Cai Xiaojie, Liu Menghui, Qin Peng, Tang Sanhua, He Lixiang, Lei Jiangjie, Zhou Yi, Xu Zemeihong, Guo Yue, Feng Chong, Zhuang Xiaodong, Liao Xinxue
Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; NHC Key Laboratory of Assisted Circulation and Vascular Diseases, Sun Yat-sen University, Guangzhou, China.
Department of Cardiology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China.
JACC Adv. 2025 Jan 29;4(2):101553. doi: 10.1016/j.jacadv.2024.101553.
Heart failure (HF)-related skeletal muscle wasting inversely affects the prognosis of HF, in which systemic inflammation may be involved. The relationships among skeletal muscle mass (SMM), systemic inflammation, and cardiovascular outcomes have not been clarified.
This study evaluated the associations of SMM with cardiovascular outcomes, systemic immune-inflammatory index (SII) with cardiovascular outcomes, and the mediation role of SII in the relationship between SMM and outcomes.
We included inpatients from the RED-CARPET trial (Real-world Data of Cardiometabolic ProtEcTion trial) with a definitive diagnosis of HF. We explored the associations of SMM with prognosis and SII with prognosis stratified by sex. Mediation analysis was applied for the role of SII in the association of SMM and the prognosis.
With a median follow-up of 4.9 years, 1402 patients with HF had 208 all-cause deaths and 106 cardiovascular deaths. Each 1-SD decrement in SMM was significantly associated with an increased risk of all-cause death (HR: 2.17; 95% CI: 1.20-3.91; P = 0.01 in males and HR: 2.90; 95% CI: 1.27-6.67; P = 0.012 in females). For cardiovascular death, the HR was 3.61 (95% CI: 1.56-8.40; P = 0.003) in males and 6.67 (95% CI: [2.33, 18.9]; P < 0.001) in females. Higher SII was associated with adverse outcomes. In the mediation analyses, SII was partially mediated in the relationship between SMM and cardiovascular death (7.1% [proportion-mediated 95% CI: 0.5%-26%]; P = 0.036 for males, and 5.4% [proportion mediated 95% CI: 0%-18.8%]; P = 0.064 for females).
Both low SMM and increased SII were significantly associated with unfavorable outcomes in HF. SII was partially mediated in the relationship between low SMM and cardiovascular death in HF.
心力衰竭（HF）相关的骨骼肌萎缩会对HF的预后产生负面影响，其中可能涉及全身炎症。骨骼肌质量（SMM）、全身炎症与心血管结局之间的关系尚未明确。
本研究评估了SMM与心血管结局的关联、全身免疫炎症指数（SII）与心血管结局的关联，以及SII在SMM与结局关系中的中介作用。
我们纳入了RED-CARPET试验（心脏代谢保护试验的真实世界数据）中确诊为HF的住院患者。我们按性别分层探讨了SMM与预后的关联以及SII与预后的关联。应用中介分析来研究SII在SMM与预后关联中的作用。
中位随访4.9年，1402例HF患者中有208例全因死亡和106例心血管死亡。SMM每降低1个标准差与全因死亡风险增加显著相关（男性HR：2.17；95%CI：1.20-3.91；P=0.01；女性HR：2.90；95%CI：1.27-6.67；P=0.012）。对于心血管死亡，男性HR为3.61（95%CI：1.56-8.40；P=0.003），女性HR为6.67（95%CI：[2.33, 18.9]；P<0.001）。较高的SII与不良结局相关。在中介分析中，SII在SMM与心血管死亡的关系中起部分中介作用（男性为7.1%[中介比例95%CI：0.5%-26%]；P=0.036；女性为5.4%[中介比例95%CI：0%-18.8%]；P=0.064）。
低SMM和升高的SII均与HF的不良结局显著相关。SII在HF中低SMM与心血管死亡的关系中起部分中介作用。
