Functional Class Deterioration Associated with Changes in Body Weight,Muscle Strength and Body Water in Chronic Stable Heart Failure Patients

Arturo Oreatejeda

doi:10.4172/2155-9880.1000301

Abstract

Background: Over the course of heart failure, clinical manifestations can be explained by changes in body composition, mainly as decrease in body weight and lean body mass and body water imbalance. The aim of this study was to examine the association of changes in weight, handgrip strength and total body water with clinical status in patients with chronic stable heart failure. Methods: In a longitudinal cohort prospective study 222 consecutive patients (55.6% men, median age 67 years) were included. They underwent measurements at the beginning and after 6 months. Weight, height, hip circumference, waist circumference, handgrip strength, total body water and extracellular water (using Bioelectrical Impedance) were evaluated. Results: Three different types of change combinations were more frequently observed in patients with functional class deterioration: a) weight loss, increase in total body water and extracellular water and decreased handgrip strength (p=0.049), b) increased weight, total body water and extracellular water and decreased handgrip strength (p=0.01) and c) unchanged weight, decreased total body water and extracellular water and decreased handgrip strength (p=0.01). Conclusions: Handgrip strength, total body water and extracellular water were better predictors of clinical deterioration than weight alone as indicators of functional class deterioration and should be evaluated in heart failure patients.

Highlights

Heart Failure (HF) is a multisystem disorder characterized by structural and functional cardiac, skeletal muscle and renal abnormalities, mainly with symptoms and signs of fluid retention, dyspnea and fatigue [1]
In a previous cross-sectional study we demonstrated the cross-inverse correlation between the fluid overload estimated with bioelectrical impedance analysis (BIA) and New York Heart Association functional class [5]
A total of 222 (123 male and 99 female) stable out patients consecutively enrolled in the Heart Failure Clinic at the Instituto Nacional de Ciencias Médicas y Nutricion “Salvador Zubirán” (INCMNSZ), were considered eligible if they were over 18 years old, with a confirmed diagnosis of HF based on European Society of Cardiology criteria

Summary

Introduction

Heart Failure (HF) is a multisystem disorder characterized by structural and functional cardiac, skeletal muscle and renal abnormalities, mainly with symptoms and signs of fluid retention, dyspnea and fatigue [1]. Accurate evaluation of functional class deterioration in heart failure can be difficult (3), because it requires objective measurements to aid early diagnosis in patients in whom symptoms may be non-specific and physical abnormalities are not evident during examination [3]. Due to these limitations, it is important to have an objective method to measure body composition and fluid changes in HF patients. Over the course of heart failure, clinical manifestations can be explained by changes in body composition, mainly as decrease in body weight and lean body mass and body water imbalance. The aim of this study was to examine the association of changes in weight, handgrip strength and total body water with clinical status in patients with chronic stable heart failure

Objectives

Methods

Results

Conclusion