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Stronger legs mean a lower risk of developing HF after AMI

Presented By
Kensuke Ueno, Kitasato University Graduate School of Medical Sciences, Japan
HFA 2023

A Japanese study demonstrated that patients with strong leg muscles have a lower risk of developing heart failure (HF) after acute myocardial infarction (AMI). This association remained significant even after adjusting for known cardiovascular risk factors.

Despite remarkable progress in treatment strategies in patients with AMI, the incidence of HF after AMI remains high. Therefore, the identification of predictive factors of the development of HF in patients with AMI is of key importance. A study presented by physiotherapist Mr Kensuke Ueno (Kitasato University Graduate School of Medical Sciences, Japan) explored whether muscle strength is an indicator of the development of HF. Included in the study were 932 participants hospitalised between 2007 to 2020 with AMI with no HF prior to admission and who did not develop HF complications during their hospital stay.

Maximal isometric quadriceps strength was assessed as an indicator of leg strength. Participants were asked to sit on a chair and contract the quadriceps muscles as hard as possible for 5 seconds. A handheld dynamometer attached to the ankle recorded the maximum value in kg. The measurement was performed on each leg and the average of both values was used. Strength was expressed relative to body weight. Patients were classified as ‘high’ or ‘low’ strength according to whether their value was above or below the median for their sex.

The identified median value for women was 33% of body weight and for men 52% of body weight. A total of 451 patients had low quadriceps strength and 481 had high strength. During an average follow-up of 4.5 years, 67 patients (7.2%) developed HF. The incidence of HF was 10.2 per 1,000 person-years in patients with high quadriceps strength and 22.9 per 1,000 person-years in those with low strength.

The cumulative incidence of HF events was significantly lower in the high-strength group than in the low-strength group (Plog-rank<0.001). After multivariate adjustment for known cardiovascular risk factors (i.e. age, sex, body mass index, prior myocardial infarction or angina pectoris, diabetes, atrial fibrillation, chronic obstructive pulmonary disease, peripheral arterial disease, and kidney function), high levels of quadriceps strengths were still associated with a lower risk of HF (HR 0.59; 95% CI 0.35–1.00; P=0.048). Moreover, each 5% body weight increment in quadriceps strength was associated with an 11% lower likelihood of HF (HR 0.89; 95% CI 0.81–0.98; P=0.014).

“Quadriceps strength is easy and simple to measure accurately in clinical practice. Our study indicated that quadriceps strength could help to identify patients at a higher risk of developing HF after myocardial infarction who could then receive more intense surveillance,” Mr Ueno concluded.

    1. Ueno K, et al. Leg strength and incidence of heart failure in patients with acute myocardial infarction, Session “moderated e-posters 3”. Heart Failure 2023, 20–23 May, Prague, Czechia.


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