基于CT评估的骨骼肌密度与皮下脂肪量对老年女性心力衰竭患者预后的预测价值

Value of skeletal muscle density and subcutaneous fat volume assessed by CT in predicting prognosis of elderly female patients with heart failure

中文关键词: 心力衰竭    老年女性    骨骼肌密度    皮下脂肪面积    预后    计算机断层扫描

英文关键词: heart failure  elderly female  skeletal muscle density  subcutaneous adipose tissue area  prognosis  computed tomography

中文摘要:

      目的 探讨基于常规胸部CT检测的骨骼肌密度（SMD）和皮下脂肪组织（SAT）面积对老年女性心力衰竭（心衰）患者全因死亡的预测价值，并评估二者联合模型的预后分层能力。方法 本研究采用回顾性队列研究，连续纳入2020年1月至2023年12月在复旦大学附属华东医院心血管内科159例住院的老年女性心衰患者。收集基线临床资料，并于T12椎体水平CT图像上定量分析SMD与SAT面积。通过受试者工作特征（ROC）曲线确定最佳截断值，采用Cox回归和Kaplan-Meier生存分析评估SMD、SAT面积与全因死亡风险的关系。结果 中位随访611 d,共记录46例（28.9%）死亡。死亡组患者的SMD和SAT均显著低于存活组。ROC分析确定SMD和SAT面积的最佳截断值分别为21.37 HU和84.72 cm²。联合模型（SMD+SAT面积）的预测效能（曲线下面积=0.74）显著优于任一单一指标。多因素Cox回归显示，低SMD和低SAT面积均是全因死亡的独立预测因素。生存分析表明，同时具有低SMD和低SAT面积的患者死亡风险最高。结论 SMD与SAT面积是老年女性心衰患者全因死亡的独立预测因子，二者联合评估能更有效地识别高危人群，可为临床精准风险分层和个体化管理提供依据。

英文摘要:

      Objective To explore the value of skeletal muscle density(SMD)and subcutaneous adipose tissue(SAT)area based on routine chest CT scans in predicting all-cause mortality in elderly female patients with heart failure(HF),and evaluate the prognostic stratification ability of a combined model of the two parameters.Methods This retrospective cohort study consecutively enrolled 159 hospitalized elderly female HF patients treated in Department of Cardiology,Huadong Hospital Affiliated to Fudan University,from January 2020 to December 2023.Their baseline clinical data were collected,and SMD and SAT area were quantitatively analyzed on CT images at the level of the T12 vertebral body.Optimal cutoff values were determined based on receiver operator character(ROC)curve analysis.Cox regression and Kaplan-Meier survival analyses were employed to assess the relationship between SMD,SAT area,and the risk of all-cause mortality.Results During a median follow-up of 611 days,a total of 46 deaths(28.9%)were recorded.The SMD and SAT area in the deceased group were significantly lower than those in the survival group.The ROC analysis determined that the optimal cutoff values for SMD and SAT area were 21.37 HU and 84.72 cm2,respectively.The predictive performance of the combined model(SMD+SAT area)(area under the curve=0.74)was significantly better than that of either single parameter.Multivariate Cox regression analysis revealed that both low SMD and low SAT area were independent predictors of all-cause mortality.Survival analysis showed that patients with both low SMD and low SAT area had the highest risk of death.Conclusion Both SMD and SAT area are independent predictors of all-cause mortality in elderly female HF patients.The combined assessment of these two parameters can more effectively identify high-risk populations,and provide a basis for clinical precise risk stratification and individualized management.