Leader: Klara Komici (UNIMOL); Other collaborator(s):
This Task has focused on the combination of frailty assessments tools with laboratory test and or clinical and diagnostic elements of deficits related to aging itself as diagnostic imaging of muscle loss and sensory loss. Application of these models would reduce the gap in the correct identification of frailty and pre-frailty status and interventional strategies would be more helpful if applied in the conditions of vulnerability or pre-clinical frailty.
Brief description of the activities and of the intermediate results
For this task, currently we are proceeding with recruitment, measurement of physical capacity, execution of multidimensional assessment scales, and echographic and echocardiographic evaluation as planned and described in the project. Following the literature review, a narrative review paper has been submitted, which results under review: Komici K., Pansini A., Bencivenga L., Rengo G., Pagano G., Guerra G. "Frailty and Parkinson's Disease: the role of Diabetes Mellitus." Frontiers in Medicine, Geriatric Medicine Section, under review.
From an analysis of the current data, we have observed a significant and independent correlation between epicardial fat assessed by echocardiography and muscle strength measured by handgrip. These data were presented as an oral presentation at the congress: ""AHL NAPOLI 2023, Scaling Up Digital Solutions for Healthy Living: Implementing Across Scientific Disciplines, Industrial Sectors and Scenarios,"" Naples, November 13-14, 2023: ""The relationship between handgrip strength and epicardial fat in healthy adults."" Additionally, an original research article has been submitted: Komici K., Bencivenga L., Arganese C., Rengo G., Guerra G. ""The relationship between muscle strength and epicardial fat in healthy adults."" Experimental Gerontology, under review.
From a preliminary analysis of the current data, it appears that the evaluation of muscle thicknesses is able to predict age-related physical decline. This result has been accepted as an abstract for the Age It GM Congress in Venice, May 2024. Komici K., Brunese MC., Merolla F., Guerra G. ""The usefulness of imaging domain to identify elderly subjects with physical decline."
Main policy, industrial and scientific implications
The evaluation with echocardiography and muscle ultrasound can have a clinical utility in predicting frailty and its outcomes. The use of imaging techniques can allow clinicians to identify frail patients or patients at risk for frailty development. Furthermore, by monitoring imaging changes over time it is possible to evaluate the effectiveness of therapy and interventions aimed at reducing frailty and improving clinical outcomes.
We worked on the following topics:
Results have been published in two artices (see outputs)
We worked on the following topics:
OUTPUTS
Submitted:
Database construction and analysis of variables which reflect multi-dimentional characteristics of vulnerability and frailty are proceeding as planned. Our data indicate imaging domains and new respiratory features may be useful in the early detection of physical decline associated to ageing and vulnerability status.
OUTPUTS
Santulli G, Bencivenga L, Rengo G, Guerra G, Mone P, Komici K. Integrating epicardial fat and heart rate recovery in adults with metabolic risk factors. Eur J Prev Cardiol. 2024 Nov 21:zwae380. doi: 10.1093/eurjpc/zwae380.
Conferences:
Congresso Nazionale Società Italiana della Medicina interna (SIMI) october 11-13 2024: THE IMPACT OF GFR ON SHORT-TERM OUTCOMES IN ELDERLY PATIENTS WITH HEART FAILURE WITH PRESERVED EJECTION FRACTION. (Delli Carpini G., Di Bartolomeo C., Dazzetti T., Martella L., Pedicino A., Giordano G., Rinaldi L, Mone P.; Komici K. ).
69 Congresso Nazionale della Societa Italiana di Gerontologia e Geriatria Firenze 11-14 Dicembre 2024 : L’UTILITÀ DELL’IMAGING DOMAIN PER IDENTIFICARE SOGGETTI ANZIANI CON DECLINO FISICO (K. Komici, M.C. Brunese, L. Bencivenga, G. Rengo, G. Guerra)
During this trimester, we are progressing on completing a database containing clinical data related to multidimensional characteristics of frailty. We have also tracked follow-up data regarding outcomes and performed additional statistical analyses on the study population.
OUTPUTS
Published:
Submitted:
Conference Presentations:
The project identified several important relationships between body composition, imaging parameters, and physical capacity:
Epicardial Fat and Muscle Strength: The research found an inverse and independent relationship between epicardial fat and muscle strength. This suggests that measuring handgrip strength (HGS) could help identify individuals with excessive epicardial fat and cardiovascular risk, while epicardial fat measurement could serve as an early detector of age-related physical decline.
Muscle Thickness and Strength: Using ultrasound to measure biceps brachii muscle thickness showed a significant positive correlation with handgrip strength in older adults. The study found that muscle thickness decreases parallel to aging in both sexes, indicating that non-invasive ultrasound evaluation could be valuable for early detection of age-related physical decline.
Lung Function and Muscle Strength: The research explored two complementary aspects of this relationship:
The project resulted in several published papers examining these relationships, including studies on:
The researchers plan to test the utility of these screening tools in follow-up studies examining outcomes like falls, hospitalizations, and cardiovascular events, with the goal of improving identification of frailty and pre-frailty states to enable more targeted interventional strategies.
OUTPUTS
Published:
Submitted:
Conference Presentations:
During this trimester, comprehensive analysis of previously collected patient data to evaluate the clinical utility of multi-domain screening tools for frailty and pre-frailty risk assessment, with particular emphasis on physical performance and imaging domains. A total of 300 patients were included in the analysis. All participants underwent standardized assessments across multiple clinical domains. Correlation analyses, regression models, and multivariate statistical techniques were employed to examine associations between physical performance markers, imaging findings, and frailty risk stratification. The analysis aims to establish the clinical utility and discriminative power of integrated physical and imaging assessment in frailty screening, providing evidence for optimized multi-domain assessment protocols in aging populations. Next steps: a) Finalization of statistical analyses and sensitivity assessments b) Preparation of findings for peer-reviewed publication c)Development of clinical recommendations based on identified screening algorithms.
OUTPUTS
Publications
1. Komici K, Fantini C, Santulli G, Bencivenga L, Femminella GD, Guerra G, Mone P, Rengo G. The role of diabetes mellitus on delirium onset: a systematic review and meta-analysis. Cardiovasc Diabetol. 2025 May 19;24(1):216. doi: 10.1186/s12933-025-02782-w.
2. Lagonigro E, Pansini A, Mone P, Guerra G, Komici K, Fantini C. The Role of Stress Hyperglycemia on Delirium Onset. J Clin Med. 2025 Jan 10;14(2):407. doi: 10.3390/jcm14020407.
3. Santulli G, Bencivenga L, Rengo G, Guerra G, Mone P, Komici K. Integrating epicardial fat and heart rate recovery in adults with metabolic risk factors. Eur J Prev Cardiol. 2025 Feb 18;32(3):266-268. doi: 10.1093/eurjpc/zwae380. PMID: 39570917
4. Brunese MC, Femminella GD, Bencivenga L, Tafuri F, Caiazzo C, Rengo G, Guerra G, Komici K. Unraveling functional decline: the relationship between muscle strength and ultrasound evaluation of biceps brachii thickness. Geroscience. 2025 Jul 18. doi: 10.1007/s11357-025-01801-8.
5. Petraglia L, Komici K, Bencivenga L, Rengo G, Pagliaro R, Sciattarella A, Ferrara N, Bianco A, Guerra G. The association between muscle strength and z scores of pulmonary function. Sci Rep. 2025 Jul 29;15(1):27662. doi: 10.1038/s41598-025-13371-y. PMID: 40730620
Progress of other publications:
During October-December 2025 we are proceeding with data analysis and our results indicate that multidimensional assessment tools effectively detect physical decline and frailty in older adults across physical, metabolic, and functional domains.
Our findings demonstrate that noninvasive imaging techniques, specifically ultrasound measurement of biceps brachii muscle thickness, show excellent reliability and significant correlation with handgrip strength in community-dwelling elderly individuals. Muscle thickness progressively decreases with age in both men and women, suggesting ultrasound could serve as an accessible screening tool for early detection of sarcopenia and physical decline.
The results also establish important connections between respiratory function and muscle strength. Analysis of pulmonary function parameters (FEV1 and FVC) reveals significant associations with handgrip strength and sarcopenia status in adults. Both absolute values and predicted parameters demonstrate utility in detecting muscle weakness, highlighting the pathophysiological link between lung function and muscular health.
Furthermore, our data show that metabolic markers are relevant for assessing frailty severity. In frail older adults with heart failure with preserved ejection fraction (HFpEF), the stress hyperglycemia ratio (SHR) emerges as an independent predictor of physical performance. Elevated SHR is associated with significantly reduced gait speed, indicating that stress-related dysglycemia may contribute to functional decline in this vulnerable population.
Collectively, these findings support a comprehensive, multimodal approach to frailty screening that incorporates physical assessment (muscle ultrasound, handgrip strength), functional testing (gait speed), respiratory evaluation, and metabolic markers to improve early identification of at-risk older adults.
OUTPUTS
Publications
1)Komici K. et al Practical Guidelines for Exercise Prescription. Under revision in Frontiers in Public Health
2)Komici K. et al. Integrating epicardial fat improves the prediction of exercise-induced hypertension and ventricular arrhythmias. EJPC Under Review
3)De Lucia N. et al NEUROPSYCHIATRIC AND NEURAL CORRELATES OF SUBJECTIVE COGNITIVE COMPLAINT. Age and Ageing Under Revision
4) Maniscalo et al Frailty and COPD: A Bidirectional Relationship in the Context of Systemic and Accelerated Aging. European J of Respiratory Research Review Under Revision
Conferences:
General Meeting 2 Naples Congress, October 29-31, presentation titled: "Unraveling Functional Decline: The Relationship between Muscle Strength and Ultrasound Evaluation of Biceps Brachii Thickness"
Invited Speaker at the SIGG National Congress, Naples, November 17-20, 2025, presentation: "CHRONIC CORONARY SYNDROMES IN THE ELDERLY IN LIGHT OF THE ESC 2024 GUIDELINES" "Optimization of Pharmacological Therapy"