Abstract 19327: Reduced Handgrip Strength Predicts Clinical Outcomes in Patients with Advanced Heart Failure Undergoing Ventricular Assist Device Placement

Abstract

BACKGROUND: Heart failure (HF) is a systemic syndrome associated with derangement of skeletal muscle structure and metabolic function which contributes to diminished exercise tolerance, patient frailty and increased morbidity and mortality. The objective of this study was to evaluate 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: Handgrip strength was measured in 53 patients with advanced HF 2.6±5.2 days prior to VAD implantation and over 6 months following surgery. We analyzed dynamics in laboratory values, post-operative complications and 30-day mortality. RESULTS: There was no difference in grip strength of the dominant versus non-dominant hands at baseline and up to 6 months after VAD implantation. Baseline handgrip strength correlated with levels of albumin (r=0.29, p=0.04). Handgrip strength progressively improved, with a statistically significant increase seen at four months and sustained at 6 months following VAD implantation (non-dominant hand: 13±28% increase at 4 months and 18±34% at 6 months, p<0.05 versus baseline). Receiver operating characteristic curve analysis determined that handgrip strength<30% of body weight distinguished patients with greater likelihood of early post-operative mortality with a sensitivity of 72% and specificity of 80% (area under curve 0.8). Patients with handgrip strength<30% of body weight had 83% survival during the first 30 days after VAD implantation compared to 100% in those with handgrip strength >30% of body weight. CONCLUSION: Patients with advanced HF lose the difference in grip strength between the dominant and non-dominant hands seen in normal reference populations further supporting the existence of a global myopathy in advanced HF. Non-dominant handgrip strength less than 30% of body weight is associated with higher mortality in the early postoperative period following VAD implantation. These findings indicate that measures of skeletal muscle function and patient frailty may have important prognostic value in the pre-operative evaluation of patients with HF undergoing VAD placement.