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Original research article
Grip strength predicts cardiac adverse events in patients with cardiac disorders: an individual patient pooled meta-analysis
  1. Rita Pavasini1,
  2. Matteo Serenelli1,
  3. Carlos A Celis-Morales2,
  4. Stuart R Gray2,
  5. Kazuhiro P Izawa3,
  6. Satoshi Watanabe4,
  7. Eloisa Colin-Ramirez5,
  8. Lilia Castillo-Martínez6,
  9. Yasuhiro Izumiya7,
  10. Shinsuke Hanatani7,
  11. Yoshiro Onoue7,
  12. Kenichi Tsujita7,
  13. Peter S Macdonald8,
  14. Sunita R Jha8,
  15. Véronique L Roger9,10,
  16. Sheila M Manemann9,
  17. Juan Sanchis11,12,
  18. Vicente Ruiz13,
  19. Giulia Bugani1,
  20. Elisabetta Tonet1,
  21. Roberto Ferrari1,14,
  22. Stefano Volpato15,
  23. Gianluca Campo1,14
  1. 1 Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
  2. 2 BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
  3. 3 Graduate School of Health Sciences, Kobe University, Kobe, Japan
  4. 4 Department of Rehabilitation Medicine, St Marianna University School of Medicine Hospital, Sugao, Japan
  5. 5 National Council for Science and Technology (CONACyT) – Sociomedical Research Department, Instituto Nacional de Cardiología ‘Ignacio Chávez’, Mexico City, Mexico
  6. 6 Clinical Nutrition Department, Instituto Nacional de Ciencias Médicas y Nutrición SZ, Mexico City, Mexico
  7. 7 Department of Cardiovascular Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
  8. 8 Heart Transplant Unit, St Vincent’s Hospital, Darlinghurst, New South Wales, Australia
  9. 9 Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
  10. 10 Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
  11. 11 Cardiology Department, Hospital Clinico Universitario, INCLIVA, Valencia, Spain
  12. 12 Department of Medicine, University of Valencia, CIBER-CV, Valencia, Spain
  13. 13 Nursing School, University of Valencia, Valencia, Spain
  14. 14 GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
  15. 15 Department of Medical Science, Section of Internal and Cardiorespiratory Medicine, University of Ferrara, Ferrara, Italy
  1. Correspondence to Dr Rita Pavasini, Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Cona 44124, Italy; pvsrti{at}


Objective Grip strength is a well-characterised measure of weakness and of poor muscle performance, but there is a lack of consensus on its prognostic implications in terms of cardiac adverse events in patients with cardiac disorders.

Methods Articles were searched in PubMed, Cochrane Library, BioMed Central and EMBASE. The main inclusion criteria were patients with cardiac disorders (ischaemic heart disease, heart failure (HF), cardiomyopathies, valvulopathies, arrhythmias); evaluation of grip strength by handheld dynamometer; and relation between grip strength and outcomes. The endpoints of the study were cardiac death, all-cause mortality, hospital admission for HF, cerebrovascular accident (CVA) and myocardial infarction (MI). Data of interest were retrieved from the articles and after contact with authors, and then pooled in an individual patient meta-analysis. Univariate and multivariate logistic regression was performed to define predictors of outcomes.

Results Overall, 23 480 patients were included from 7 studies. The mean age was 62.3±6.9 years and 70% were male. The mean follow-up was 2.82±1.7 years. After multivariate analysis grip strength (difference of 5 kg, 5× kg) emerged as an independent predictor of cardiac death (OR 0.84, 95% CI 0.79 to 0.89, p<0.0001), all-cause death (OR 0.87, 95% CI 0.85 to 0.89, p<0.0001) and hospital admission for HF (OR 0.88, 95% CI 0.84 to 0.92, p<0.0001). On the contrary, we did not find any relationship between grip strength and occurrence of MI or CVA.

Conclusion In patients with cardiac disorders, grip strength predicted cardiac death, all-cause death and hospital admission for HF.

Trial registration number CRD42015025280.

  • heart disease
  • heart failure
  • meta-analysis

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  • Contributors Conceived and designed the research: RP, GC, CAC-M. Acquired the data: MS, ET, GB. Performed statistical analysis: GC, RP, MS. Drafted the manuscript: all authors. Made critical revision of the manuscript for key intellectual content: all authors.

  • Funding This study was supported by the University of Ferrara.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Every study included in the meta-analysis has been published after the approval of an ethics committee, and each patient enrolled signed an informed consent. For this reason, the present meta-analysis does not require further ethics committee approval.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data sets used and analysed during the current study are available from the corresponding author on reasonable request.