老年慢性心力衰竭合并肌少症患者心脏结构和功能参数对预后的影响

Impact of left ventricular geometry and function on prognosis in elderly patients with chronic heart failure and sarcopenia

目的:探讨老年慢性心力衰竭(CHF)合并肌少症患者心脏结构及功能参数对预后的影响。方法:选取2020年3月至2022年3月中国人民解放军西部战区总医院收治的125例老年CHF合并肌少症患者作为观察组,选取同期相匹配的125例单纯老年CHF患者作为对照组。比较2组患者左室后壁厚度(LVPWT)、左室舒张末期内径(LVEDD)、左室短轴缩短率(LVFS)、左室射血分数(LVEF)、左房室瓣口舒张期血流频谱E峰与A峰比值(E/A)以及脑钠肽(BNP)水平。随访6个月后,比较2组患者主要不良事件发生情况。将观察组患者按照是否发生主要不良事件分为预后不良组和预后良好组,比较2组指标差异。结果:观察组LVPWT大于对照组,LVEDD小于对照组,LVEF和E/A指数低于对照组,BNP水平高于对照组(P均<0.05)。观察组不良事件发生率为33.6%(42/125),高于对照组的12.8%(16/125)。预后不良组年龄≥75岁、有冠状动脉粥样硬化心脏病史、心功能Ⅲ级、体质量指数(BMI)≤20 kg/m2的比例均高于预后良好组(P<0.05)。预后不良组治疗后LVPWT大于预后良好组,LVEDD小于预后良好组,LVEF及E/A指数低于预后良好组,治疗1周后BNP水平高于预后良好组(P均<0.05)。结论:合并肌少症可加重老年CHF患者左心室肥厚、心脏收缩及舒张功能低下,使患者临床预后更差,LVPWT、LVEDD、LVEF、E/A指标及BNP水平的改变与预后相关。

Objective:To explore the prognostic role of left ventricular geometry and function in elderly patients with chronic heart failure(CHF)and sarcopenia.Methods:A total of 125 elderly patients with CHF and sarcopenia admitted to General Hospital of the Western Theater Command of People's Liberation Army between March 2020 and March 2022 were enrolled(observation group).Another 125 elderly patients with CHF only during the same period were served as controls(control group).Echocardiographic left ventricular posterior wall thickness(PWT),end-diastolic diameter(EDD),fractional shortening(FS),ejection fraction(EF),transmitral early to late diastolic flow velocity ratio(E/A ratio)and plasma level of brain natriuretic peptide(BNP)were determined.All patients were followed up for 6 months,and the occurrence of major adverse events was recorded.According to the presence or absence of adverse events,patients in observation group were further divided into poor(42 cases)and good(83 cases)prognosis subgroups,and the differences in various indexes between the two subgroups were compared.Results:Left ventricular PWT was greater,EDD was smaller,EF and E/A ratio were lower,and BNP level was higher in observation group than those in control group(all P<0.05).The incidence of adverse events was higher in observation group[(33.6%(42/125)vs.12.8%(16/125)].The proportions of patients with an age≥75 years,history of coronary heart disease,cardiac functional classⅢand body mass index(BMI)≤20 kg/m^(2) were larger in poor prognosis subgroup compared with good prognosis subgroup(all P<0.05).After one week of medical treatment,left ventricular PWT was greater,EDD was smaller,EF and E/A ratio were lower,and plasma BNP was higher in poor prognosis group compared to good prognosis group(all P<0.05).Conclusion:Elderly patients with CHF and sarcopenia often have left ventricular hypertrophy and systolic and diastolic dysfunction,which confers a worse clinical prognosis.