Abdominal skeletal muscle mass as a predictor of mortality in Japanese patients undergoing left ventricular assist device implantation

Abstract

Aims We assessed preoperative muscle wasting in patients undergoing left ventricular assist device (LVAD) implantations using abdominal skeletal muscle images on computed tomography (CT) and explored the associations between the preoperative muscle wasting and clinical outcomes after LVAD implantation. Methods and results We retrospectively examined the records of 111 patients who underwent continuous‐flow LVAD implantations as bridge‐to‐transplant therapy from January 2010 to December 2016 at our institution. After 33 patients were excluded, the study cohort consisted of 78 individuals. CT images used to calculate the skeletal muscle index (SMI) at the third lumbar vertebra level were obtained before the LVAD implantation procedures. Patients were classified as having muscle wasting if their SMI fell into the lowest gender‐based tertile. The median SMI for the study patients was 37.6 cm 2 /m 2 . The SMI cut‐off values for the lowest tertiles were 36.7 cm 2 /m 2 for men and 28.2 cm 2 /m 2 for women, resulting in 26 patients (33.3%) with muscle wasting in this study. During the mean follow‐up of 738 ± 379 days, there were 10 deaths (12.8% mortality). Seven of the 26 patients with muscle wasting (26.9%) died, and 3 of the 52 patients without muscle wasting (5.8%) died. The times to all‐cause mortality were significantly different between patients with and without muscle wasting ( P = 0.0094). Muscle wasting was found to be associated with mortality in univariate and multivariate Cox analyses (hazard ratio: 4.32; 95% CI: 1.19–20.2). Conclusions Preoperative muscle wasting was associated with a higher mortality in patients with LVAD. Assessment of the abdominal skeletal muscle area on CT prior to LVAD implantation can help predict mortality.

Muscle wasting as an independent predictor of survival in patients with chronic heart failure

“…25 Thus, even though these authors identified low psoas muscle area in patients with chronic HF after an acute hospitalization as an independent predictor of death, these findings should not be extrapolated to the skeletal muscle mass of the extremities. Very similarly, Tsuji et al 5 examined psoas muscle mass in 78 patients undergoing left ventricular assist device implantation. They found that perioperative muscle wasting as extrapolated from the psoas measurement approach was associated with higher mortality in their patient cohort.…”

“…The large range mirrors the association with the cohort under investigation. For example, stable ambulatory patients seem to have lower prevalence values than patients with acute or advanced HF, [5][6][7] and patients with dilated cardiomyopathy may have higher prevalence values than patients with ischaemic heart disease. 2,3,8 It is important to note that skeletal muscle wasting, in geriatric populations commonly called sarcopenia, is different from cachexia, because only cachexia is by definition associated with weight loss.…”

Skeletal Muscle Index at Intensive Care Unit Admission Is a Predictor of Intensive Care Unit-Acquired Weakness in Patients With Sepsis

“…Currently, a quantitative assessment of the cross-sectional muscle area using computed tomography (CT) images is available to assess changes in skeletal muscle mass [14]. This assessment calculates the skeletal muscle index (SMI) (cm 2 /m 2 ) by dividing the cross-sectional area (cm 2 ) of the skeletal muscle at the level of the third lumbar vertebra (L3) by the square of the patient’s height (m 2 ) on CT [15]. SMI measured using CT may reflect MRC scores.…”

Muscle Wasting and Sarcopenia in Heart Failure—The Current State of Science

“…Muscle wasting is one of the main causes for exercise intolerance and ventilatory inefficiency in HF patients [57]. It promotes the aggravation of other clinical conditions and causes a deterioration of quality of life [58]. It is associated with a longer hospital stay [59], more frequent re-hospitalizations [60], and worsened prognosis [61].…”