MUSCLE STATUS PHENOTYPE IN PATIENTS ON THE WAITING LIST FOR CARDIAC TRANSPLANTATION

Highlights

The study was the first to identify a specific phenotype of muscle status in patients on the waiting list for heart transplantation: pronounced weakness of the lower extremity muscles (a decrease in strength by 30–70%) compared to other categories of cardiac surgical patients. The study also revealed the systemic nature of muscle involvement, with a close correlation between the strength of the symmetrical muscle groups in the lower extremities, which highlights the need for personalized rehabilitation programs, including the use of electromyostimulation to address these impairments.

Aim. To compare the muscular status of patients on the heart transplantation (HT) waiting list with that of other cardiac surgery patients.

Methods. The study included 213 patients divided into three groups: Group I (n = 30) – HT candidates; Group II (n = 122) – patients prior to scheduled cardiac surgery; Group III (n = 61) – patients with a complicated postoperative period. Muscular status was assessed using the Lafayette MMT 01165 isokinetic dynamometer (knee and foot extensors/flexors) and the DK 100 dynamometer (handgrip strength). Echocardiography was performed in all groups; volume sphygmography (vascular stiffness and hemodynamics) – in Group I.

Results. Group I had a higher proportion of males (p = 0,042) and revascularization rate (p ≤ 0,027) vs. Groups II/III. Patients in Group I showed enlarged heart dimensions and critically low LVEF (22%; p < 0,001). Group I demonstrated significant lower limb muscle weakness vs. Groups II/III (p < 0,001): knee extensors – 30,1–40,2% lower; knee flexors – 35,8–36,4% lower; foot extensors – 69,4–69,9% lower; foot flexors – 37,8–44,2% lower. Handgrip strength did not differ between groups (p > 0,100). Regression analysis confirmed systemic muscular involvement (strong interrelationship between symmetrical muscle groups, p < 0,001).

Conclusion. Patients on the HT waiting list show severe lower limb muscle weakness compared to other cardiac surgery patients. Multiple regression analysis revealed that right knee extensors associate only with contralateral muscles. Findings will inform personalized electromyostimulation programs for HT candidates.

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