Sarcopenia in cardiac surgery: Dual X-ray absorptiometry study from the McGill frailty registry

Joshi, Aayushi; Mancini, Rita; Probst, Stephan; Abikhzer, Gad; Langlois, Yves; Morin, Jean‐François; Rudski, Lawrence; Afilalo, Jonathan

doi:10.1016/j.ahj.2021.04.008

Cited by 10 publications

(5 citation statements)

References 27 publications

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“…This can be used for additional assessment of other body composition compartments, including appendicular lean soft tissue (often called appendicular skeletal muscle mass). DXA has also been used in different surgical contexts 91–94 …”

Section: Assessing Malnutrition: a Focus On Novel And Nascent Methodsmentioning

confidence: 99%

“…DXA has also been used in different surgical contexts. [91][92][93][94] The use of D 3 creatine dilution 95 can also be explored in these patients, although this method is currently more feasible for research settings owing to the need for isotope data analysis. As such, its relevance and practicality in clinical settings remain to be determined.…”

Section: Additional Methodsmentioning

confidence: 99%

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Nascent to novel methods to evaluate malnutrition and frailty in the surgical patient

Prado

Ford

Gonzalez

et al. 2022

J Parenter Enteral Nutr

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Preoperative nutrition status is an important determinant of surgical outcomes, yet malnutrition assessment is not integrated into all surgical pathways. Given its importance and the high prevalence of malnutrition in patients undergoing surgical procedures, preoperative nutrition screening, assessment, and intervention are needed to improve postoperative outcomes. This narrative review discusses novel methods to assess malnutrition and frailty in the surgical patient. The Global Leadership Initiative for Malnutrition (GLIM) criteria are increasingly used in surgical settings although further spread and implementation are strongly encouraged to help standardize the diagnosis of malnutrition. The use of body composition (ie, reduced muscle mass) as a phenotypic criterion in GLIM may lead to a greater number of patients identified as having malnutrition, which may otherwise be undetected if screened by other diagnostic tools. Skeletal muscle loss is a defining criterion of malnutrition and frailty. Novel direct and indirect approaches to assess muscle mass in clinical settings may facilitate the identification of patients with or at risk for malnutrition. Selected imaging techniques have the additional advantage of identifying myosteatosis (an independent predictor of morbidity and mortality for surgical patients). Feasible pathways for screening and assessing frailty exist and may determine the cost/benefit of surgery, long‐term independence and productivity, and the value of undertaking targeted interventions. Finally, the evaluation of nutrition risk and status is essential to predict and mitigate surgical outcomes. Nascent to novel approaches are the future of objectively identifying patients at perioperative nutrition risk and guiding therapy toward optimal perioperative standards of care.

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Section: Assessing Malnutrition: a Focus On Novel And Nascent Methodsmentioning

confidence: 99%

Section: Additional Methodsmentioning

confidence: 99%

Nascent to novel methods to evaluate malnutrition and frailty in the surgical patient

Prado

Ford

Gonzalez

et al. 2022

J Parenter Enteral Nutr

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Section: Discussionmentioning

confidence: 99%

“…The chronic nature of most cardiac conditions prior to reaching the point of surgical intervention and the fact that the cardiac disease process itself usually limits physical activity, means that patients awaiting cardiac surgery usually exhibit a high prevalence of frailty and loss of muscle mass and function, a condition usually referred to as sarcopenia. [32][33][34] In 2019, our group published a review of 483 publications, of which 10 (including 4 metanalysis and 6 RCTs) represented the best evidence to answer the clinical question 'does prehabilitation improve outcomes in cardiac surgical patients?'. 35 The RCTs were limited by small sample sizes (the smallest had a sample size of 15) and no trial combined physical activity and IMT (the 2 interventions with the largest evidence base of impact for outcomes) as components in the intervention.…”

Section: Discussionmentioning

confidence: 99%

Prehabilitation in elective patients undergoing cardiac surgery: a randomised control trial (THE PrEPS TRIAL) – a study protocol

et al. 2023

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IntroductionPrehabilitation prior to surgery has been shown to reduce postoperative complications, reduce length of hospital stay and improve quality of life after cancer and limb reconstruction surgery. However, there are minimal data on the impact of prehabilitation in patients undergoing cardiac surgery, despite the fact these patients are generally older and have more comorbidities and frailty. This trial will assess the feasibility and impact of a prehabilitation intervention consisting of exercise and inspiratory muscle training on preoperative functional exercise capacity in adult patients awaiting elective cardiac surgery, and determine any impact on clinical outcomes after surgery.Methods and analysisPrEPS is a randomised controlled single-centre trial recruiting 180 participants undergoing elective cardiac surgery. Participants will be randomised in a 1:1 ratio to standard presurgical care or standard care plus a prehabilitation intervention. The primary outcome will be change in functional exercise capacity measured as change in the 6 min walk test distance from baseline. Secondary outcomes will evaluate the impact of prehabilitation on preoperative and postoperative outcomes including; respiratory function, health-related quality of life, anxiety and depression, frailty, and postoperative complications and resource use. This trial will evaluate if a prehabilitation intervention can improve preoperative physical function, inspiratory muscle function, frailty and quality of life prior to surgery in elective patients awaiting cardiac surgery, and impact postoperative outcomes.Ethics and disseminationA favourable opinion was given by the Sheffield Research Ethics Committee in 2019. Trial findings will be disseminated to patients, clinicians, commissioning groups and through peer-reviewed publication.Trial registration numberISRCTN13860094.

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“…Sarcopenia manifests as a generalized, progressive loss of skeletal muscle mass and strength, and is related to metabolic, physiologic, functional impairments, and poor clinical outcomes after various types of surgery ( 3 , 18 - 21 ). Reduced muscle mass may result in an insidious functional decline, and increase the morbidity and mortality rates after cardiac surgery ( 1 - 3 , 22 ). Grip strength, chair stand test, and gait speed are used as measuring muscle strength and physical performance in sarcopenia ( 4 ).…”

Section: Discussionmentioning

confidence: 99%

Nutritional indices for screening sarcopenia before adult cardiac surgery

Lee¹,

Choi²,

Park³

et al. 2023

J Thorac Dis

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Background Malnutrition can increase and exacerbate sarcopenia, and preoperative nutritional indices could have potential use as screening tools for sarcopenia in all patients, not only those with limited activity. Muscle strengths, such as grip strength, chair stand test, are used to screen for sarcopenia, but these measurements are time-consuming and cannot be applied to all patients. This retrospective study was conducted to determine whether nutritional indices can predict the presence of sarcopenia before adult cardiac surgery. Methods The study subjects were 499 patients aged ≥18 who had undergone cardiac surgery using a cardiopulmonary bypass (CPB). Bilateral psoas muscle mass areas at the top level of the iliac crest were measured by abdominal computed tomography. Preoperative nutritional statuses were evaluated using COntrolling NUTritional status (CONUT) score, Prognostic Nutritional Index (PNI), and Nutritional Risk Index (NRI). Receiver operating characteristic (ROC) curve analysis was used to identify the nutritional index that best predicted the presence of sarcopenia. Results The 124 patients (24.8%) in the sarcopenic group were older (69.0 vs. 62.0 years; P<0.001), and had a lower mean body weight (58.90 vs. 65.70 kg; P<0.001) and body mass index (BMI) (2.22 vs. 2.49 kg/m 2 ; P<0.001), and a poorer nutritional status than the 375 patients in the non-sarcopenic group. ROC curve analysis showed that NRI [area under the curve (AUC) 0.716, confidence intervals (CI): 0.664–0.768] better predicted the presence of sarcopenia than CONUT score (AUC 0.607, CI: 0.549–0.665) or PNI (AUC 0.574, CI: 0.515–0.633). The optimal NRI cut-off value was 105.25, which provided a sensitivity of 67.7% and a specificity of 65.1% for the prevalence of sarcopenia. The median durations of mechanical support (17 vs. 16 hours; P=0.008) and intensive care unit stay (3 vs. 2 days; P=0.001) were significantly longer in the sarcopenic group. Conclusions NRI offers a more straightforward, faster, and reproducible screening tool than muscle strength or mass measurement for identifying sarcopenia, and an alternative means of assessment in patients with limited activity before adult cardiac surgery.

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Sarcopenia in cardiac surgery: Dual X-ray absorptiometry study from the McGill frailty registry

Cited by 10 publications

References 27 publications

Nascent to novel methods to evaluate malnutrition and frailty in the surgical patient

Nascent to novel methods to evaluate malnutrition and frailty in the surgical patient

Prehabilitation in elective patients undergoing cardiac surgery: a randomised control trial (THE PrEPS TRIAL) – a study protocol

Nutritional indices for screening sarcopenia before adult cardiac surgery

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