Grip strength predicts cardiac adverse events in patients with cardiac disorders: an individual patient pooled meta-analysis.

Rita Pavasini, Matteo Serenelli, Carlos A Celis-Morales, Stuart R Gray, Kazuhiro P Izawa, Satoshi Watanabe, Eloisa Colin-Ramirez, Lilia Castillo-Martínez, Yasuhiro Izumiya, Shinsuke Hanatani, Yoshiro Onoue, Kenichi Tsujita, Peter S Macdonald, Sunita R Jha, Véronique L Roger, Sheila M Manemann, Juan Sanchis, Vicente Ruiz, Giulia Bugani, Elisabetta Tonet, Roberto Ferrari, Stefano Volpato, Gianluca Campo

Journal: Heart (British Cardiac Society) 2020;105(11):834-841

PMID: 30455175

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Abstract

OBJECTIVE

Grip strength is a well-characterised measure of weakness and of poor muscle performance, but there is a lack of consensus on its prognostic implications in terms of cardiac adverse events in patients with cardiac disorders.

METHODS

Articles were searched in PubMed, Cochrane Library, BioMed Central and EMBASE. The main inclusion criteria were patients with cardiac disorders (ischaemic heart disease, heart failure (HF), cardiomyopathies, valvulopathies, arrhythmias); evaluation of grip strength by handheld dynamometer; and relation between grip strength and outcomes. The endpoints of the study were cardiac death, all-cause mortality, hospital admission for HF, cerebrovascular accident (CVA) and myocardial infarction (MI). Data of interest were retrieved from the articles and after contact with authors, and then pooled in an individual patient meta-analysis. Univariate and multivariate logistic regression was performed to define predictors of outcomes.

RESULTS

Overall, 23 480 patients were included from 7 studies. The mean age was 62.3±6.9 years and 70% were male. The mean follow-up was 2.82±1.7 years. After multivariate analysis grip strength (difference of 5 kg, 5× kg) emerged as an independent predictor of cardiac death (OR 0.84, 95% CI 0.79 to 0.89, p<0.0001), all-cause death (OR 0.87, 95% CI 0.85 to 0.89, p<0.0001) and hospital admission for HF (OR 0.88, 95% CI 0.84 to 0.92, p<0.0001). On the contrary, we did not find any relationship between grip strength and occurrence of MI or CVA.

CONCLUSION

In patients with cardiac disorders, grip strength predicted cardiac death, all-cause death and hospital admission for HF.

TRIAL REGISTRATION NUMBER

CRD42015025280.

Address: Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy.; BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.; Graduate School of Health Sciences, Kobe University, Kobe, Japan.; Department of Rehabilitation Medicine, St Marianna University School of Medicine Hospital, Sugao, Japan.; National Council for Science and Technology (CONACyT) - Sociomedical Research Department, Instituto Nacional de Cardiología 'Ignacio Chávez', Mexico City, Mexico.; Clinical Nutrition Department, Instituto Nacional de Ciencias Médicas y Nutrición SZ, Mexico City, Mexico.; Department of Cardiovascular Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.; Heart Transplant Unit, St Vincent's Hospital, Darlinghurst, New South Wales, Australia.; Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA.; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.; Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA.; Cardiology Department, Hospital Clinico Universitario, INCLIVA, Valencia, Spain.; Department of Medicine, University of Valencia, CIBER-CV, Valencia, Spain.; Nursing School, University of Valencia, Valencia, Spain.; Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy.; GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy.; Department of Medical Science, Section of Internal and Cardiorespiratory Medicine, University of Ferrara, Ferrara, Italy.

DOI: 10.1136/heartjnl-2018-313816