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Low skeletal muscle mass is associated with low aerobic capacity and increased mortality risk in patients with coronary heart disease - a CARE CR study

Nichols, Simon; O'Doherty, Alasdair F.; Taylor, Claire; Clark, Andrew L.; Carroll, Sean; Ingle, Lee

Authors

Simon Nichols

Alasdair F. O'Doherty

Claire Taylor

Andrew L. Clark

Abstract

BACKGROUND
In patients with chronic heart failure, there is a positive linear relationship between skeletal muscle mass (SMM) and peak oxygen consumption (V˙O2peak ); an independent predictor of all-cause mortality. We investigated the association between SMM and V˙O2peak in patients with coronary heart disease (CHD) without a diagnosis of heart failure.

METHODS
BACKGROUND
In patients with chronic heart failure, there is a positive linear relationship between skeletal muscle mass (SMM) and peak oxygen consumption (V˙O2peak ); an independent predictor of all-cause mortality. We investigated the association between SMM and V˙O2peak in patients with coronary heart disease (CHD) without a diagnosis of heart failure.


METHODS
Male patients with CHD underwent maximal cardiopulmonary exercise testing and dual X-ray absorptiometry assessment. V˙O2peak, the ventilatory anaerobic threshold and peak oxygen pulse were calculated. SMM was expressed as appendicular lean mass (lean mass in both arms and legs) and reported as skeletal muscle index (SMI; kg m-2 ), and as a proportion of total body mass (appendicular skeletal mass [ASM%]). Low SMM was defined as a SMI < 7·26 kg m-2 , or ASM% < 25·72%. Five-year all-cause mortality risk was calculated using the Calibre 5-year all-cause mortality risk score.


RESULTS
Sixty patients were assessed. Thirteen (21·7%) had low SMM. SMI and ASM% correlated positively with V˙O2peak (r = 0·431 and 0·473, respectively; P< 0·001 for both). SMI and ASM% predicted 16·3% and 12·9% of the variance in V˙O2peak , respectively. SMI correlated most closely with peak oxygen pulse (r = 0·58; P< 0·001). SMI predicted 40·3% of peak V˙O2 /HR variance. ASM% was inversely associated with 5-year all-cause mortality risk (r = -0·365; P = 0·006).


CONCLUSION
Skeletal muscle mass was positively correlated with V˙O2peak in patients with CHD. Peak oxygen pulse had the strongest association with SMM. Low ASM% was associated with a higher risk of all-cause mortality. The effects of exercise and nutritional strategies aimed at improving SMM and function in CHD patients should be investigated.

Journal Article Type Article
Publication Date 2019-01
Print ISSN 1475-0961
Electronic ISSN 1475-097X
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 39
Issue 1
Pages 93-102
Institution Citation Nichols, S., O'Doherty, A. F., Taylor, C., Clark, A. L., Carroll, S., & Ingle, L. (2019). Low skeletal muscle mass is associated with low aerobic capacity and increased mortality risk in patients with coronary heart disease - a CARE CR study. Clinical physiology and functional imaging, 39(1), 93-102. https://doi.org/10.1111/cpf.12539
DOI https://doi.org/10.1111/cpf.12539
Keywords Cardiorespiratory fitness; Coronary disease; Sarcopenia; Skeletal muscle
Publisher URL https://onlinelibrary.wiley.com/doi/full/10.1111/cpf.12539

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Copyright Statement
©2018 The Authors.Clinical Physiology and Functional Imaging published by John Wiley & Sons Ltd on behalf of Scandinavian Society of Clinical Physiology and Nuclear Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.



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