标准评估的营养不良在NIDCM患者中的预后价值及其与腰大肌体积的关联。我们纳入了2000年12月至2020年6月期间连续的139例NIDCM患者。入院时使用GLIM标准评估营养不良情况。中位随访期为4.7年。心脏事件定义为心脏死亡、因HF恶化住院和致命性心律失常的综合情况。此外，我们对48例患者使用计算机断层扫描容积法测量了腰大肌体积。基线时，中位年龄为50岁，132例患者（95.0%）患有纽约心脏协会心功能I级或II级HF。中位腰大肌体积为460.8 cm³。根据GLIM标准，共有26例患者（18.7%）存在营养不良。Kaplan-Meier生存分析显示，营养不良患者的心脏事件比非营养不良患者更多（对数秩检验，P＜0.001）。多因素Cox比例风险回归分析显示，基于GLIM标准的营养不良是心脏事件的独立决定因素（风险比，2.065；95%置信区间，1.166 - 3.656；P = 0.014）。在总共48例患者中评估的腰大肌体积，营养不良患者低于非营养不良患者（中位数，369.0 vs. 502.3 cm³；P = 0.035），且与体重指数相关（r = 0.441；P = 0.002）。使用GLIM标准进行营养筛查可能有助于预测NIDCM患者未来的心脏事件，反映了营养不良与低腰大肌体积之间的潜在关系。
