Izawa Kazuhiro P, Watanabe Satoshi, Osada Naohiko, Kasahara Yusuke, Yokoyama Hitoshi, Hiraki Koji, Morio Yuji, Yoshioka Satoru, Oka Koichiro, Omiya Kazuto
Department of Rehabilitation Medicine, St Marianna University School of Medicine, Kawasaki, Japan.
Eur J Cardiovasc Prev Rehabil. 2009 Feb;16(1):21-7. doi: 10.1097/HJR.0b013e32831269a3.
Whether upper-extremity and lower-extremity muscle strength can predict a prognosis of congestive heart failure (CHF) patients is unclear. This study evaluated the impact of muscle strength on long-term mortality in patients with CHF.
Prospective observational study of male Japanese CHF patients.
Clinical characteristics (age, body mass index, left ventricular ejection fraction, heart failure etiology, and medications) were obtained from hospital records of 148 male outpatients with stable CHF. Brain natriuretic peptide was determined as an index of disease severity. Peak oxygen uptake ((Equation is included in full-text article.)), handgrip, and knee extensor muscle strength were also determined.
After 1331.9+/-700.3 days of follow-up, 13 cardiovascular-related deaths occurred, and the patients were divided into two groups: survival (n=135) and nonsurvival (n=13). No significant differences were found between the groups in clinical characteristics, brain natriuretic peptide levels, and knee extensor muscle strength. Peak(Equation is included in full-text article.)(P=0.011) and handgrip strength (P=0.008) were significantly lower in the nonsurvival versus survival group. Left ventricular ejection fraction, peak(Equation is included in full-text article.), and handgrip strength were found by univariate Cox proportional hazards analysis to be significant prognostic indexes of survival. Multivariate analysis, however, revealed handgrip strength to be an independent predictor of prognosis. A handgrip strength cutoff value of 32.2 kgf was determined by the analysis of receiver-operating characteristics and was assessed. Kaplan-Meier survival curves after log-rank test showed significant prognostic difference between the two groups (P=0.008).
Handgrip strength may be useful for forecasting prognosis in patients with CHF.
上肢和下肢肌肉力量能否预测充血性心力衰竭（CHF）患者的预后尚不清楚。本研究评估了肌肉力量对CHF患者长期死亡率的影响。
对日本男性CHF患者进行前瞻性观察研究。
从148例稳定CHF男性门诊患者的医院记录中获取临床特征（年龄、体重指数、左心室射血分数、心力衰竭病因和用药情况）。测定脑钠肽作为疾病严重程度的指标。还测定了峰值摄氧量（（公式包含在全文中。））、握力和膝关节伸肌力量。
经过1331.9±700.3天的随访，发生了13例心血管相关死亡，患者被分为两组：存活组（n = 135）和非存活组（n = 13）。两组在临床特征、脑钠肽水平和膝关节伸肌力量方面未发现显著差异。非存活组的峰值（（公式包含在全文中。））（P = 0.011）和握力（P = 0.008）明显低于存活组。单因素Cox比例风险分析发现左心室射血分数、峰值（（公式包含在全文中。））和握力是存活的重要预后指标。然而，多因素分析显示握力是预后的独立预测因素。通过受试者工作特征分析确定握力截断值为32.2 kgf并进行评估。对数秩检验后的Kaplan-Meier生存曲线显示两组之间存在显著的预后差异（P = 0.008）。
握力可能有助于预测CHF患者的预后。
