Reduced Handgrip Strength as a Marker of Frailty Predicts Clinical Outcomes in Patients With Heart Failure Undergoing Ventricular Assist Device Placement

Abstract

Background Heart failure (HF) is associated with the derangement of muscle structure and metabolism, contributing to exercise intolerance, frailty, and mortality. Reduced handgrip strength is associated with increased patient frailty and higher morbidity and mortality. We evaluated handgrip strength as a marker of muscle function and frailty for prediction of clinical outcomes after ventricular assist device (VAD) implantation in patients with advanced HF. Methods and Results Handgrip strength was measured in 72 patients with advanced HF before VAD implantation (2.3 ± 4.9 days pre-VAD). We analyzed dynamics in handgrip strength, laboratory values, postoperative complications, and mortality. Handgrip strength correlated with serum albumin levels (r = 0.334, P = .004). Compared with baseline, handgrip strength increased post-VAD implantation by 18.2 ± 5.6% at 3 months (n = 29) and 45.5 ± 23.9% at 6 months (n = 27). Patients with a handgrip strength <25% of body weight had an increased risk of mortality, increased postoperative complications, and lower survival after VAD implantation. Conclusion Patients with advanced HF show impaired handgrip strength indicating a global myopathy. Handgrip strength <25% of body weight is associated with higher postoperative complication rates and increased mortality after VAD implantation. Thus, the addition of measures of skeletal muscle function underlying the frailty phenotype to traditional risk markers might have incremental prognostic value in patients undergoing evaluation for VAD placement.

Preoperative Pectoralis Muscle Quantity and Attenuation by Computed Tomography Are Novel and Powerful Predictors of Mortality After Left Ventricular Assist Device Implantation

“…21,22 Although frailty lacks a consensus definition, it has been shown to be an important prognostic marker in LVAD therapy. [22][23][24] It is not surprising that low muscle mass, which correlates with frailty, was strongly associated with mortality in this data set. These CT obtained measures, however, have the advantage of being highly repeatable and easily obtained in patients who may not be well enough to perform traditional frailty assessments.…”

Activities Worth Living For

“…The lack of a cohort of young patients limits the generalizability of the findings, as ADLs may be different for young versus older patients with CHF. Most importantly, the ability to perform ADLs is a complex process that involves the entire spectrum of patient-reported outcomes, many of which have been proven to be independent predictors of mortality and hospitalizations such as health-related quality of life, 11 frailty, 12 and optimism. 13 Adjustment for these other key factors with the addition of emotional/social support and expectations would enable the identification of the incremental benefit of assessments of patient limitations with ADLs.…”

Capacidade funcional, força muscular e qualidade de vida na insuficiência cardíaca

“…A medida da força de preensão manual (FPM) por dinamometria, tem sido relatada como bom indicador da força muscular global e preditor da mortalidade em idosos. Além disso, notou-se que cardiopatas apresentam diminuição da FPM com o envelhecimento, com declínio em seus valores após 45 anos de idade, além de ser forte indicador da capacidade funcional daqueles indivíduos 5,6 . Nesse contexto, a aferição da FPM, surge como uma ferramenta útil e de baixo custo na aferição da força muscular em pacientes com IC, uma vez que caracteriza o status funcional muscular geral 6 .…”