Simple handgrip test could help doctors detect early heart ageing in seniors
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Ewe See Hooi (standing, left), director of echocardiography at the National Heart Centre Singapore (NHCS), and Angela Koh, director of the Cardiovascular Ageing and Longevity Programme at NHCS, demonstrating the use of advanced echocardiography techniques to assess the heart’s structure and function, particularly the left atrium and its interaction with the left ventricle.
ST PHOTO: GIN TAY
- Reduced muscle strength and mass in elderly people are linked to impaired left atrial heart function, an early sign of heart failure.
- The left atrium's role is crucial but often overlooked; weaker hand grip strength correlates with poor coordination between left atrium and ventricle.
- Using hand grip tests to assess muscle health may help detect heart failure risk early in ageing populations, aiding timely intervention.
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SINGAPORE – A simple squeeze of a handgrip could soon help doctors gauge how well an elderly person’s heart is ageing, long before any symptoms appear.
Weak grip strength in healthy seniors has been linked to early, hidden decline in the heart’s upper left chamber – the left atrium – according to new research by the National Heart Centre Singapore (NHCS).
The discovery could change how doctors screen for early heart disease.
Traditionally, they tend to check the lower left ventricle, which pumps blood to the entire body.
However, waiting for damage to show up in the left ventricle is often “too late”, said NHCS cardiologist Angela Koh.
“When we talk about managing heart disease, most of the problems occur at the left ventricle,” said Koh, a senior consultant with the Department of Cardiology at the centre.
The left side of the heart tends to “work harder” than the right side, dealing with much higher pressure and workload because it pumps oxygen-rich blood to the entire body, making it more vulnerable to strain and disease, she added.
But by the time the symptoms appear, the patients “would have come in with heart failure, abnormal heart rhythms, heart attacks or massive muscle damage”.
Koh also noted that while the left ventricle is usually diseased in an elderly patient with heart failure, the left atrium is normal.
“We did not really know why, so we needed to delve into this,” she said.
Koh and a team of researchers from NHCS enlisted 255 participants from the Cardiac Ageing Study, which looked at characteristics and influences of heart health among the elderly between September 2014 and December 2017.
The participants, whose mean age was 71, did not have heart issues, stroke or cancer. They were put through an MRI scan, clinical data questionnaires and skeletal muscle assessment within a day.
About 44 per cent of the participants were women.
The researchers discovered that early warning signs showed up in the left atrium long before the left ventricle fails.
Loss of muscle mass and strength was linked to reduced heart function in the left atrium, rather than the left ventricle.
“The left atrium is actually the one that pumps oxygen-rich blood across to the left ventricle. This is frequently ignored but a lot of ‘secrets’ are actually held in the left atrium,” Koh said.
These “secrets” include how the left atrium manages oxygen-rich blood, stores hormones, and hides structural features that could be mistaken for serious medical problems in scans.
“What we did was look at the relationship between muscle strength and muscle mass in relation to heart function. Using the handgrip test, we found that weaker handgrip strength was associated with reduced heart function in the left atrium,” Koh said.
The test measures upper body muscle strength and serves as a vital indicator of overall physical health and functional decline in older adults.
“Those participants with weaker grip strength or lower lean muscle mass had larger left atrium to left ventricle volume ratio. This showed that there was less effective coordination between the two heart chambers,” she said.
Cardiologist Louis Teo, director of the Heart Failure Programme at NHCS, noted that while there has been limited discussion on the left atrium, it is central to heart failure with preserved ejection fraction – a condition often driven by “stiff heart syndrome” in older adults.
Cardiologist Louis Teo (left), director of the Heart Failure Programme at NHCS, talking about how understanding early changes in the ageing heart can help identify individuals at risk of heart failure sooner, with implications for heart failure prevention.
ST PHOTO: GIN TAY
“An abnormal left atrium is what we look for in this group of heart failure patients,” said Teo, who is a consulting doctor for some of the participants.
The study was published in Communications Medicine, a peer-reviewed, open-access scientific journal, on Aug 22.
With Singapore now a super-aged society, where more than 21 per cent of its population are aged 65 and above, there is an increasing awareness of tracking muscle shrinkage, or sarcopenia, among the elderly.
Teo said: “From what we have learnt from this study, if we are able to use the handgrip test and look at the patients’ lean muscle mass, this test would be simple enough for us to detect those patients at risk within the community.”