Guzmán-Carreras Alicia, San Miguel-Agudo Jorge, Paz-Cabezas Mateo, Bernabeu-Wittel Máximo, Muñoz-Rivas Nuria, Sánchez-Sauce Beatriz, Aguilar-Rodríguez Fernando, Cabeza-Osorio Luis, Andrès Emmanuel, Lorenzo-Villalba Noel, Méndez-Bailón Manuel
Servicio de Medicina Interna, Hospital Clínico San Carlos, 28040 Madrid, Spain.
Faculty of Medicine. Universidad Complutense de Madrid, Hospital Clínico San Carlos, 28040 Madrid, Spain.
J Clin Med. 2024 Aug 18;13(16):4873. doi: 10.3390/jcm13164873.
Sarcopenia is a comorbidity associated with heart failure, which aggravates its prognosis. To analyze the differential characteristics of polypathological patients with acute heart failure (AHF) based on the presence of low muscle strength, as well as to study whether this condition is associated with a worse prognosis. An observational study of 377 patients with a diagnosis of acute heart failure from the prospective multicentric PROFUND-IC registry was carried out. The main variable is low muscle strength, which is assessed with dynamometry or prehensile strength. Epidemiological and anthropometric characteristics, as well as associated comorbidities, were analyzed. Likewise, the etiology of the AHF episode, the number of admissions in the previous year, and the NYHA scale were also included. Finally, scores on functionality, treatment established, and mortality and readmission rates were studied. Quantitative variables are described as mean, and standard deviation, and qualitative variables are expressed as absolute numbers and percentages. A descriptive and bivariate analysis was performed according to the presence of low muscle strength (handgrip <27 kg in men and <16 kg in women), using the Welch test for quantitative measures and Chi-square for qualitative variables. In addition, Kaplan-Meier curves of readmission and mortality and a logistic regression analysis were also performed. 377 patients were included (56% female, mean age 83 years). 310 (82.23%) had low muscle strength. Those with low muscle strength were older (84 vs. 78 years, < 0.001), with more cognitive impairment (11.9% vs. 0%, = 0.021), worse functional class ( = 0.016), lower scores in the Barthel index and Rockwood scale ( < 0.001), and higher in the PROFUND index ( < 0.001). They had higher rates of readmission and mortality without statistically significant differences. The PROFUND index is significantly associated with low muscle strength (OR 1.19, CI (1.09-1.31), < 0.001). Elderly polypathological patients with acute heart failure and low muscle strength have a higher PROFUND index and a lower probability of survival per year.
肌肉减少症是一种与心力衰竭相关的合并症，会加重心力衰竭的预后。分析基于肌肉力量低下的急性心力衰竭（AHF）多病理患者的差异特征，并研究这种情况是否与更差的预后相关。对前瞻性多中心PROFUND-IC登记处377例诊断为急性心力衰竭的患者进行了观察性研究。主要变量是肌肉力量低下，通过握力计或抓力进行评估。分析了流行病学和人体测量学特征以及相关合并症。同样，还纳入了AHF发作的病因、前一年的住院次数和纽约心脏协会（NYHA）分级。最后，研究了功能评分、既定治疗、死亡率和再入院率。定量变量用均值和标准差描述，定性变量用绝对数和百分比表示。根据肌肉力量低下的情况（男性握力<27kg，女性握力<16kg）进行描述性和双变量分析，定量测量使用韦尔奇检验，定性变量使用卡方检验。此外，还进行了再入院和死亡率的Kaplan-Meier曲线分析以及逻辑回归分析。纳入了377例患者（56%为女性，平均年龄83岁）。310例（82.23%）肌肉力量低下。肌肉力量低下的患者年龄更大（84岁对78岁，P<0.001），认知障碍更多（11.9%对0%，P = 0.021），功能分级更差（P = 0.016），Barthel指数和Rockwood量表得分更低（P<0.001），PROFUND指数更高（P<0.001）。他们的再入院率和死亡率更高，但无统计学显著差异。PROFUND指数与肌肉力量低下显著相关（比值比1.19，可信区间（1.09 - 1.31），P<0.001）。患有急性心力衰竭且肌肉力量低下的老年多病理患者PROFUND指数更高，每年的生存概率更低。
