Prevalence and prognostic impact of bone disease in chronic heart failure with reduced ejection fraction.

Autor: Verheyen N; Department of Internal Medicine, Division of Cardiology, University Heart Center, Medical University of Graz, Graz, Austria., Schmid J; Department of Radiology, Division of General Radiology, Medical University of Graz, Graz, Austria., Kolesnik E; Department of Internal Medicine, Division of Cardiology, University Heart Center, Medical University of Graz, Graz, Austria., Schwegel N; Department of Internal Medicine, Division of Cardiology, University Heart Center, Medical University of Graz, Graz, Austria., Späth J; Department of Internal Medicine, Division of Cardiology, University Heart Center, Medical University of Graz, Graz, Austria., Kattnig L; Department of Internal Medicine, Division of Cardiology, University Heart Center, Medical University of Graz, Graz, Austria.; Department of Paediatrics and Adolescent Medicine, State Hospital Hochsteiermark - Leoben, Leoben, Austria., Riepl H; Department of Internal Medicine, Division of Cardiology, University Heart Center, Medical University of Graz, Graz, Austria., Zach D; Department of Internal Medicine, Division of Cardiology, University Heart Center, Medical University of Graz, Graz, Austria., Santner V; Department of Internal Medicine, Division of Cardiology, University Heart Center, Medical University of Graz, Graz, Austria., Höller V; Department of Internal Medicine, Division of Cardiology, University Heart Center, Medical University of Graz, Graz, Austria., Pilz S; Department of Internal Medicine, Division of Diabetology and Endocrinology, Medical University of Graz, Graz, Austria., Tomaschitz A; Health Center Trofaiach, Trofaiach, Austria., Fuchsjäger M; Department of Radiology, Division of General Radiology, Medical University of Graz, Graz, Austria., Fahrleitner-Pammer A; Department of Internal Medicine, Division of Diabetology and Endocrinology, Medical University of Graz, Graz, Austria., Dimai HP; Department of Internal Medicine, Division of Diabetology and Endocrinology, Medical University of Graz, Graz, Austria., Obermayer-Pietsch B; Department of Internal Medicine, Division of Diabetology and Endocrinology, Medical University of Graz, Graz, Austria., Fruhwald F; Department of Internal Medicine, Division of Cardiology, University Heart Center, Medical University of Graz, Graz, Austria., Scherr D; Department of Internal Medicine, Division of Cardiology, University Heart Center, Medical University of Graz, Graz, Austria., Zirlik A; Department of Internal Medicine, Division of Cardiology, University Heart Center, Medical University of Graz, Graz, Austria., von Lewinski D; Department of Internal Medicine, Division of Cardiology, University Heart Center, Medical University of Graz, Graz, Austria., Ablasser K; Department of Internal Medicine, Division of Cardiology, University Heart Center, Medical University of Graz, Graz, Austria.
Jazyk: angličtina
Zdroj: ESC heart failure [ESC Heart Fail] 2024 Jun; Vol. 11 (3), pp. 1730-1738. Date of Electronic Publication: 2024 Mar 07.
DOI: 10.1002/ehf2.14741
Abstrakt: Aims: Chronic heart failure is associated with a bone-catabolic state and increases the risk of osteoporosis and fractures. Prospective studies investigating the clinical relevance of bone disease in heart failure are lacking. We aimed to assess the prevalence and prognostic impact of osteoporosis and vertebral fractures (VFs) in chronic heart failure with reduced ejection fraction (HFrEF).
Methods and Results: Symptomatic outpatients with chronic heart failure and a previous diagnosis of overtly reduced left ventricular ejection fraction < 40% on stable, optimal HFrEF therapy and left ventricular ejection fraction < 50% at enrolment were included into a prospective single-centre study. Osteoporosis was determined with dual-energy X-ray absorptiometry and defined as a T-score ≤ 2.5 at any site. VFs were assessed using X-ray of both thoracic and lumbar spine applying the semiquantitative Genant score. We enrolled 205 patients (22% women), with a median age of 66 (IQR 58-74) years. Median left ventricular ejection fraction was 37 (IQR 30-43) % and median N-terminal pro B-type natriuretic peptide was 964 (IQR 363-2173) pg/mL. Osteoporosis, as defined by bone mineral density, and at least one VF were prevalent in 31 (15%) and 29 patients (14%). Osteoporosis or VF were present in 55 patients (27%) and 5 patients (2%) had both osteoporosis and a VF. During a median follow-up of 4.7 (IQR 4.0-5.3) years, 18 patients (9%) died due to cardiovascular (CV) cause, and 46 patients (22%) had a worsening heart failure (WHF) hospitalization. In multivariate Cox regression analyses, presence of VF independently predicted CV death (HR 2.82, 95% CI 1.04-7.65, P = 0.042), WHF hospitalizations (HR 2.39, 95% CI 1.18-4.82, P = 0.015), and a composite endpoint of CV death and WHF hospitalizations (HR 2.44, 95% CI 1.23-4.82, P = 0.011). Osteoporosis was not significantly associated with CV events.
Conclusions: In a prospective study, bone disease affected every fourth patient with HFrEF, and patients with VF at baseline had a two-fold risk of subsequent CV death or WHF hospitalization. Prevalent bone disease, particularly VF, should be considered as a clinically relevant comorbidity in HFrEF.
(© 2024 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)
Databáze: MEDLINE
Externí odkaz: