Related Factors Of Geriatric Chronic Heart Failure Patients With Sarcopenia

Background and objective: With the global population aging and the extension of the average life span,the prevalence of Chronic Heart Failure(CHF)will further increase,which has become a health problem that has attracted much attention in the field of cardiovascular diseases worldwide.When the geriatric patients of chronic heart failure complicated with sarcopenia,their exercise ability will further decline,and the quality of life will further decrease.Besides the long-time prognosis will also deteriorate.At present,the research on the treatment strategy of sarcopenia is not sufficient,and the clinical aim is to prevent sarcopenia.The purpose of our study is to collect the general clinical data,common serological indexes,the cardiac indexes as well as the skeletal muscle indexes in geriatric patients with chronic heart failure.We will explore the relationship between various indexes and appendicular skeletal muscle mass indexes as well as sarcopenia.The purpose of this study is to find out the influencing factors of sarcopenia in geriatric patients with chronic heart failure and to provide theoretical basis of prevention and treatment for chronic heart failure with sarcopenia.Methods: Geriatric inpatients with chronic heart failure in The Affiliated Hospital of Inner Mongolia Medical University from January 2021 to January 2022 were selected,and all the enrolled inpatients signed informed consents.The main inclusion criteria are more than 60 years of age,meeting the diagnosis standard of chronic heart failure,and the sarcopenia group must meet the diagnostic criteria for sarcopenia.The main exclusion criteria are suffering from critical illness,hardly establishing effective communication,being active period of system disease that significantly affects body movement and having pacemaker as well as metal prostheses or other metal implants.The patients were divided into CHF with sarcopenia group and CHF without sarcopenia group according to with sarcopenia or not.The general clinical data of all eligible inpatients,including age,sex,height,weight and prevalence of common chronic diseases,were recorded.The main serological test indicators included N-terminal probrain natriuretic peptide,albumin,prealbumin,serum lipid and renal function indexes.The patients received transthoracic echocardiography in the ultrasound department of our hospital.The left ventricular ejection fraction(LVEF)was recorded,and the left ventricular mass index(LVMI)was calculated as cardiac indexes.The patients were assessed for muscle strength and physical function(5 sit-down tests and SPPB scores)under the guidance of professionals during hospitalization,and the appendicular skeletal muscle mass index(ASMI)was evaluated,which were recorded as skeletal muscle indexes.The general clinical information,main serological test indicators,cardiac indexes and skeletal muscle indexes were analyzed between the group of chronic heart failure with sarcopenia and chronic heart failure without sarcopenia.The difference of the indexes between the two groups were compared,and the correlation between some measurement indexes and appendicular skeletal muscle mass index were analyzed.The Logistic regression model of sarcopenia were constructed to analyze the influencing factors.Results:1.Comparison of general clinical data between two groups: there was no significant statistical difference in the prevalence of hypertension,diabetes,atrial fibrillation,chronic obstructive pulmonary disease between the two groups(P>0.05).There was significant difference of two groups in body mass index(25.04±3.34 vs.21.91±3.49,P<0.001),and the prevalence of coronary heart disease(16.3% vs.41.2%,P=0.006)and cerebral infarction(8.2% vs.25.5%,P=0.041).2.Comparison of serological test indicators between two groups: N-terminal pro-brain natriuretic peptide(NT-proBNP),serum Albumin(ALB),serum Prealbumin(PAB),lipoprotein-A(Lpa),triglyceride(TG),low density lipoprotein cholesterol(LDL),high density lipoprotein cholesterol(HDL),total cholesterol(TC),serum creatinine(SCR),blood urea nitrogen(BUN),uric acid(UA),total homocysteine(THCY)had no significant statistical difference(P>0.05).3.Comparison of cardiac indexes between two groups: there was no significant statistical difference in cardiac function indexes(LVEF and LVMI)between two groups(P>0.05).4.Comparison of skeletal muscle indexes between two groups: there was no significant statistical difference in the completion time or rate of 5-sit-down tests(P>0.05).The muscle strength(21.92±6.83 vs.16.50±6.29,P<0.001),the SPPB scores [8.0(5.0,9.0)vs.6.0(2.0,9.0),P = 0.011),and the ASMI(6.98±0.91 vs.5.52±0.99,P<0.001)between the two groups had significant statistical difference.5.Linear correlation or rank correlation was performed after the results of normality test and drawn scatter plot.The results suggested that age,BMI,TC,HDL,SCR,UA,LVEF,LVMI,muscle strength and SPPB scores of CHF patients were significantly correlated with ASMI(P<0.05).6.The results of geriatric CHF patients with sarcopenia multivariate Logistic regression model suggested that BMI(OR=0.800,95%CI :0.678～0.944,P=0.008)and muscle strength(OR=0.877,95%CI: 0.803～0.958,P=0.004)were the influencing factors of sarcopenia.Conclusions:1.The group of geriatric CHF patients with sarcopenia had a higher prevalence of cerebral infarction and coronary heart disease,and a lower muscle strength,BMI,ASMI,and SPPB scores.2.The indicators for Age,BMI,TC,HDL,SCR,UA,LVEF,LVMI,muscle strength and SPPB scores are correlated with ASMI in geriatric patients with CHF.3.Muscle strength and BMI are independent predictors of sarcopenia in geriatric patients with CHF.Lower muscle strength and BMI will increase the risk of sarcopenia in geriatric CHF patients,and early screening should be conducted for geriatric CHF patients.