title: 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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Cardiology, Department of Surgery, Columbia University Medical Center, New York, New York. Electronic address: pcs2121@columbia.edu.
authors.forename: Christine J
authors.initials: CJ
authors.lastname: Chung
authors.affiliation: Division of Cardiology, Department of Surgery, Columbia University Medical Center, New York, New York.
authors.forename: Christina
authors.initials: C
authors.lastname: Wu
authors.affiliation: Division of Cardiology, Department of Surgery, Columbia University Medical Center, New York, New York.
authors.forename: Meaghan
authors.initials: M
authors.lastname: Jones
authors.affiliation: Division of Cardiology, Department of Surgery, Columbia University Medical Center, New York, New York.
authors.forename: Tomoko S
authors.initials: TS
authors.lastname: Kato
authors.affiliation: Division of Cardiology, Department of Surgery, Columbia University Medical Center, New York, New York.
authors.forename: Tien T
authors.initials: TT
authors.lastname: Dam
authors.affiliation: Division of Cardiology, Department of Surgery, Columbia University Medical Center, New York, New York.
authors.forename: Raymond C
authors.initials: RC
authors.lastname: Givens
authors.affiliation: Division of Cardiology, Department of Surgery, Columbia University Medical Center, New York, New York.
authors.forename: Danielle L
authors.initials: DL
authors.lastname: Templeton
authors.affiliation: Division of Cardiology, Department of Surgery, Columbia University Medical Center, New York, New York.
authors.forename: Mathew S
authors.initials: MS
authors.lastname: Maurer
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, New York.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, New York.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
authors.affiliation: Division of Cardiology, Department of Surgery, Columbia University Medical Center, New York, New York.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Mancini
authors.affiliation: Division of Cardiology, Department of Surgery, Columbia University Medical Center, New York, New York.
authors.forename: P Christian
authors.initials: PC
authors.lastname: Schulze
mesh_terms: D015331:Cohort Studies; D005260:Female; D018737:Hand Strength / Q000502:physiology*; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D006353:Heart-Assist Devices / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality; D011237:Predictive Value of Tests; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
keywords: Heart failure; handgrip strength; skeletal muscle; ventricular assist device