Prognostic Impact of Gait Speed, Muscle Strength and Muscle Mass in Chronic Heart Failure—A Prospective Cohort Study

Figures

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  Figure 1. Cumulative incidences of worsening heart failure (WHF) or cardiovascular (CV) death according to muscle parameters. Curves were estimated with competing risk cumulative incidence estimators treating death from other causes as the competing event of interest and compared with Gray's test. Low 4 m gait speed was defined as a 4 m gait speed ≤0.8 m/s, low maximum handgrip strength was defined as <27 kg in males and <16 kg in females, and low appendicular skeletal muscle index (ASMI) was defined as <7 kg/m2 in males and <5.5 kg/m2 in females. (A) Gait speed. (B) Handgrip strength. (C) ASMI.

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  Figure 2. Predicted multivariable‐adjusted cumulative incidences of worsening heart failure (WHF) or cardiovascular (CV) death according to muscle parameters. Curves were predicted from multiple‐imputed and multivariable‐adjusted Fine and Gray competing risk regression models treating death from other causes as the competing event of interest. In detail, (A)–(C) were predicted from Models 2, 4 and 6 in Table 3, respectively. Low 4 m gait speed was defined as a 4 m gait speed ≤0.8 m/s, low maximum handgrip strength was defined as <27 kg in males and <16 kg in females, and low appendicular skeletal muscle index (ASMI) was defined as <7 kg/m2 in males and <5.5 kg/m2 in females. (A) Gait speed. (B) Handgrip strength. (C) ASMI.

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  Figure 3. Exploratory analysis—univariable associations between muscle parameters and other study outcomes. Reported results are subdistribution hazard ratios (blue circles) and 95% confidence intervals (CIs) (black range bands around the blue circles) for the respective muscle parameters from univariable competing risk regression models on the indicated outcomes. Low 4 m gait speed was defined as a 4 m gait speed ≤0.8 m/s, low maximum handgrip strength was defined as <27 kg in males and <16 kg in females, and low appendicular skeletal muscle index (ASMI) was defined as <7 kg/m2 in males and <5.5 kg/m2 in females. CV, cardiovascular; WHF, worsening heart failure.

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  Figure 4. Subgroup analyses—association between muscle parameters and worsening heart failure or cardiovascular death across selected clinical and biomarker subgroups. Reported results are subdistribution hazard ratios (blue circles) and 95% confidence intervals (CIs) (black range bands around the blue circles) for the respective muscle parameters from univariable competing risk regression models on the primary outcome (worsening heart failure or cardiovascular death). The subdistribution hazard ratios were obtained by fitting an interaction term between the respective muscle parameter and the selected subgroup variable (rather than by fitting individual models within the subgroups), and no P values are provided due to high type I error probability. 4mGS, 4 m gait speed; AF, atrial fibrillation; ASMI, appendicular skeletal muscle index; DM, diabetes mellitus; eGFR, estimated glomerular filtration rate; LVEF, left ventricular ejection fraction; NT‐proBNP, N‐terminal pro‐brain natriuretic peptide; pts, patients.