Prognostic impact of gait speed, muscle strength and muscle mass in chronic heart failure-A prospective cohort study.

IF 3.2 2区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS ESC Heart Failure Pub Date : 2025-02-04 DOI:10.1002/ehf2.15221

Vladimir Cejka, Hermann Riepl, Nora Schwegel, Ewald Kolesnik, David Zach, Viktoria Santner, Viktoria Höller, Natascha Schweighofer, Barbara Obermayer-Pietsch, Thomas Pieber, Caroline Morbach, Stefan Frantz, Andreas Zirlik, Dirk von Lewinski, Stefan Störk, Florian Posch, Klemens Ablasser, Nicolas Verheyen

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Abstract

Aims: Heart failure (HF) impairs skeletal muscle mass and function, which contributes to reduced physical performance. We investigated the prognostic impact of gait speed (GS), handgrip strength (HG) and appendicular skeletal muscle index (ASMI) on cardiovascular outcomes in a prospective HF cohort.

Methods: This single-centre prospective cohort study included adults with stable chronic HF with a previous diagnosis of overtly reduced left ventricular ejection fraction (LVEF) <40% and LVEF < 50% at enrolment. GS was measured by the 4 m GS test, maximal HG was measured with a hydraulic dynamometer, and ASMI was measured by dual-energy X-ray absorptiometry. The primary combined outcome was cardiovascular death or worsening HF. Fine and Gray regression models were calculated, treating non-cardiovascular death as the competing event.

Results: Two hundred five patients (78% male) were analysed. The median age was 66 (quartiles: 58-74) years, 31% had diabetes mellitus, and the median LVEF was 37 (30-43) %. Median GS was 1.0 (0.8-1.0) m/s, median HG was 32 (24-40) kg, and median ASMI was 8.0 (7.2-8.9) kg/m². During a median follow-up of 4.7 (4.0-5.3) years, the primary outcome was observed in 52 patients. In models adjusted for key clinical covariates, lower GS predicted a higher risk of cardiovascular death or worsening HF [subdistribution hazard ratio (SHR) per 0.1 m/s increase = 0.81, 95% confidence interval (CI) 0.68-0.95], whereas HG (SHR per 5 kg increase = 0.97, 95% CI 0.84-1.10) and ASMI (SHR per 1 kg/m² increase = 1.17, 95% CI 0.94-1.44) did not. In the analysis of effect modification, these associations were consistent across key clinical subgroups.

Conclusions: Higher GS was independently associated with a lower risk of cardiovascular death or worsening HF, whereas HG and ASMI were not. We prospectively confirm GS as a physical performance measure with clear prognostic significance for patients with HF.

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目的：心力衰竭（HF）会损害骨骼肌质量和功能，导致体能下降。我们在一个前瞻性心力衰竭队列中调查了步速（GS）、手握力（HG）和骨骼肌指数（ASMI）对心血管预后的影响：这项单中心前瞻性队列研究纳入了既往诊断为左心室射血分数（LVEF）明显降低的稳定型慢性心房颤动成人患者：共分析了 25 名患者（78% 为男性）。中位年龄为 66 岁（四分位数：58-74），31% 患有糖尿病，中位 LVEF 为 37（30-43）%。中位 GS 为 1.0 (0.8-1.0) m/s，中位 HG 为 32 (24-40) kg，中位 ASMI 为 8.0 (7.2-8.9) kg/m2。在中位随访 4.7（4.0-5.3）年期间，52 名患者观察到了主要结果。在根据主要临床协变量调整的模型中，较低的 GS 预测心血管死亡或 HF 恶化的风险较高[每增加 0.1 m/s 的亚分布危险比 (SHR) = 0.81，95% 置信区间 (CI) 0.68-0.95]，而 HG（每增加 5 kg 的 SHR = 0.97，95% CI 0.84-1.10）和 ASMI（每增加 1 kg/m2 的 SHR = 1.17，95% CI 0.94-1.44）则不预测。在效应修正分析中，这些关联在主要临床亚组中是一致的：结论：较高的 GS 与较低的心血管死亡或 HF 恶化风险独立相关，而 HG 和 ASMI 则不相关。我们通过前瞻性研究证实，GS是一种对心房颤动患者具有明确预后意义的体能表现测量指标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

ESC Heart Failure Medicine-Cardiology and Cardiovascular Medicine

CiteScore

7.00

自引率

7.90%

发文量

461

审稿时长

12 weeks

期刊介绍： ESC Heart Failure is the open access journal of the Heart Failure Association of the European Society of Cardiology dedicated to the advancement of knowledge in the field of heart failure. The journal aims to improve the understanding, prevention, investigation and treatment of heart failure. Molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, as well as the clinical, social and population sciences all form part of the discipline that is heart failure. Accordingly, submission of manuscripts on basic, translational, clinical and population sciences is invited. Original contributions on nursing, care of the elderly, primary care, health economics and other specialist fields related to heart failure are also welcome, as are case reports that highlight interesting aspects of heart failure care and treatment.