| PART Ⅰ CHARACTERISTICS OF BODY COMPOSITION IN HOSPITALIZED PATIENTS WITH CHRONIC HEART FAILURE WITH REDUCED EJECTION FRACTIONObjective: This part of the study aimed to explore the basic characteristics of body composition of hospitalized patients with chronic heart failure with reduced ejection fraction(HFrEF).Methods: This part of study continuously included 150 HFrEF patients who were hospitalized in the Cardiology Department of the First Affiliated Hospital of Chongqing Medical University from October 2018 to May 2020,who were matched 1:1 by age and gender among apparently healthy populations who were hospitalized for health checkup as the control group.All heart failure and the control group patients underwent the the body composition analyzer(Inbody S10)test which was based on bioelectrical impedance analysis.Statistical methods were used to compare the body composition characteristics of the heart failure group and the control group.In addition,the patients with heart failure were grouped according to whether the appendicular skeletal muscle mass decreased,and the BMI distribution of each group was analyzed.A decrease in the appendicluar skeletal muscle mass is defined as the appendicular skeletal muscle mass index [aSMI,the appendicular skeletal muscle mass(kg)/height(m)2] is less than 7.0 kg/ m~2 in males,and is less than 5.7 kg/m~2 in females.BMI≤18.5kg/m~2 was defined as low body weight;18.5kg/m~2<BMI<24kg/m~2 was defined as normal body weight,and BMI≥24kg/m~2 was defined as overweight and obesity.Results: The average aSMI of hospitalized HFrEF patients was significantly lower than that of the control group [7.05(4.43-26.6)vs.8.6(6.58-35.8)kg/m~2,P<0.05].Regardless of whether aSMI decreased in male patients,the proportion of normal weight patients was similar(53.6% vs.53.8%,P<0.05),but the proportion of low-weight patients in the aSMI-decreasing group increased(11.5% vs.0%,P<0.05),and the proportion of obese and overweight patients decreased(46.4 % vs.34.6%,P>0.05);among female patients,the proportion of patients with low and normal weight was higher in the aSMI-decreased group compared with the non-decreasing group(6.20% vs.13.6%,P<0.05;59.4% vs.72.7%,P<0.05),while the proportion of overweight and obese patients declined(34.4% vs.13.6%,P<0.05).Conclusion: The general nutritional status of HFrEF patients is significantly worse than that of the healthy controls.In HFrEF patients with decreased appendicular skeletal muscle mass,the proportion of low body weight is increased,while the proportion of overweight and obesity is decreased.PART Ⅱ CORRELATION OF APPENDICULAR SKELETAL MUSCLE MASS WITH PROGNOSIS OF CHRONIC HEART FAILURE WITH REDUCED EJECTION FRACTIONObjective: This study aimed to investigate the potential association between appendicular skeletal muscle mass measured by bioelectrical impedance and prognosis in patients with chronic heart failure with reduced ejection fraction(HFrEF).Methods: The present study continuously included 200 patients with HFrEF who were hospitalized in the Cardiology Department of the First Affiliated Hospital of Chongqing Medical University from October 2018 to May 2020.All enrolled participants underwent venous blood specimen collection,anthropological measurement,echocardiography examination,body composition analyzer test,and nutritional status evaluation.The appendicular skeletal muscle mass was measured by the human body composition analyzer(Inbody S10)based on the bioelectrical impedance method.A decrease in the appendicluar skeletal muscle mass is defined as the same mentioned above.All patients were followed up for 1 year and the end-point event was defined as all-cause mortality.A multivariate cox cox proportional hazard model was used to explore the potential correlation between aSMI and all-cause death within 1 year for patients with HFrEF.The Kaplan-Meier curve was drawn to compare the all-cause mortality of HFrEF with or without decreased aSMI.Results: A total of 188 HFrEF patients were finally enrolled and finished the follow-up program and 72 cases of death(38.3%)were observed.40 deaths were observed in the aSMI-decreased group(n=72) while 32 deaths were observed in the non-aSMI-decreased group(n=116).The percentages of patients with decreased aSMI in HFrEF patients with NYHAII,III,and IV cardiac function were: 30.0%,34.5% and 46,2%(P for trend <0.05).Compared with patients with non-decreased aSMI,HFrEF patients with decreased aSMI had a 2.13-fold higher risk of death [HR:2.13,95%CI: 1.57-2.34,P <0.05] in 1 year of follow-up.After further adjustment for the confounding factors including body mass index,hemoglobin,NRS2002 score and triceps skin fold thickness,HFrEF patients with decreased aSMI still had a 2.21 times higher risk of death(HR: 2.13,95%CI: 1.92-3.23,P <0.05)than those without decreased aSMI.The Kaplan-Meier curve showed that there was a significant difference between the cumulative all-cause mortality within 1 year between HFrEF patients with and without decreased aSMI(log-rank test,P <0.05).Conclusion: In patients with HFrEF,the prevalence of decreased aSMI rises with the increasing NYHA heart function level.A decreased aSMI may be an independent risk factor for a poor prognosis of HFrEF patients.PART Ⅲ CORRELATION OF PHASE ANGLE WITH THE PROGNOSIS OF CHRONIC HEART FAILURE WITH REDUCED EJECTION FRACTIONObjective: This part of study aimed to explore the potential association of phase angle(Ph A)level with the prognosis in patients with chronic heart failure with reduced ejection fraction(HFrEF).Methods: The present study continuously included 200 patients with HFrEF who were hospitalized in the Cardiology Department of the First Affiliated Hospital of Chongqing Medical University from October 2018 to May 2020.All patients underwent venous blood specimen collection,anthropological measurement,echocardiography test,body composition analyzer test,and nutritional status evaluation.The phase angle was measured by a body composition analyzer(Inbody S10)based on the bioelectrical impedance method.All patients were followed up for 1 year and the end-point event was defined as all-cause mortality during the follow-up time.A multivariate cox cox proportional hazard model was used to explore the potential correlation between the level of phase angle and all-cause death within 1 year for patients with HFrEF.The Kaplan-Meier curve was drawn to compare the mortality of HFrEF with high and low phase angle.Results: A total of 188 HFrEF patients were finally enrolled and finished the follow-up program and 72 cases of death(38.3%)were observed.The average level of phase angle for all the enrolled patients were 4.24±0.34°.the patients were divived into two groups,namely the high Ph A(Ph A>4.2°,n=81)group and the low Ph A(Ph A≤4.2°,n=107)group.18 deaths(22.2%)were observed in the high Ph A group while 54 deaths(50.5%)were observed in the low Ph A group.The multivariate cox cox proportional hazard model showed that for every 1°decrease in Ph A,the risk of death in patients with HFrEF within 1 year increased by 3.24 times [hazard ratio(HR): 3.24,95% confidence interval(CI): 2.31-4.65,P<0.05] after further adjusting for age,gender,body mass index,BNP,hemoglobin,NRS2002 score,triceps skin fold thickness as well as treatment medicine.Compared with patients with high Ph A,those with low Ph A had a 2.30 times(HR:2.30,95%CI:2.03-2.59,P<0.05)higher risk for all-cause death in 1-year follow-up time even after the adjustment of those confounding factors.The Kaplan-Meier curve showed that there was a significant difference as to the cumulative rate of all-cause death between HFrEF patients with high and low Ph A within 1 year(P<0.05).Conclusion: Decreased Ph A measured by BIA may be an independent risk factor for a poor prognosis of HFrEF patients. |
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