阑尾肌力量的改善预示着心力衰竭患者死亡率的降低

IF 3.2 3区医学 Q2 NUTRITION & DIETETICS

Nutrition Pub Date : 2025-03-22 DOI:10.1016/j.nut.2025.112774

Takumi Noda P.T., Ph.D. , Kentaro Kamiya P.T., Ph.D. , Nobuaki Hamazaki P.T., Ph.D. , Takashi Miki P.T., M.Sc. , Kohei Nozaki P.T., Ph.D. , Takafumi Ichikawa P.T. , Masashi Yamashita P.T., Ph.D. , Shota Uchida P.T., Ph.D. , Kensuke Ueno P.T., Ph.D. , Emi Maekawa M.D., Ph.D. , Tasuku Terada C.E.P., Ph.D. , Jennifer L. Reed R.Kin., Ph.D. , Minako Yamaoka-Tojo M.D., Ph.D. , Atsuhiko Matsunaga P.T., Ph.D. , Junya Ako M.D., Ph.D.

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引用次数: 0

摘要

背景：心力衰竭（HF）患者全身肌力下降与预后不良和身体功能下降有关。我们研究了阑尾肌无力（动力减退）的改善是否预示着心衰患者更好的预后和身体功能的改善。方法在出院前（基线）和门诊心脏康复（CR）后（随访）评估握力和腿部力量，并将患者分为基线/随访时无动力、基线/随访时无动力、基线/随访时无动力、基线/随访时无动力、基线/随访时有动力、基线/随访时有动力4种情况。采用Cox回归和混合效应分析来检验运动障碍状况变化与全因死亡率和身体功能（6分钟步行距离和步态速度）之间的关系。结果纳入分析的607例患者（中位年龄70岁，男性64%）中，92例患者在随访期间（中位2.81年）死亡。基线/随访时动力不足组（校正风险比[aHR]: 1.936, 95%可信区间[CI]: 1.086 ~ 3.451）和基线/随访时无动力不足组（aHR: 2.442, 95% CI: 1.032 ~ 5.766）的死亡率高于基线/随访时无动力不足组。基线/随访时动力不足组和非动力不足组的死亡风险无差异（aHR: 1.270, 95% CI: 0.670 ~ 2.409）。运动障碍的改善与6分钟步行距离的增加相关（p = 0.004），但与步态速度无显著相关性（p = 0.173）。结论：心衰患者CR后动力不足与较高的死亡风险和较低的运动能力相关。

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Improved appendicular muscle strength predicts lower mortality in patients with heart failure

Background

A decrease in general muscle strength is associated with a poor prognosis and lower physical function in patients with heart failure (HF). We examined whether improved appendicular muscle weakness (dynapenia) conditions would predict a better prognosis and improved physical functions in patients with HF.

Methods

Handgrip and leg strength were assessed before discharge (baseline) and after outpatient cardiac rehabilitation (CR) (follow-up), based on which patients were divided into four dynapenia conditions: non-dynapenia at baseline/follow-up, dynapenia at baseline/non-dynapenia at follow-up, non-dynapenia at baseline/dynapenia at follow-up, and dynapenia at baseline/follow-up. Cox regression and mixed-effects analyses were performed to examine associations between changes in the dynapenia condition and all-cause mortality and physical functions (6-minute walking distance and gait speed).

Results

Of 607 patients included in the analyses (median age 70 years, 64% male), 92 patients died during the follow-up period (median 2.81 years). The dynapenia at baseline/follow-up group (adjusted hazard ratio [aHR]: 1.936, 95% confidence interval [CI]: 1.086–3.451) and non-dynapenia at baseline/dynapenia at follow-up group (aHR: 2.442, 95% CI: 1.032–5.766) had higher mortality rates compared to the non-dynapenia at baseline/follow-up group. The mortality risk was not different between the group with dynapenia at baseline/non-dynapenia at follow-up (aHR: 1.270, 95% CI: 0.670–2.409) and the group with non-dynapenia at baseline/follow-up. Improved dynapenia conditions were associated with increased 6-minute walking distance (p = 0.004) but not significantly associated with gait speed (p = 0.173).

Conclusions

Dynapenia following CR is associated with a higher risk of mortality and lower exercise capacity in patients with HF.

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来源期刊

Nutrition 医学-营养学

CiteScore

7.80

自引率

2.30%

发文量

300

审稿时长

60 days

期刊介绍： Nutrition has an open access mirror journal Nutrition: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. Founded by Michael M. Meguid in the early 1980''s, Nutrition presents advances in nutrition research and science, informs its readers on new and advancing technologies and data in clinical nutrition practice, encourages the application of outcomes research and meta-analyses to problems in patient-related nutrition; and seeks to help clarify and set the research, policy and practice agenda for nutrition science to enhance human well-being in the years ahead.