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

Nicols, Simon, O'Doherty, Alasdair, Taylor, Claire, Clarke, Andrew, Carroll, Sean and Ingle, Lee (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). pp. 93-102. ISSN 1475-0961

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Abstract

Background: In patients with chronic heart failure, there is a positive linear relationship between skeletal muscle mass (SMM) and peak oxygen consumption (V̇O2peak); an independent predictor of all-cause mortality. We investigated the association between SMM and V̇O2peak 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. V̇O2peak, the ventilatory anaerobic threshold and peak oxygen pulse (peak V̇O2/HR) were calculated. SMM was expressed as appendicular lean mass (lean mass in both arms and legs) and reported as skeletal muscle index (SMI; kg/m2), and as a proportion of total body mass (appendicular skeletal mass [ASM%]). Low SMM was defined as a SMI<7.26 kg/m2, or ASM% <25.72%). 5-year all-cause mortality risk was calculated using the Caliber 5-year all-cause mortality risk score. Results: Sixty patients were assessed. Thirteen (21.7%) had low SMM. SMI and ASM% correlated positively with V̇O2peak (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 V̇O2peak, respectively. SMI correlated most closely with peak V̇O2/HR (r=0.58; p<0.001). SMI predicted 40.3% of peak V̇O2/HR variance. ASM% was inversely associated with 5-year all-cause mortality risk (r=-0.365; P=0.006).Conclusion: SMM was positively correlated with V̇O2peak in patients with CHD. Peak V̇O2/HR 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.

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