Quadriceps Strength as a Predictor of Mortality in Coronary Artery Disease

Kamiya, Kentaro; Masuda, Takashi; Tanaka, Shinya; Hamazaki, Nobuaki; Matsue, Yuya; Mezzani, Alessandro; Matsuzawa, Ryota; Nozaki, Kohei; Maekawa, Emi; Noda, Chiharu; Yamaoka‐Tojo, Minako; Arai, Yasuo; Matsunaga, Atsuhiko; Izumi, Tohru; Ako, Junya

doi:10.1016/j.amjmed.2015.06.035

Cited by 96 publications

(62 citation statements)

References 42 publications

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“…Physical frailty is emerging as a syndrome of pre-disability and can be minimized or reversed by a number of interventions. The elderly cardiac population has a high prevalence of physical frailty characterized by decreased physical performance, such as weakness [9] and/or slowness [10]. Therefore, the assessment of physical performance in older adults with cardiovascular disease is essential for clinical management and therapeutic decision-making.…”

Section: Introductionmentioning

confidence: 99%

Office-Based Physical Assessment in Patients Aged 75 Years and Older with Cardiovascular Disease

et al. 2019

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Background: The detection of impaired physical performance in older adults with cardiovascular disease is essential for clinical management and therapeutic decision-making. There is a requirement for an assessment tool that can be used conveniently, rapidly, and securely in clinical practice for screening decreased physical performance. Objective: The present study was performed to evaluate the association of office-based physical assessments with decreased physical performance and to compare the prognostic capability of these assessments in older adults with cardiovascular disease. Methods: A total of 1,040 patients aged 75 years and older with cardiovascular disease were included in this analysis. One-leg standing time (OLST) and handgrip strength were measured as office-based physical assessment tools, and short physical performance battery (SPPB), 6-min walk distance, and usual gait speed were also measured at hospital discharge as measurements of physical performance. All-cause mortality was assessed by death registry at the hospital. We examined the association of office-based measures with physical performance and all-cause mortality. Results: The areas under the curve of OLST for SPPB < 10, 6-min walk distance < 300 m, and usual gait speed < 1.0 m/s were 0.87 (95% CI 0.83–0.91), 0.83 (95% CI 0.80–0.86), and 0.81 (95% CI 0.78–0.85), respectively. The discrimination abilities of OLST for decreased physical performance were significantly higher than those of handgrip strength. After adjusting for the effects of patient characteristics, the hazard ratio for all-cause mortality in the < 3 s group for OLST was 1.68 (95% CI 1.06–2.67, p = 0.03). Handgrip strength, however, was not significantly associated with mortality risk in these participants. Conclusion: Short OLST, in particular < 3 s, is associated with decreased physical performance and elevated mortality risk in elderly patients with cardiovascular disease. OLST can be conveniently measured in the clinician’s office as a screening tool for impaired physical performance.

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Section: Introductionmentioning

confidence: 99%

Office-Based Physical Assessment in Patients Aged 75 Years and Older with Cardiovascular Disease

et al. 2019

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“…Sarcopenia is becoming a major health issue with the aging of the world's population [1][2][3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Sarcopenia: Prevalence and Prognostic Implications in Elderly Patients with Cardiovascular Disease

Kamiya

Hamazaki²,

Matsuzawa³

et al. 2017

JCSM Clinical Reports

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Aims Sarcopenia has recently been given an ICD-10 code. However, there have been no systematic investigations regarding the prevalence or prognostic value of sarcopenia in cardiovascular disease (CVD) according to the international consensus definition. The present study was performed to investigate the prevalence and prognostic value of sarcopenia in elderly patients with CVD. Methods and resultsThe study population consisted of 1603 admitted patients aged ≥ 65 years (74.4 ± 6.2 years, 1049 men) with CVD. Sarcopenia was defined according to the recommended diagnostic algorithm of the Asia Working Group for Sarcopenia. The endpoint for the study was all-cause mortality. The overall sarcopenia prevalence rate was 29.7% (19.6% in men and 48.7% in women). The prevalence rates of sarcopenia across major diagnostic categories were as follows: acute coronary syndrome, 17.8%; post-cardiac surgery, 31.8%; and heart failure, 35.2%. During the 2.3 ± 2.1-year follow-up period, 175 deaths occurred. Patients with sarcopenia showed higher risk of allcause mortality compared with non-sarcopenic patients (adjusted hazard ratio: 1.44; 95% confidence interval: 1.01 -2.05; P = 0.044).Conclusions Sarcopenia is highly prevalent among elderly patients with CVD and is associated with increased mortality risk.

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“…The primary endpoint of the trial was chosen as the change in quadriceps isometric strength (QIS) between baseline and 2 weeks, because this measure is highly predictive of exercise capacity and mortality, 27,28 The secondary outcomes in the trial are the changes in physical and cognitive function between baseline and at 2 weeks. Handgrip strength, SPPB score, usual gait speed, and 6-minute walking distance are measured as determinants of physical function.…”

Section: Discussionmentioning

confidence: 99%

“…The primary endpoint of the trial was chosen as the change in quadriceps isometric strength (QIS) between baseline and 2 weeks, because this measure is highly predictive of exercise capacity and mortality, and frail elderly AHF patients show impairment of muscle strength in the lower extremities . Maximal QIS is measured with a handheld dynamometer (μ‐Tas; ANIMA, Tokyo, Japan) as described previously . With the patient sitting on a bench, 5‐second maximal isometric voluntary contractions of the quadriceps are collected 3 times successively for both legs, with the knee joint fixed at 90° flexion and the hip joint at ~90° flexion.…”

Section: Methodsmentioning

confidence: 99%

Effects of Acute Phase Intensive Electrical Muscle Stimulation in Frail Elderly Patients With Acute Heart Failure (ACTIVE‐EMS): Rationale and protocol for a multicenter randomized controlled trial

Tanaka

Matsue

Yonezawa

et al. 2017

Clinical Cardiology

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In elderly patients with acute heart failure (AHF), clinical outcome is adversely affected by frailty. Although a number of potentially effective interventions for frailty have been reported, little is known about the effects of rehabilitation programs in frail elderly AHF patients. We postulated that addition of electrical muscle stimulation (EMS), which induces muscle contraction without requiring patient volition, to early rehabilitation would be efficacious in frail elderly AHF patients. The ACTIVE‐EMS (Effects of Acute Phase Intensive Electrical Muscle Stimulation in Frail Elderly Patients With AHF; UMIN000019551) trial is a multicenter, randomized controlled trial that will enroll 80 patients from 3 hospitals in Japan. AHF patients age ≥ 75 years positive for frailty, defined as Short Physical Performance Battery score 4 to 9, will be randomly assigned to receive early rehabilitation program only or EMS add‐on therapy for 2 weeks. The primary endpoint of the trial is the change in quadriceps isometric strength between baseline and 2 weeks, with changes in physical function and cognitive function, and clinical safety and feasibility of EMS therapy as secondary outcomes. ACTIVE‐EMS is the first randomized trial to evaluate the clinical effectiveness of adding EMS therapy to early rehabilitation in frail elderly AHF patients. The results of this study will provide insight for the development of appropriate rehabilitation programs for this high‐risk population.

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Quadriceps Strength as a Predictor of Mortality in Coronary Artery Disease

Abstract: A high level of quadriceps strength was strongly associated with a lower risk of both all-cause and CV mortality in patients with CAD. Evaluation of QIS offered incremental prognostic information beyond pre-existing risk factors.

Cited by 96 publications

References 42 publications

Office-Based Physical Assessment in Patients Aged 75 Years and Older with Cardiovascular Disease

Office-Based Physical Assessment in Patients Aged 75 Years and Older with Cardiovascular Disease

Sarcopenia: Prevalence and Prognostic Implications in Elderly Patients with Cardiovascular Disease

Effects of Acute Phase Intensive Electrical Muscle Stimulation in Frail Elderly Patients With Acute Heart Failure (ACTIVE‐EMS): Rationale and protocol for a multicenter randomized controlled trial

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