Journal
JOURNAL OF CARDIAC FAILURE
Volume 20, Issue 5, Pages 310-315Publisher
CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS
DOI: 10.1016/j.cardfail.2014.02.008
Keywords
Heart failure; ventricular assist device; skeletal muscle; handgrip strength
Categories
Funding
- National Heart, Lung, and Blood Institute [K23 HL095742-01, P30 HL101272-01, UL1 RR 024156, HL073029]
- Doris Duke Charitable Foundation
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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 BF 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 handgiip 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.
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