# Muscle Strength and Left Ventricular Systolic and Diastolic Dysfunction in Chronic Kidney Disease Men: A Pilot Study

## TL;DR

This study finds that muscle strength tests in men with advanced kidney disease are not equivalent and that lower leg strength predicts heart function issues better than hand grip strength.

## Contribution

The study introduces FTSST as a more sensitive predictor of left ventricular diastolic dysfunction than HGS in CKD patients.

## Key findings

- Upper limb muscle strength did not correlate with lower limb muscle strength in CKD patients.
- Prolonged FTSST was associated with worse left ventricular diastolic and systolic function markers.
- Decreased muscle strength was linked to reduced systolic function in both left and right ventricles.

## Abstract

Background: Sarcopenia is defined by decreased muscle strength along with low muscle quantity or quality. The assessment of muscle strength may be performed by grip strength test or chair stand test (CST) and both of these tests are treated as equivalent tools for assessing muscle strength. Heart failure with preserved ejection fraction (HFpEF) contributes to the progression of sarcopenia, and it is left ventricular diastolic dysfunction (LVDd) which primarily leads to the development of HFpEF. The aim of this study was to examine the relationship of muscle strength with echocardiographic parameters of LVDd in patients with CKD and eGFR ≤ 29 mL/min/1.73 m2 not treated with dialysis. Methods: The study samples consisted of 46 men with CKD stages G4–G5 not treated with dialysis: 23 participants with HGS < 27 kg and 23 individuals with HGS ≥ 27 kg. The assessment of muscle strength was provided by the hand grip strength (HGS) test and the five-times sit-to-stand test (FTSST). Transthoracic echocardiography was performed with the use of a convex probe in conjunction with a Logiq P6 ultrasound system. Results: In G4–G5 CKD patients, upper limb muscle strength did not correspond to lower limb muscle strength. Participants with prolonged FTSST had a lower mean value of septal e’ and higher mean E/e’ compared to individuals with correct both HGS and FTSST. Participants with correct HGS and prolonged FTSST had the lowest mean left ventricular ejection fraction (LVEF), as well as the lowest mean tricuspid annular plane systolic excursion (TAPSE). Conclusions: In G4–G5 CKD patients not treated with dialysis, HGS and FTSST are not equivalent and should not be used interchangeably. In this population, decreased muscle strength is associated with LVDd and FTSST is more sensitive than HGS in the prediction of LVDd. Low muscle strength is also associated with systolic function of the left and right ventricle in G4–G5 CKD patients not treated with dialysis.