Nakade Taisuke, Maeda Daichi, Matsue Yuya, Kagiyama Nobuyuki, Fujimoto Yudai, Sunayama Tsutomu, Dotare Taishi, Jujo Kentaro, Saito Kazuya, Kamiya Kentaro, Saito Hiroshi, Ogasahara Yuki, Maekawa Emi, Konishi Masaaki, Kitai Takeshi, Iwata Kentaro, Wada Hiroshi, Kasai Takatoshi, Nagamatsu Hirofumi, Momomura Shin-Ichi, Minamino Tohru
Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Can J Cardiol. 2024 Dec;40(12):2542-2551. doi: 10.1016/j.cjca.2024.07.031. Epub 2024 Aug 21.
Sarcopenia is a substantial therapeutic target, yet the validity of risk stratification values per the latest Asian Working Group for Sarcopenia in 2019 (AWGS 2019) remains unconfirmed in patients with heart failure. We hypothesized that using the 6-minute walk test (6MWT) to assess physical performance improves risk stratification.
The study included 832 hospitalized patients with heart failure who could walk at discharge. Sarcopenia was diagnosed using both the original AWGS 2019 criteria (AWGS 2019 model) and an alternative method in which physical performance components were replaced with the 6MWT (modified model). An < 300 m 6MWT indicated low physical performance in the modified model. The primary outcome was 2-year mortality.
Sarcopenia and severe sarcopenia were identified in 45 and 150 patients with the AWGS 2019 model and in 75 and 108 patients with the modified model, respectively. Over the 2-year follow-up period, 145 (17.4%) deaths occurred. Adjusted Cox proportional hazard analysis showed both sarcopenia and severe sarcopenia were significantly associated with 2-year mortality in the modified model. In the AWGS 2019 model, only severe sarcopenia was significantly related to 2-year mortality. The modified model demonstrated significant net reclassification improvement (NRI) over the AWGS 2019 model (NRI, 0.396; 95% CI, 0.214-0.578; P < 0.001).
In patients with heart failure who were ambulatory at discharge, sarcopenia assessment with the modified AWGS 2019 model using the 6MWT as a physical performance component improved risk stratification compared with the original AWGS 2019 model. Reconsidering the current criteria to improve risk stratification is necessary to ensure timely, appropriate treatment.
UMIN000023929.
肌肉减少症是一个重要的治疗靶点，但2019年最新版亚洲肌肉减少症工作组（AWGS 2019）风险分层值在心力衰竭患者中的有效性仍未得到证实。我们假设使用6分钟步行试验（6MWT）评估身体功能可改善风险分层。
该研究纳入了832例出院时能够行走的住院心力衰竭患者。采用原始的AWGS 2019标准（AWGS 2019模型）和一种替代方法诊断肌肉减少症，后者将身体功能成分替换为6MWT（改良模型）。在改良模型中，6MWT<300 m表明身体功能低下。主要结局为2年死亡率。
AWGS 2019模型分别在45例和150例患者中识别出肌肉减少症和严重肌肉减少症，改良模型分别在75例和108例患者中识别出肌肉减少症和严重肌肉减少症。在2年随访期内，发生了145例（17.4%）死亡。校正后的Cox比例风险分析显示，改良模型中肌肉减少症和严重肌肉减少症均与2年死亡率显著相关。在AWGS 2019模型中，只有严重肌肉减少症与2年死亡率显著相关。改良模型相对于AWGS 2019模型显示出显著的净重新分类改善（NRI）（NRI，0.396；95%CI，0.214-0.578；P<0.001）。
在出院时能够行走的心力衰竭患者中，与原始的AWGS 2019模型相比，使用改良的AWGS 2019模型（将6MWT作为身体功能成分）进行肌肉减少症评估可改善风险分层。为确保及时、适当的治疗，有必要重新考虑当前标准以改善风险分层。
UMIN000023929。
