In patients with heart failure, it is unknown whether the extracellular water (ECW)/intracellular water (ICW) ratio is associated with muscle strength, and thus, it is not well understood whether poor muscle quality contributes to muscular weakness. This study examined the relationship among hand grip strength, skeletal muscle mass index (SMI), and upper limb ECW/ICW ratio in patients with heart failure. This study followed a cross-sectional design. Demographic data, medical information, and hand grip strength were collected. The SMI and ECW/ICW ratio were measured using bio-impedance analysis (BIA). Hierarchical multiple regression analysis was conducted to identify factors associated with hand grip strength. 51 patients with heart failure were analyzed for this study (mean age 84.58 ± 7.18). Hierarchical multiple regression analysis identified SMI as well as upper limb ECW/ICW ratio as factors associated with hand grip strength, independent of age, sex, body mass index, and Life Space Assessment scores. Standardized partial regression coefficients representing the magnitude of involvement of each independent variable were 0.33 and - 0.16. The coefficient of determination adjusted for degrees of freedom (R2), representing the contribution rate of the regression equation, was 0.830. We revealed that loss of hand grip strength in patients with heart failure is associated with not only with a decrease in skeletal muscle mass, but also with a decline in muscle quality, characterized by an increased upper limb ECW/ICW ratio. BIA is a simple and useful method to measure the ECW/ICW ratio, and in turn, the muscle quality, in patients with heart failure.
Keywords: Hand grip strength; Heart failure; Skeletal muscle mass index; The extracellular water/intracellular water ratio.
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