Reduced thoracic skeletal muscle size is associated with adverse outcomes in diabetes patients with heart failure and reduced ejection fraction: quantitative analysis of sarcopenia by using cardiac MRI
Background:<bold> </bold>Sarcopenia is frequently found in patients with heart failure with reduced ejection fraction (HFrEF) and is associated with reduced exercise capacity, poor quality of life and adverse outcomes. Recent evidence suggests that axial thoracic skeletal muscle size could be used as a surrogate to assess sarcopenia in HFrEF. Since diabetes mellitus (DM) is one of the most common comorbidities with HFrEF, we aimed to explore the potential association of axial thoracic skeletal muscle size with left ventricular (LV) remodeling and determine its prognostic significance in this condition.Methods: A total of 243 diabetes patients with HFrEF were included in this study. Bilateral axial thoracic skeletal muscle size was obtained using cardiac MRI. Patients were stratified by the tertiles of axial thoracic skeletal muscle index (SMI). LV structural and functional indices, as well as amino-terminal pro-B-type natriuretic peptide (NT-proBNP), were measured. The determinants of elevated NT-proBNP were assessed using linear regression analysis. The associations between thoracic SMI and clinical outcomes were assessed using a multivariable Cox proportional hazards model.Results:<bold> </bold>Patients in the lowest tertile of thoracic SMI displayed a deterioration in LV systolic strain in three components, together with an increase in LV mass and a heavier burden of myocardial fibrosis (all P < 0.05). Moreover, thoracic SMI (beta = -0.25; P < 0.001), rather than body mass index (beta = -0.04; P = 0.55), was independently associated with the level of NT-proBNP. The median follow-up duration was 33.6 months (IQR, 20.4-52.8 months). Patients with adverse outcomes showed a lower thoracic SMI (40.1 [34.3, 47.9] cm(2)/m(2) vs. 45.3 [37.3, 55.0] cm(2)/m(2); P < 0.05) but a similar BMI (P = 0.76) compared with those without adverse outcomes. A higher thoracic SMI indicated a lower risk of adverse outcomes (hazard ratio: 0.96; 95% confidence interval: 0.92-0.99; P = 0.01).Conclusions:<bold> </bold>With respect to diabetes patients with HFrEF, thoracic SMI is a novel alternative for evaluating muscle wasting in sarcopenia that can be obtained by a readily available routine cardiac MRI protocol. A reduction in thoracic skeletal muscle size predicts poor outcomes in the context of DM with HFrEF.
基金:
This study was financially supported by the National Natural Science
Foundation of China (82120108015, 82371925), Science and Technology
Support Program of Sichuan Province (2022NSFSC1494, 2023ZYD0100) and
the 1–3–5 project for disciplines of excellence of West China Hospital, Sichuan
University (ZYGD23019).
第一作者机构:[1]Sichuan Univ, West China Hosp, Dept Radiol, Funct & Mol Imaging Key Lab Sichuan Prov, Chengdu, Sichuan, Peoples R China
通讯作者:
推荐引用方式(GB/T 7714):
Shi Ke,Zhang Ge,Fu Hang,et al.Reduced thoracic skeletal muscle size is associated with adverse outcomes in diabetes patients with heart failure and reduced ejection fraction: quantitative analysis of sarcopenia by using cardiac MRI[J].CARDIOVASCULAR DIABETOLOGY.2024,23(1):doi:10.1186/s12933-023-02109-7.
APA:
Shi, Ke,Zhang, Ge,Fu, Hang,Li, Xue-Ming,Yu, Shi-Qin...&Yang, Zhi-Gang.(2024).Reduced thoracic skeletal muscle size is associated with adverse outcomes in diabetes patients with heart failure and reduced ejection fraction: quantitative analysis of sarcopenia by using cardiac MRI.CARDIOVASCULAR DIABETOLOGY,23,(1)
MLA:
Shi, Ke,et al."Reduced thoracic skeletal muscle size is associated with adverse outcomes in diabetes patients with heart failure and reduced ejection fraction: quantitative analysis of sarcopenia by using cardiac MRI".CARDIOVASCULAR DIABETOLOGY 23..1(2024)