Prognostic implications of psoas muscle area in patients undergoing transcatheter aortic valve implantation

Kofler, Markus; Reinstadler, Sebastian Johannes; Mayr, Agnes; Stastny, Lukas; Reindl, Martin; Dumfarth, Julia; Dachs, Theresa-Marie; Wachter, Kristina; Rustenbach, Christian; Friedrich, Guy; Feuchtner, Gudrun; Klug, Gert; Bramlage, Peter; Metzler, Bernhard; Grimm, Michael; Baumbach, Hardy; Bonaros, Nikolaos

doi:10.1093/ejcts/ezy244

Cited by 21 publications

(20 citation statements)

References 17 publications

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“…[5][6][7] In adults, studies have found that a low tPMA is an independent risk factor for complications and mortality after various surgical procedures. [8][9][10][11][12][13] Children with end-stage organ disease were shown to have smaller tPMA compared to healthy matched trauma victims, independent of anthropometric markers, 14 and severe muscle loss has been associated with adverse events in children after induction therapy for acute lymphoblastic leukemia. 15 Very recently, age-and gender-specific tPMA reference values for L3-4 and L4-5 lumbar levels were published with a freely-available online z-score calculator tool.…”

Section: Introductionmentioning

confidence: 98%

“…The total psoas muscle area (tPMA), measured at intervertebral lumbar disc levels on cross‐sectional abdominal images from computed tomography (CT) scanning, and magnetic resonance imaging (MRI), is an established method to measure sarcopenia 5–7 . In adults, studies have found that a low tPMA is an independent risk factor for complications and mortality after various surgical procedures 8–13 . Children with end‐stage organ disease were shown to have smaller tPMA compared to healthy matched trauma victims, independent of anthropometric markers, 14 and severe muscle loss has been associated with adverse events in children after induction therapy for acute lymphoblastic leukemia 15 .…”

Section: Introductionmentioning

confidence: 99%

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Sarcopenia is a prognostic outcome marker in children with high‐risk hepatoblastoma

Ritz¹,

Kolorz²,

Hubertus³

et al. 2021

Pediatric Blood & Cancer

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Background Children with hepatoblastoma (HB) are at risk of sarcopenia due to immobility, chemotherapy, and malnutrition. We hypothesized that children with HB have a low preoperative total psoas muscle area (tPMA), reflecting sarcopenia, which negatively impacts outcome. Procedure Retrospective study of children (1‐10 years) with hepatoblastoma treated at a large university children's hospital from 2009 to 2018. tPMA was measured as the sum of the right and left psoas muscle area (PMA) at intervertebral disc levels L3‐4 and L4‐5. z‐Scores were calculated using age‐ and gender‐specific reference values and were compared to anthropometric measurements, clinical variables, and outcomes. Sarcopenia was defined as a tPMA z‐score below −2. Results Thirty‐three children were included. Mean tPMA z‐score was −2.18 ± 1.08, and 52% were sarcopenic. A poor correlation between tPMA and weight was seen (r = 0.35; confidence interval [CI] 0.01, 0.62; P = .045), and most children had weights within the normal range (mean z‐score −0.55 ± 1.39). All children categorized as high risk with relapse (n = 5/12) were sarcopenic before surgery. Relapse was significantly higher in the high‐risk sarcopenic group compared to the nonsarcopenic group (P = .008). The change in tPMA z‐score 1‐4 months after surgery did not improve in patients with relapse, but did improve in 75% of children without relapse. Conclusions The majority of children with HB were sarcopenic prior to surgery. Especially in children with high‐risk hepatoblastoma, sarcopenia is an additional risk factor for relapse. Large multicenter studies are needed to confirm these preliminary results.

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Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Sarcopenia is a prognostic outcome marker in children with high‐risk hepatoblastoma

Ritz¹,

Kolorz²,

Hubertus³

et al. 2021

Pediatric Blood & Cancer

View full text Add to dashboard Cite

show abstract

“…Evaluation of body composition as a possible predictor of cardiovascular disease is well established. For example, abdominal obesity has been shown to be highly predictive of coronary heart disease, and the psoas muscle area at the level of the third lumbar vertebra (L3) appears to predict outcome in patients undergoing transcatheter aortic valve implantation 16,17 . CT allows straightforward analysis of body composition and quantification of sarcopenia 18,19 .…”

Section: Introductionmentioning

confidence: 99%

Artificial intelligence‐based analysis of body composition in Marfan: skeletal muscle density and psoas muscle index predict aortic enlargement

Beetz

Maier

Shnayien

et al. 2021

J cachexia sarcopenia muscle

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Background Patients with Marfan syndrome are at risk for aortic enlargement and are routinely monitored by computed tomography (CT) imaging. The purpose of this study is to analyse body composition using artificial intelligence (AI)‐based tissue segmentation in patients with Marfan syndrome in order to identify possible predictors of progressive aortic enlargement. Methods In this study, the body composition of 25 patients aged ≤50 years with Marfan syndrome and no prior aortic repair was analysed at the third lumbar vertebra (L3) level from a retrospective dataset using an AI‐based software tool (Visage Imaging). All patients underwent electrocardiography‐triggered CT of the aorta twice within 2 years for suspected progression of aortic disease, suspected dissection, and/or pre‐operative evaluation. Progression of aortic enlargement was defined as an increase in diameter at the aortic sinus or the ascending aorta of at least 2 mm. Patients meeting this definition were assigned to the ‘progressive aortic enlargement’ group (proAE group) and patients with stable diameters to the ‘stable aortic enlargement’ group (staAE group). Statistical analysis was performed using the Mann–Whitney U test. Two possible body composition predictors of aortic enlargement—skeletal muscle density (SMD) and psoas muscle index (PMI)—were analysed further using multivariant logistic regression analysis. Aortic enlargement was defined as the dependent variant, whereas PMI, SMD, age, sex, body mass index (BMI), beta blocker medication, and time interval between CT scans were defined as independent variants. Results There were 13 patients in the proAE group and 12 patients in the staAE group. AI‐based automated analysis of body composition at L3 revealed a significantly increased SMD measured in Hounsfield units (HUs) in patients with aortic enlargement (proAE group: 50.0 ± 8.6 HU vs. staAE group: 39.0 ± 15.0 HU; P = 0.03). PMI also trended towards higher values in the proAE group (proAE group: 6.8 ± 2.3 vs. staAE group: 5.6 ± 1.3; P = 0.19). Multivariate logistic regression revealed significant prediction of aortic enlargement for SMD (P = 0.05) and PMI (P = 0.04). Conclusions Artificial intelligence‐based analysis of body composition at L3 in Marfan patients is feasible and easily available from CT angiography. Analysis of body composition at L3 revealed significantly higher SMD in patients with progressive aortic enlargement. PMI and SMD significantly predicted aortic enlargement in these patients. Using body composition as a predictor of progressive aortic enlargement may contribute information for risk stratification regarding follow‐up intervals and the need for aortic repair.

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“…Psoas muscle mass index (PMI) has received growing recognition as an objective and quantitative marker to assess loss of skeletal muscle mass and has been suggested as a useful predictive marker for long-term outcome in patients undergoing cardiovascular or oncologic surgeries. 8,9 On the other hand, the prognostic implications and risk stratification capability of PMI in patients with ADHF are currently unknown. Accordingly, the purpose of the present study was to investigate the long-term prognostic value of PMI in hospitalized patients with ADHF.…”

Section: Introductionmentioning

confidence: 99%

“…Risk stratification highlighting skeletal muscle abnormalities may act as a better indicator and help prognostic prediction. Psoas muscle mass index (PMI) has received growing recognition as an objective and quantitative marker to assess loss of skeletal muscle mass and has been suggested as a useful predictive marker for long‐term outcome in patients undergoing cardiovascular or oncologic surgeries 8,9 . On the other hand, the prognostic implications and risk stratification capability of PMI in patients with ADHF are currently unknown.…”

Section: Introductionmentioning

confidence: 99%

Loss of skeletal muscle mass predicts cardiac death in heart failure with a preserved ejection fraction but not heart failure with a reduced ejection fraction

et al. 2020

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Aims Loss of skeletal muscle mass is an important determinant associated with poor long-term prognosis in patients with acute decompensated heart failure (ADHF). However, limited evidence is available. This study investigated the prognostic value of the psoas muscle mass index (PMI) in patients with ADHF. Methods and results A total of 210 consecutive patients aged ≥60 years with ADHF were enrolled using a prospective database between 2015 and 2017. Primary endpoint was incidence of cardiac death. Cross-sectional psoas muscle area at the L3 vertebral level was obtained by computed tomography, and PMI was calculated by height. Reduced PMI was defined as a PMI below the 25th sex-specific percentile. Patients were also classified by their left ventricular ejection fraction (EF) as having either heart failure with a reduced ejection fraction (HFrEF, EF < 50%) or heart failure with a preserved ejection fraction (HFpEF, EF ≥ 50%). The median follow-up period was 1.8 years. There were 44 cardiac deaths (21%) during the study period. Patients with reduced PMI had significantly higher cardiac death rates than those with preserved PMI (33% vs. 17%, log-rank test P = 0.006). In subgroup analysis, HFpEF patients with reduced PMI had significantly higher cardiac death rates than those with preserved PMI (38% vs. 16%, log-rank test P = 0.006); conversely, HFrEF patients had comparable cardiac death rates regardless of their PMI group (27% for reduced PMI vs. 18% for preserved PMI, log-rank test P = 0.24). Multivariate Cox proportional hazards model revealed that patients with reduced PMI had a 2.3-fold higher risk of cardiac death compared with patients with preserved PMI (95% confidence interval 1.23-4.42, P = 0.01). Conclusions Reduced PMI helps to predict long-term outcome in patients with HFpEF but not HFrEF.

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Prognostic implications of psoas muscle area in patients undergoing transcatheter aortic valve implantation

Cited by 21 publications

References 17 publications

Sarcopenia is a prognostic outcome marker in children with high‐risk hepatoblastoma

Sarcopenia is a prognostic outcome marker in children with high‐risk hepatoblastoma

Artificial intelligence‐based analysis of body composition in Marfan: skeletal muscle density and psoas muscle index predict aortic enlargement

Loss of skeletal muscle mass predicts cardiac death in heart failure with a preserved ejection fraction but not heart failure with a reduced ejection fraction

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