{"title":"Determinant of functional independence in older patients with heart failure: physical function vs. muscle mass","authors":"Suguru Honma , Satoshi Katano , Toshiyuki Yano , Ryohei Nagaoka , Aki Habaguchi , Ryo Numazawa , Katsuhiko Ohori , Hidemichi Kouzu , Masaki Katayose , Nobuhiro Yoshioka , Masato Furuhashi , Akiyoshi Hashimoto","doi":"10.1016/j.archger.2025.105933","DOIUrl":null,"url":null,"abstract":"<div><h3>Aim</h3><div>While sarcopenia affects functional independence in older patients with heart failure (HF), the differential impact of its components—including muscle mass (MM), muscle strength (MS), and physical function (PF)—remain underexplored. We investigated these components’ independent and synergistic associations with functional independence in older patients with HF, including sex-specific differences.</div></div><div><h3>Methods</h3><div>We studied 587 older patients with HF (299 women; mean age, 79±7 years). MM, MS, and PF were assessed using dual-energy X-ray absorptiometry, handgrip strength, and physical performance tests (gait speed, five-times sit-to-stand test [FTSS], short physical performance battery [SPPB]), respectively. Cutoffs for each component followed the Asian Working Group for Sarcopenia 2019 criteria. Functional independence was assessed using the Barthel Index (BI).</div></div><div><h3>Results</h3><div>Sarcopenia was associated with lower BI scores. Poor PF independently predicted reduced BI scores (slow gait speed: 8.4 points; prolonged FTSS: 10.9 points; low SPPB: 14.8 points; all <em>p</em> < 0.001), whereas low MM and weak MS did not. Low MM amplified the negative impact of poor PF on BI scores consistently across sexes. Machine-learning analysis revealed MM status-specific predictors of PF: clinical factors (female sex, HF symptoms) and comorbidities predicted poor PF in patients with normal MM; renin-angiotensin system inhibition, and cardiomyopathy were associated with preserved PF in patients with low MM.</div></div><div><h3>Conclusions</h3><div>In older patients with HF, sarcopenia is closely and negatively associated with BI score primarily through poor PF; MM potentially modifies this relationship independent of sex. MM status-specific factors associated with PF suggest the importance of phenotype-specific approaches in facilitating functional independence.</div></div>","PeriodicalId":8306,"journal":{"name":"Archives of gerontology and geriatrics","volume":"137 ","pages":"Article 105933"},"PeriodicalIF":3.5000,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of gerontology and geriatrics","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0167494325001906","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GERIATRICS & GERONTOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Aim
While sarcopenia affects functional independence in older patients with heart failure (HF), the differential impact of its components—including muscle mass (MM), muscle strength (MS), and physical function (PF)—remain underexplored. We investigated these components’ independent and synergistic associations with functional independence in older patients with HF, including sex-specific differences.
Methods
We studied 587 older patients with HF (299 women; mean age, 79±7 years). MM, MS, and PF were assessed using dual-energy X-ray absorptiometry, handgrip strength, and physical performance tests (gait speed, five-times sit-to-stand test [FTSS], short physical performance battery [SPPB]), respectively. Cutoffs for each component followed the Asian Working Group for Sarcopenia 2019 criteria. Functional independence was assessed using the Barthel Index (BI).
Results
Sarcopenia was associated with lower BI scores. Poor PF independently predicted reduced BI scores (slow gait speed: 8.4 points; prolonged FTSS: 10.9 points; low SPPB: 14.8 points; all p < 0.001), whereas low MM and weak MS did not. Low MM amplified the negative impact of poor PF on BI scores consistently across sexes. Machine-learning analysis revealed MM status-specific predictors of PF: clinical factors (female sex, HF symptoms) and comorbidities predicted poor PF in patients with normal MM; renin-angiotensin system inhibition, and cardiomyopathy were associated with preserved PF in patients with low MM.
Conclusions
In older patients with HF, sarcopenia is closely and negatively associated with BI score primarily through poor PF; MM potentially modifies this relationship independent of sex. MM status-specific factors associated with PF suggest the importance of phenotype-specific approaches in facilitating functional independence.
期刊介绍:
Archives of Gerontology and Geriatrics provides a medium for the publication of papers from the fields of experimental gerontology and clinical and social geriatrics. The principal aim of the journal is to facilitate the exchange of information between specialists in these three fields of gerontological research. Experimental papers dealing with the basic mechanisms of aging at molecular, cellular, tissue or organ levels will be published.
Clinical papers will be accepted if they provide sufficiently new information or are of fundamental importance for the knowledge of human aging. Purely descriptive clinical papers will be accepted only if the results permit further interpretation. Papers dealing with anti-aging pharmacological preparations in humans are welcome. Papers on the social aspects of geriatrics will be accepted if they are of general interest regarding the epidemiology of aging and the efficiency and working methods of the social organizations for the health care of the elderly.