Abstract
BackgroundLimited information is available regarding the prognostic potential of muscular fitness parameters in heart failure (HF) with reduced ejection fraction (HFrEF).HypothesisWe aimed to investigate the predictive potential of knee extensor muscle strength and power on rehospitalization and evaluate the correlation between exercise capacity and muscular fitness in patients newly diagnosed with HFrEF.MethodsNinety nine patients hospitalized with a new diagnosis of HF were recruited (64 men; aged 58.7 years [standard deviation (SD), 13.2 years]; 32.3% ischemic; ejection fraction, 28% [SD, 8%]). The inclusion criteria were left ventricular ejection fraction <40% and sufficient clinical stability to undergo exercise testing. Aerobic exercise capacity was measured with cardiopulmonary exercise testing. Knee extensor maximal voluntary isometric contraction (MVIC) and muscle power (MP) were measured using the Baltimore therapeutic equipment system. The clinical outcome was HF rehospitalization.ResultsOver a mean follow‐up period of 1709 ± 502 days, 39 patients were rehospitalized due to HF exacerbation. HF rehospitalization was more probable for patients with diabetes and lower oxygen uptake at peak exercise (peak VO2), knee extensor MVIC, and MP. The Kaplan–Meier survival analysis revealed significantly different cumulative HF rehospitalization rates according to the tertiles of peak VO2 (P = 0.005) and MP (P = 0.002). Multivariable Cox proportional hazard model showed that the lowest tertiles of peak VO2 (hazard ratio (HR), 6.26; 95% confidence interval (CI), 1.93–20.27); and MP (HR, 5.29; 95% CI, 1.05–26.53) were associated with HF rehospitalization. Knee extensor muscle power was an independent predictor for rehospitalization in patients with HFrEF.ConclusionKnee extensor muscle power was an independent predictor for rehospitalization in patients with HFrEF.
Highlights
Heart failure (HF) is a chronic debilitating disease associated with a 50% mortality rate within 5 years of diagnosis.[1]
We found that both muscle power (MP) and maximal voluntary isometric contraction (MVIC) were lower in patients with heart failure (HF) rehospitalization than in those without rehospitalization
Both these parameters exhibited a significant correlation with the peak oxygen uptake (VO2)
Summary
Heart failure (HF) is a chronic debilitating disease associated with a 50% mortality rate within 5 years of diagnosis.[1]. The loss of muscle mass and strength occurs progressively with aging.[9] Irrespective of aging, chronic diseases accelerate the atrophy of muscle fibers or lower the efficiency of energy production in the muscles, leading to low levels of muscular fitness, which is associated with poor prognosis.[10,11] In patients with HF, muscular strength predict long-term survival.[6] the effect of muscle fitness on rehospitalization has not been fully investigated. Rehospitalization is an important outcome for patients with HFrEF, as it relates to quality of life and high financial burdens for the community.[12] Muscular strength is one of the most common indicators of muscular fitness. We aimed to do the following: (a) investigate the predictive potential of knee extensor muscle strength and power on rehospitalization; and (b) evaluate the correlation between exercise capacity and muscular fitness in patients newly diagnosed with HFrEF
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