Nakamura Kensuke, Kinugasa Yoshiharu, Sota Takeshi, Hirai Masayuki, Kato Masahiko, Yamamoto Kazuhiro
Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University, Yonago, Japan.
Division of Rehabilitation, Tottori University Hospital, Yonago, Japan.
ESC Heart Fail. 2024 Dec;11(6):3757-3766. doi: 10.1002/ehf2.14950. Epub 2024 Jul 11.
A high extracellular water (ECW) to intracellular water (ICW) ratio of skeletal muscle as assessed by bioelectrical impedance analysis is reportedly associated with loss of muscle strength. However, the validity of this index for heart failure (HF), which is likely associated with changes in the water distribution, is unclear.
This study involved 190 patients with HF. The total ECW and ICW of both upper and lower extremities were measured, and a high ECW/ICW ratio was defined as an ECW/ICW ratio higher than the median (≥0.636 for men, ≥0.652 for women). Low muscle strength was defined as reduced handgrip strength according to the criteria established by the Asian Working Group for Sarcopenia. Patients with a high ECW/ICW ratio had a lower handgrip strength (21.1 ± 8.1 kg vs. 27.6 ± 9.3 kg, P ≤ 0.05) and 6 min walk distance (329 ± 116 m vs. 440 ± 114 m) than those with a low ECW/ICW ratio. An increasing ECW and/or decreasing ICW was associated with a higher ECW/ICW ratio and a lower handgrip strength (P < 0.05). In the multivariate logistic regression analysis, a high ECW/ICW ratio and low skeletal muscle mass were independently associated with low muscle strength (P < 0.05).
A high ECW/ICW ratio in limb muscles, that is, the water imbalance of increasing ECW and/or decreasing ICW, is useful in assessing muscle quality in patients with HF.
据报道，通过生物电阻抗分析评估的骨骼肌细胞外水（ECW）与细胞内水（ICW）的高比例与肌肉力量丧失有关。然而，该指标在心力衰竭（HF）中的有效性尚不清楚，心力衰竭可能与水分布变化有关。
本研究纳入了190例HF患者。测量上下肢的总ECW和ICW，高ECW/ICW比例定义为高于中位数的ECW/ICW比例（男性≥0.636，女性≥0.652）。根据亚洲肌少症工作组制定的标准，低肌肉力量定义为握力降低。高ECW/ICW比例的患者握力较低（21.1±8.1kg对27.6±9.3kg，P≤0.05），6分钟步行距离较短（329±116m对440±114m），而低ECW/ICW比例的患者则相反。ECW增加和/或ICW减少与较高的ECW/ICW比例和较低的握力相关（P<0.05）。在多因素逻辑回归分析中，高ECW/ICW比例和低骨骼肌质量与低肌肉力量独立相关（P<0.05）。
肢体肌肉中高ECW/ICW比例，即ECW增加和/或ICW减少的水失衡，有助于评估HF患者的肌肉质量。
