Zhang Hao, Hu Weiwei, Yuan Mengxuan, Lu Dasheng, Gao Yang, Dai Qiming
Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, PR China.
Department of Cardiology, Affiliated Hospital of Yangzhou University, Yangzhou, PR China.
ESC Heart Fail. 2023 Oct;10(5):2982-2989. doi: 10.1002/ehf2.14482. Epub 2023 Jul 31.
Previous studies have shown a significant reduction in skeletal muscle content in patients with chronic heart failure (CHF). The present study focused on the erector spinae muscle (ESM) to determine whether ESM content is associated with the development and severity of CHF.
A total of 652 patients were included in this trial for the study. According to the diagnostic criteria of CHF, 652 patients were divided into two groups, namely, the control group (268 patients) and the CHF group (384 patients). Meanwhile, to assess whether the ESM is associated with the severity of CHF, patients in the CHF group were divided into two groups according to left ventricular ejection fraction (LVEF) values: heart failure with preserved ejection fraction (HFpEF, LVEF ≥50%, 256 patients) and heart failure with reduced ejection fraction (HFrEF, LVEF ≤40%, 68 patients). Receiver operating curve analysis was performed to assess whether ESM content could predict CHF and determine its severity. Compared with the control group, the patients in the CHF group were older, the prevalence of coronary heart disease (CHD) and atrial fibrillation was higher, the colour ultrasound results showed that LVEF decreased significantly, and the left ventricular end-diastolic internal diameter and left ventricular end-systolic internal diameter increased significantly. Besides, patients in the CHF group had significantly lower ESM content, and ESM is an independent predictor of heart failure, with an odds ratio of 0.713 (CHF group vs. control group, 95% confidence interval 0.626-0.811, P < 0.001). Compared with the HFpEF group, the HFrEF group has a lower prevalence of CHD, LVEF decreased significantly, the left ventricular end-diastolic internal diameter and left ventricular end-systolic internal diameter increased significantly, also patients in the HFrEF group had significantly lower ESM content compared with patients in the HFpEF group, and ESM is an independent predictor of the severity of heart failure, with an odds ratio of 0.514 (HFrEF group vs. HFpEF group, 95% confidence interval (0.418-0.633, P < 0.05). The results of receiver operating curve analysis showed that the sensitivity and specificity of ESM content for the diagnosis of CHF were 65.6% and 71.6%, respectively, while the sensitivity and specificity of ESM content for predicting the severity of CHF were 47.1% and 89.1%, respectively.
The ESM is of great value in predicting the onset and severity of CHF.
既往研究表明，慢性心力衰竭（CHF）患者的骨骼肌含量显著降低。本研究聚焦于竖脊肌（ESM），以确定ESM含量是否与CHF的发生及严重程度相关。
本试验共纳入652例患者进行研究。根据CHF诊断标准，将652例患者分为两组，即对照组（268例患者）和CHF组（384例患者）。同时，为评估ESM是否与CHF严重程度相关，根据左心室射血分数（LVEF）值将CHF组患者分为两组：射血分数保留的心力衰竭（HFpEF，LVEF≥50%，256例患者）和射血分数降低的心力衰竭（HFrEF，LVEF≤40%，68例患者）。进行受试者工作特征曲线分析，以评估ESM含量能否预测CHF并确定其严重程度。与对照组相比，CHF组患者年龄更大，冠心病（CHD）和心房颤动的患病率更高，彩色超声结果显示LVEF显著降低，左心室舒张末期内径和左心室收缩末期内径显著增加。此外，CHF组患者的ESM含量显著更低，且ESM是心力衰竭的独立预测指标，比值比为0.713（CHF组与对照组相比，95%置信区间0.626 - 0.811，P < 0.001）。与HFpEF组相比，HFrEF组CHD患病率更低，LVEF显著降低，左心室舒张末期内径和左心室收缩末期内径显著增加，HFrEF组患者的ESM含量也显著低于HFpEF组患者，且ESM是心力衰竭严重程度的独立预测指标，比值比为0.514（HFrEF组与HFpEF组相比，95%置信区间（0.418 - 0.633，P < 0.05）。受试者工作特征曲线分析结果显示，ESM含量诊断CHF的敏感性和特异性分别为65.6%和71.6%，而ESM含量预测CHF严重程度的敏感性和特异性分别为47.1%和89.1%。
ESM在预测CHF的发生及严重程度方面具有重要价值。
