Celkupa Didjana, Sweigart Benjamin A, Chery Joronia, Coston Alex, Telfer Laura, Lawrence Matthew, Kiernan Michael S, Couper Gregory S, Kawabori Masashi, LeBrasseur Nathan, Saltzman Edward, Vest Amanda R
CardioVascular Center, Tufts Medical Center, Boston, MA.
Biostatistics, Epidemiology, and Research Design (BERD) Center, Tufts Clinical and Translational Science Institute, Tufts Medical Center, Boston, MA.
JHLT Open. 2025 Jul 4;9:100338. doi: 10.1016/j.jhlto.2025.100338. eCollection 2025 Aug.
We observed significant gains in appendicular lean mass (ALM) over the first 6 months of left ventricular assist device (LVAD) support for patients with heart failure with reduced ejection fraction (HFrEF). We sought to determine whether improved HF neurohumoral stability, inflammation, physical activity, or nutrition, are most closely related to this muscle mass recovery.
We prospectively recruited 30 adults with HFrEF ±21 days from LVAD implantation. Dual X-ray absorptiometry (DXA) measured ALM at baseline and at 3- and 6-months post-LVAD implantation ( = 22 with ALM at baseline and 3 months). Markers of neurohumoral HF stability (NT-proBNP, growth differentiation factor-15), inflammation [high sensitivity C-reactive protein (hsCRP)], habitual physical activity (24-hour average steps), and nutritional intake (24-hour average dietary protein) were also recorded. Mixed effects models separately evaluated the change in each parameter over time and relationships with the change in ALM.
At baseline, participants (87% male, mean age 56 ± 12 years) showed a significant negative association between ALM and log N-terminal-pro B natriuretic peptide (NT-proBNP) ( = -0.38, 95% CI -0.66, -0.001, = 0.050) and log growth differentiation factor-15 (GDF-15) ( = -0.42, 95% CI -0.69, -0.05, = 0.027). Over the 6-month study period, NT-proBNP and hsCRP decreased, 24-hour steps increased, whereas GDF-15 and 24-hour dietary protein were unchanged. There was an increase in ALM across study timepoints, which was significantly associated only with reductions in log NT-proBNP and hsCRP on mixed effects models.
The recovery in ALM over the first 6 months of LVAD support was most closely associated with improved HF neurohumoral stability and inflammation, rather than activity or nutritional changes.
我们观察到，对于射血分数降低的心力衰竭（HFrEF）患者，在左心室辅助装置（LVAD）支持的前6个月中，其四肢瘦体重（ALM）有显著增加。我们试图确定改善的心力衰竭神经体液稳定性、炎症、身体活动或营养，哪一个与这种肌肉质量恢复关系最为密切。
我们前瞻性招募了30名植入LVAD后±21天的HFrEF成年患者。采用双能X线吸收法（DXA）在基线以及LVAD植入后3个月和6个月时测量ALM（n = 22，在基线和3个月时测量了ALM）。还记录了神经体液性心力衰竭稳定性标志物（N末端B型利钠肽原（NT-proBNP）、生长分化因子-15）、炎症指标[高敏C反应蛋白（hsCRP）]、日常身体活动量（24小时平均步数）和营养摄入量（24小时平均膳食蛋白质摄入量）。混合效应模型分别评估了每个参数随时间的变化以及与ALM变化的关系。
在基线时，参与者（87%为男性，平均年龄56±12岁）的ALM与log N末端B型利钠肽原（NT-proBNP）（r = -0.38，95%CI -0.66，-0.001，P = 0.050）和log生长分化因子-15（GDF-15）（r = -0.42，95%CI -0.69，-0.05，P = 0.027）之间存在显著负相关。在6个月的研究期间，NT-proBNP和hsCRP降低，24小时步数增加，而GDF-15和24小时膳食蛋白质摄入量没有变化。在整个研究时间点上，ALM有所增加，在混合效应模型中，这仅与log NT-proBNP和hsCRP的降低显著相关。
在LVAD支持的前6个月中，ALM的恢复与心力衰竭神经体液稳定性和炎症的改善关系最为密切，而非活动或营养变化。
