Dynapenia and presarcopenia in patients with coronary atherosclerosis: clinical predictors and cardiac structural and functional features

Aim. To assess the prevalence of dynapenia, presarcopenia and their relationship with structural and functional parameters of the heart in patients with coronary atherosclerosis.

Material and methods. The study included 136 people with stable types of coronary artery disease (CAD). Hand grip test was performed to measure muscle strength. In women, a decrease in grip strength of <16 kg was a sign of decreased muscle strength, while in men — <27 kg (according to the guidelines of the Writing Group for the European Working Group on Sarcopenia in Older People 2 of 2019). All patients underwent computed tomography with skeletal muscle index (SMI, cm²/m²) estimation. The threshold values of SMI, a decrease in which was regarded as a decrease in muscle volume, were 52,4 cm²/m² for men and 38,5 cm²/m² for women. If patients had an isolated decrease in SMI according to computed tomography, the condition was classified as presarcopenia. With a decrease in muscle strength according to the hand grip test, the condition was classified as dynapenia. All patients underwent echocardiography using a standard technique.

Results. The analysis revealed that individuals with presarcopenia were exclusively male and were taller (175 (168; 179) cm) than those with normal muscle mass (166 (159; 172,5) cm (p=0,001)), but the body mass index in presarcopenia was lower (27,3 (24,4; 30,3) kg/m² and 29,5 (25,8; 33,1) kg/m²) in individuals without this pathology (p=0,02). When comparing echocardiographic parameters, a lower left ventricular (LV) ejection fraction was found among patients with presarcopenia. The LV end-diastolic volume (EDV), LV end-systolic volume (ESV), LV end-diastolic dimension (EDD), and LV end-systolic dimension (ESD) were greater in the group of patients with presarcopenia compared to other patients (p<0,05). Patients with presarcopenia were more likely to have prior myocardial infarction — 24 patients (68,6%) versus 41 (46,6%) in the group without presarcopenia (p=0,02). Patients with dynapenia differed in the following parameters: they were older (68 (65,6; 71,4) years versus 65 years (63; 67,9) in rest of the sample), mostly women (74,2%) and shorter (164 (159,6; 165,4) cm) compared to individuals without dynapenia (170 (168; 172) cm (p<0,05)). Patients with dynapenia were more likely to have prior type 2 diabetes and chronic kidney disease (p<0,05).

Conclusion. Patients with presarcopenia and CAD more often have prior myocardial infarction and larger LV size and volume. Patients with dynapenia and coronary atherosclerosis are more often female, have shorter stature, and more often had chronic kidney disease and diabetes.

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