老年心力衰竭患者心血管-肾脏-代谢重叠与身体功能及预后的关联：FRAGILE-HF和SONIC-HF的事后分析

Association of Cardiovascular-Kidney-Metabolic Overlap with Physical Function and Prognosis in Older Patients with Heart Failure: A Post-hoc Analysis of the FRAGILE-HF and SONIC-HF.

作者信息

Nakade Taisuke, Matsue Yuya, Ikeda Yoshiaki, Maeda Daichi, Kagiyama Nobuyuki, Fujimoto Yudai, Inoue Hanako, 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, Toki Misako, Yoshioka Kenji, Momomura Shin-Ichi, Minamino Tohru

机构信息

Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.

Department of Cardiology, Hirakata City Hospital, Osaka, Japan.

出版信息

Eur J Prev Cardiol. 2025 May 6. doi: 10.1093/eurjpc/zwaf279.

DOI:10.1093/eurjpc/zwaf279

PMID:40326534

Abstract

AIMS

The prevalence and impact of cardiovascular, kidney, and metabolic (CKM) overlap on physical function and prognosis in older patients with heart failure (HF) remain unclear. This study aimed to assess the impact of overlapping CKM conditions on physical function and prognosis in older patients with HF.

METHODS

This post-hoc analysis of the FRAGILE-HF (main cohort) and SONIC-HF (validation cohort), both prospective multicentre studies, included patients aged ≥65 years who were hospitalised for HF. CKM overlap was defined as the presence of one or more of the following comorbidities: atherosclerotic cardiovascular disease, chronic kidney disease, or type 2 diabetes mellitus. The primary outcome was a composite of all-cause death and HF readmission within 2 years. Physical function was assessed using gait speed, five-time chair stand test (5CST), short physical performance battery (SPPB), and 6-min walk test (6MWT). To validate the prognostic association of CKM overlap, we conducted an external validation using the SONIC-HF cohort, an independent prospective study with identical inclusion criteria.

RESULTS

Of 1,113 patients (mean age: 80±8 years, 58.1% male), 193 (17.3%) had no CKM conditions, 370 (33.2%) had one, and 550 (49.5%) had two or three. A multivariable logistic regression model, adjusted for age, sex, comorbidities, and New York Heart Association functional class, showed that two or three CKM conditions were independently associated with lower physical function (5CST: odds ratio [OR]=1.91, P<0.001; SPPB: OR=1.87, P=0.001; 6MWT: OR=1.84, P=0.003). Kaplan-Meier analysis demonstrated a significant stepwise association between CKM overlap and the primary outcome in both the FRAGILE-HF and SONIC-HF cohorts (Log-rank: P < 0.001). Adjusted Cox analysis demonstrated that the overlapping CKM conditions were associated with the primary outcome, with two or more CKM conditions showing a statistically significant association in the FRAGILE-HF cohort (HR = 1.64, P = 0.003). Similarly, although statistical significance was not reached in the SONIC-HF cohort, a stepwise increase in HR was observed (2-3 CKM conditions: HR = 1.90, 95% CI: 0.97-3.73, P = 0.063).

CONCLUSION

Older patients with HF who have greater CKM overlap exhibited significantly poorer physical function and prognosis.

摘要

目的

心血管、肾脏和代谢（CKM）重叠情况对老年心力衰竭（HF）患者身体功能和预后的患病率及影响尚不清楚。本研究旨在评估CKM重叠情况对老年HF患者身体功能和预后的影响。

方法

这是一项对FRAGILE-HF（主要队列）和SONIC-HF（验证队列）的事后分析，这两项均为前瞻性多中心研究，纳入了因HF住院的≥65岁患者。CKM重叠定义为存在以下一种或多种合并症：动脉粥样硬化性心血管疾病、慢性肾脏病或2型糖尿病。主要结局是2年内全因死亡和HF再入院的复合结局。使用步速、五次起坐试验（5CST）、简短体能状况量表（SPPB）和6分钟步行试验（6MWT）评估身体功能。为验证CKM重叠的预后关联，我们使用SONIC-HF队列进行了外部验证，这是一项具有相同纳入标准的独立前瞻性研究。

结果

在1113例患者（平均年龄：80±8岁，男性占58.1%）中，193例（17.3%）无CKM合并症，370例（33.2%）有一种，550例（49.5%）有两种或三种。在对年龄、性别、合并症和纽约心脏协会心功能分级进行校正的多变量逻辑回归模型中，有两种或三种CKM合并症与较低的身体功能独立相关（5CST：比值比[OR]=1.91，P<0.001；SPPB：OR=1.87，P=0.001；6MWT：OR=1.84，P=0.003）。Kaplan-Meier分析表明，在FRAGILE-HF和SONIC-HF队列中，CKM重叠与主要结局之间存在显著的逐步关联（对数秩检验：P<0.001）。校正后的Cox分析表明，CKM重叠情况与主要结局相关，在FRAGILE-HF队列中，有两种或更多CKM合并症显示出统计学显著关联（HR = 1.64，P = 0.003）。同样，虽然在SONIC-HF队列中未达到统计学显著性，但观察到HR逐步增加（2 - 3种CKM合并症：HR = 1.90，95%CI：0.97-3.73，P = 0.063）。