Kentaro Kamiya1, Takashi Masuda2, Shinya Tanaka3, Nobuaki Hamazaki4, Yuya Matsue5, Alessandro Mezzani6, Ryota Matsuzawa7, Kohei Nozaki7, Emi Maekawa8, Chiharu Noda8, Minako Yamaoka-Tojo2, Yasuo Arai9, Atsuhiko Matsunaga2, Tohru Izumi8, Junya Ako8. 1. Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan. Electronic address: k-kamiya@kitasato-u.ac.jp. 2. Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan. 3. Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan. 4. Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan; Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan. 5. Department of Cardiology, Kameda Medical Center, Chiba, Japan. 6. Exercise Pathophysiology Laboratory, Cardiac Rehabilitation Division, Salvatore Maugeri Foundation IRCCS, Scientific Institute of Veruno, Italy. 7. Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan. 8. Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan. 9. Department of Health Information Management, Kitasato University Hospital, Sagamihara, Japan.
Abstract
BACKGROUND: The purpose of this study was to investigate the prognostic value of quadriceps isometric strength (QIS) in coronary artery disease (CAD). METHODS: The study population consisted of 1314 patients aged >30 years (64.7 ± 10.6 years, 1051 male) with CAD who were hospitalized for acute coronary syndrome or coronary artery bypass grafting. Maximal QIS was evaluated as a marker of leg strength and expressed relative to body weight (% body weight). The primary and secondary endpoints were all-cause death and cardiovascular (CV) death, respectively. RESULTS: During a mean follow-up of 5.0 ± 3.5 years, corresponding to 6537 person-years, there were 118 all-cause deaths and 63 CV deaths. A higher QIS remained associated with decreased all-cause mortality and CV mortality risks (hazard ratio for increasing 10% body weight of QIS 0.77, 95% confidence interval 0.67-0.89, P < .001 for all-cause death; hazard ratio 0.66, 95% confidence interval 0.54-0.82, P < .001 for CV death) after adjustment for other prognostic factors. The inclusion of QIS significantly increased both continuous net reclassification improvement (cNRI) and integrated discrimination improvement (IDI) for all-cause death (cNRI: 0.25, P = .009; IDI: 0.007, P = .030) and CV death (cNRI: 0.34, P = .008; IDI: 0.013, P = .008). CONCLUSIONS: A high level of quadriceps strength was strongly associated with a lower risk of both all-cause and CV mortality in patients with CAD. Evaluation of QIS offered incremental prognostic information beyond pre-existing risk factors.
BACKGROUND: The purpose of this study was to investigate the prognostic value of quadriceps isometric strength (QIS) in coronary artery disease (CAD). METHODS: The study population consisted of 1314 patients aged >30 years (64.7 ± 10.6 years, 1051 male) with CAD who were hospitalized for acute coronary syndrome or coronary artery bypass grafting. Maximal QIS was evaluated as a marker of leg strength and expressed relative to body weight (% body weight). The primary and secondary endpoints were all-cause death and cardiovascular (CV) death, respectively. RESULTS: During a mean follow-up of 5.0 ± 3.5 years, corresponding to 6537 person-years, there were 118 all-cause deaths and 63 CV deaths. A higher QIS remained associated with decreased all-cause mortality and CV mortality risks (hazard ratio for increasing 10% body weight of QIS 0.77, 95% confidence interval 0.67-0.89, P < .001 for all-cause death; hazard ratio 0.66, 95% confidence interval 0.54-0.82, P < .001 for CV death) after adjustment for other prognostic factors. The inclusion of QIS significantly increased both continuous net reclassification improvement (cNRI) and integrated discrimination improvement (IDI) for all-cause death (cNRI: 0.25, P = .009; IDI: 0.007, P = .030) and CV death (cNRI: 0.34, P = .008; IDI: 0.013, P = .008). CONCLUSIONS: A high level of quadriceps strength was strongly associated with a lower risk of both all-cause and CV mortality in patients with CAD. Evaluation of QIS offered incremental prognostic information beyond pre-existing risk factors.
Authors: James Steele; James Fisher; Martin Skivington; Chris Dunn; Josh Arnold; Garry Tew; Alan M Batterham; David Nunan; Jamie M O'Driscoll; Steven Mann; Chris Beedie; Simon Jobson; Dave Smith; Andrew Vigotsky; Stuart Phillips; Paul Estabrooks; Richard Winett Journal: BMC Public Health Date: 2017-04-05 Impact factor: 3.295