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.

Keywords: Heart failure; handgrip strength; skeletal muscle; ventricular assist device.

Fig. 1

Characterization of average bilateral handgrip strength presented as a percentage of total body weight before ventricular assistive device implantation.

Fig. 2

Correlation of handgrip strength and albumin. Nondominant handgrip strength (percentage of body weight) shows a positive correlation with serum albumin.

Fig. 3

Change in handgrip strength of the dominant and nondominant hands after ventricular assistive device implantation. Handgrip strength increases significantly starting at 3 months after left ventricular assistive device implantation (*P < .05 vs baseline; **P < .005 vs baseline; ***P < .0005 vs baseline).

Fig. 4

Survival after VAD implantation. Mortality after VAD implantation is higher in those with handgrip strength <25% of total body weight (solid line, handgrip strength >25% body weight, n = 56; dotted line, handgrip strength <25% body weight, n = 16). BW, body weight; HGS, handgrip strength; LVAD, left ventricular assistive device; VAD, ventricular assistive device.