In Heart Failure, Gait Speed Matters More Than Muscle Strength for Prognosis: Study Finds

"Assessing muscular function related to locomotion is more critical for evaluating the risk of adverse cardiovascular events than focusing solely on muscle strength and mass," the researchers wrote in ESC Heart Failure.

Heart failure affects skeletal muscle mass and function, leading to reduced physical performance. In the study, Nicolas Verheyen, Division of Cardiology, Department of Internal Medicine, University Heart Center, Medical University of Graz, Graz, Austria, and colleagues examined the prognostic impact of gait speed, handgrip strength (HG), and appendicular skeletal muscle index (ASMI) on cardiovascular outcomes in a prospective HF cohort.

For this purpose, the researchers conducted a single-center prospective cohort study involving adults with stable chronic HF who had a previous diagnosis of overtly reduced left ventricular ejection fraction (LVEF) <40% and LVEF <50% at enrolment. Gait speed was measured using the 4-meter GS test, maximal HG was assessed with a hydraulic dynamometer, and appendicular skeletal muscle index (ASMI) was determined using dual-energy X-ray absorptiometry.

The primary combined outcome was cardiovascular death or worsening HF, with Fine and Gray regression models used to account for non-cardiovascular death as a competing event.

The investigation uncovered the following findings:

• A total of 205 patients (78% male) were included in the study, with a median age of 66 years. 31% of participants had diabetes mellitus, and the median left ventricular ejection fraction was 37%.
• The median gait speed was 1.0 m/s, the median handgrip strength (HG) was 32 kg, and the median appendicular skeletal muscle index was 8.0 kg/m².
• During a median follow-up period of 4.7 years, 52 patients experienced the primary outcome.
• After adjusting for key clinical covariates, lower GS was found to predict a higher risk of cardiovascular death or worsening heart failure (subdistribution hazard ratio [SHR] per 0.1 m/s increase = 0.81).
• In contrast, HG (SHR per 5 kg increase = 0.97) and ASMI (SHR per 1 kg/m² increase = 1.17) did not show significant associations with the outcome.
• The associations between GS and cardiovascular outcomes were consistent across key clinical subgroups.

"In patients with stable heart failure and either reduced or improved left ventricular ejection fraction, our study found that among gait speed, handgrip strength, and appendicular skeletal muscle index, only GS had a significant prognostic impact on adverse cardiovascular outcomes," the researchers wrote.

"These findings suggest that evaluating muscular function, particularly about locomotion, is more crucial for assessing the risk of adverse cardiovascular events than focusing solely on muscle strength and mass," they concluded.

Reference:

Cejka, V., Riepl, H., Schwegel, N., Kolesnik, E., Zach, D., Santner, V., Höller, V., Schweighofer, N., Obermayer-Pietsch, B., Pieber, T., Morbach, C., Frantz, S., Zirlik, A., Störk, S., Posch, F., Ablasser, K., & Verheyen, N. Prognostic impact of gait speed, muscle strength and muscle mass in chronic heart failure—A prospective cohort study. ESC Heart Failure. https://doi.org/10.1002/ehf2.15221