Study On The Influencing Factors Of Sarcopenia In Elderly Patients With HFpEF,HFmrEF,HFrEF

Objective:To explore the distribution and influencing factors of three groups of left ventricular ejection fraction(LVEF<40%,40-49%,≥50%)in elderly patients with chronic heart failure(HF)combined with sarcopenia by the First Affiliated Hospital of Chengdu Medical College.Methods:First,a cross-sectional study was conducted.The subjects were elderly patients with CHF in the Department of Geriatrics and Cardiology of the First Affiliated Hospital of Chengdu Medical College from January 2017 to April 2018.According to the 2016 European guidelines classification method,by the classification of LVEF>50%,LVEF 40~49%,LVEF<40%,the above populations were divided into the group of heart failure preserved ejection fraction(HFpEF),the group of heart failure with middle-range ejection fraction(HFmrEF)and the group of heart failure with reduced ejection fraction(HFrEF).According to the diagnostic criteria of sarcopenia:(1)skeletal muscle mass reduction[by bio-electrical impedance analysis(BIA),appendicular skeletal muscle mass index(ASMI)≤7.0 kg/m~2 for male,while≤5.7kg/m~2 for female],(2)muscle strength reduced(grip strength<26kg for male,<18kg for female),(3)dysfunction(pace≤0.8m/s),meet condition(1)and meet condition(2)and/or(3)to diagnose sarcopenia,Therefore,we explored the composition ratio of HFmrEF,HFrEF,HFpEF in elderly patients with sarcopenia.Then,case-control study was conducted.According to whether the patient is complicated with sarcopenia,each of three groups people is further divided into two subgroups.Record the patient’s general basic data,etiology/complication,partial biochemical and echocardiography data,type of drug taken,compare the differences and analyze.Statistical significance and clinical-related factors were then subjected to binary Logistic regression analysis.Initially explored the influencing factors of sarcopenia in the three groups.Results:1.During this study,the HFpEF group accounted for 51.4%(378/734)in the elderly CHF,while the HFmrEF group accounted for 20.2%(148/374),and the HFrEF group accounted for 28.3%(208/734).Among all elderly CHF,patients with sarcopenia accounted for 35.1%(258/734).Among them,29.1%(110/378)of patients with sarcopenia in the HFpEF group,39.2%(58/148)with sarcopenia in the HFmrEF group,and 43.2%(90/208)with sarcopenia in the HFrEF group.2.In the HFpEF group,univariate analysis of the non-sarcopenia and sarcopenia group showed:age,overweight or obesity,NYHA classification,ischemic heart disease(IHD),valve and congenital structural abnormalities,type 2 diabetes(T2DM),above stage 3 chronic kidney disease(CKD),hyperthyroidism,albumin,triglycerides,takingβ-blockers,pace,grip strength,appendicular skeletal mass index(ASMI),and short physical performance battery(SPPB),there were differences between these items,and these were statistically significant(P<0.05).In the binary Logistic regression analysis,after adjusting for confounding factors,the older the age,overweight or obesity,complicated with valve and congenital structural abnormalities,complicated with T2DM,stage 3 or more CKD,high albumin level and higher NYHA grade were independent influencing factors of sarcopenia.3.In the HFmrEF group,univariable analysis of non-sarcopenia group and sarcopenia group showed that drinking history,overweight or obesity,NYHA grade,IHD,dilated cardiomyopathy(DCM),T2DM,chronic anemia,chronic obstructive pulmonary disease(COPD),albumin,homocysteine,TG,LDL-C,left ventricular end-diastolic diameter(LVEDD),taking ACEI/ARB drugs,pace,ASMI,SPPB,there were differences between these items,and these were statistically significant(P<0.05).In the binary Logistic regression analysis,after adjusting for confounding factors,the older the age,combined with IHD,combined with DCM,chronic anemia,high albumin level,higher NYHA classification,taking ACEI/ARB drugs were independent influencing factors of sarcopenia.4.In the HFrEF group,univariate analysis of non-sarcopenia and sarcopenia group showed:overweight or obesity,IHD,DCM,valve and congenital structural abnormalities,T2DM,above stage 3 CKD,chronic anemia,albumin,creatinine,eGFR,LVEDD,LVEF,taking ACEI/ARB drugs,pace,ASMI,SPPB,there were differences between these items,and these were statistically significant(P<0.05).In the binary Logistic regression analysis,after adjusting for confounding factors,combined with DCM,combined with valve and congenital structural abnormalities,combined with T2DM,combined with CKD above stage 3,combined with chronic anemia,and high albumin levels and taking ACEI/ARB drugs are independent influencing factors for sarcopenia.Conclusion:There are differences in the influencing factors of HFpEF,HFmrEF,and HFrEF in elderly patients with HF who have sarcopenia.1.In the HFpEF group,the older the age,overweight or obesity,the higher the NYHA grade,combined the valve and congenital structural abnormalities,combined with T2DM,and combined with CKD above stage 3,resulted in the higher the risk of sarcopenia.Meanwhile,the higher the albumin level,the lower the risk of sarcopenia.2.In the HFmrEF group,the older the age,the higher the NYHA classification,combined with IHD,combined with DCM,and combined with chronic anemia,resulting in the higher the risk of sarcopenia.However,taking ACEI/ARB drugs and the higher the albumin level,the lower the risk of sarcopenia in the group.3.In the HFmrEF group,combined with DCM,combined with valve and congenital structural abnormalities,combined with T2DM,combined with CKD above stage 3,and combined with chronic anemia,resulted in the higher the risk of sarcopenia.Meanwhile the higher the albumin level,taking ACEI/ARB medications,the lower the risk of sarcopenia.