Muscle mass matters: handgrip strength as a functional marker in hear failure

Abstract Heart failure (HF) is a clinical syndrome associated with reduced muscle mass and an increased risk of sarcopenia. The coexistence of these conditions may further worsen clinical outcomes and negatively affect quality of life and survival. In this context, handgrip strength represents a reliable indicator of muscle function and overall functional status. It is closely related to total lean body mass, which can be quantitatively assessed by dual-energy X-ray absorptiometry (DEXA) and bioelectrical impedance analysis (BIA), providing an objective evaluation of structural changes. Thus, handgrip strength can serve as a practical marker for assessing sarcopenia and functional capacity in patients with heart failure. Purpose To identify the determinants of handgrip strength in patients with heart failure and to analyze its association with lean body mass measured by DEXA and BIA. Methods Multiple linear regression was performed including: age, LVEF, peripheral edema, and body fat mass measured by BIA. The model was optimized through backward elimination. Pearson and Spearman correlations were used to assess the relationship between handgrip strength and lean body mass determined by DEXA and BIA. Results A total of 25 patients with HF were included (mean age 69.8 ± 11.7 years, 68% male, mean NT-proBNP 5977 ± 6710 pg/mL, mean LVEF 43.8% ± 16.2%). Correlation analysis revealed strong positive relationships between lean mass and handgrip strength for both methods: DEXA lean mass vs handgrip: r = 0.701, p < 0.001; BIA lean mass vs handgrip: r = 0.708, p < 0.001. Тhe full multiple linear regression model demonstrated statistically significant predictive capacity for handgrip strength, explaining 57.9% of its variance (R² = 0.579; p = 0.0035). Despite this overall explanatory power, the adjusted value (adjusted R² = 0.468) indicated that several predictors contributed minimally and did not enhance model stability. Examination of the β-coefficients and significance levels showed that only age and total lean body mass (BIA) exhibited consistent and meaningful associations with handgrip strength, whereas the remaining variables had weak or uncertain effects. The final multiple linear regression model identified age and total lean body mass (BIA) as the only significant determinants of handgrip strength (adjusted R² = 0.507). Lean mass showed a strong and statistically significant association with handgrip performance (β = +0.553; 95% CI 0.302–0.804; p = 0.0002), while age demonstrated an independent negative association (β = –0.184; 95% CI –0.351 to –0.016; p = 0.034). Conclusion The comparable correlations between DEXA- and BIA-derived lean mass and handgrip strength support the reliability of BIA as an accessible alternative for muscle mass assessment in patients with heart failure. In addition, regression analysis confirmed lean mass as the principal determinant of handgrip strength, while age emerged as an independent negative predictor.Predicted handgrip strengthFor image description, please refer to the figure legend and surrounding text.