Low skeletal muscle density combined with muscle dysfunction predicts adverse events after adult cardiovascular surgery

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
M Yamashita ◽  
K Kamiya ◽  
A Matsunaga ◽  
T Kitamura ◽  
N Hamazaki ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Adverse Events ◽  
Cardiovascular Surgery ◽  
Clinical Investigation ◽  
Psoas Muscle ◽  
Predictive Ability ◽  
Muscle Dysfunction ◽  
Poor Prognostic Factor ◽  
Muscle Density ◽  
Net Reclassification Improvement

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): This study was supported by the Grant for Japan Society for the Promotion of Science (JSPS) KAKENHI. Introduction Although muscle dysfunction is widely known as a poor prognostic factor in patients with cardiovascular disease, no study has examined whether the addition of low skeletal muscle density (SMD) assessed by computed tomography (CT) to muscle dysfunction is useful. Purpose The present study aimed to examine whether SMDs can strengthen the predictive ability of muscle dysfunction for adverse events in patients who underwent cardiovascular surgery. Methods We retrospectively reviewed 853 patients (median age: 69 years, 65.1% male) aged ≥40 years who had preoperative CT for risk management purposes and muscle dysfunctions measured during postoperative cardiac rehabilitation. Muscle dysfunctions were determined from weakness (low grip strength) and slowness (slow gait speed) based on the Asia Working Group for Sarcopenia. Low SMD based on transverse abdominal CT images was defined as a mean Hounsfield unit of the psoas muscle <45. To examine the complementary prognostic value for all-cause deaths, all-cause events, and cardiovascular-related events when low SMDs were added to four patterns of muscle dysfunction (weakness only, slowness only, weakness or slowness, and weakness and slowness), the continuous net reclassification improvement (cNRI) and integrated discrimination improvement (IDI) index were calculated. Results For all definitions of muscle dysfunction, the addition of SMDs was shown to significantly improve the cNRI (estimates: 0.377 to 0.468 for all-cause death, 0.220 to 0.248 for all-cause events, 0.308 to 0.322 for cardiovascular-related events) and IDI (estimates: 0.005 to 0.011 for all-cause death, 0.005 to 0.010 for all-cause events, 0.009 to 0.012 for cardiovascular-related events) in all analyses. Low SMDs combined with muscle dysfunctions were associated with the highest risk of all-cause death (Figure 1: A-D). Patients with neither low SMDs nor muscle dysfunction had the lowest risk of all-cause events and cardiovascular-related events (Figure1: E-L). Conclusion The predictive ability of muscle dysfunction for adverse events was consistently increased by addition of SMDs in patients who underwent cardiovascular surgery. Our results suggest that when CT is performed for any clinical investigation, the addition of the organic assessment of skeletal muscle can strengthen the diagnostic accuracy of muscle wasting. Abstract Figure 1

scholarly journals Low muscle mass assessed by psoas muscle area is associated with clinical adverse events in elderly patients with heart failure

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0247140
Author(s):  
Takehiro Funamizu ◽  
Yuji Nagatomo ◽  
Mike Saji ◽  
Nobuo Iguchi ◽  
Hiroyuki Daida ◽  
...  
Keyword(s):  
Heart Failure ◽  
Skeletal Muscle ◽  
Adverse Events ◽  
Elderly Patients ◽  
Muscle Mass ◽  
Skeletal Muscle Mass ◽  
Psoas Muscle ◽  
Composite Endpoint ◽  
Left Ventricular Ejection ◽  
Muscle Area

Background Acute decompensated heart failure (ADHF) is a growing healthcare burden with increasing prevalence and comorbidities due to progressive aging society. Accumulating evidence suggest that low skeletal muscle mass has a negative impact on clinical outcome in elderly adult population. We sought to determine the significance of psoas muscle area as a novel index of low skeletal muscle mass in elderly patients with ADHF. Methods In this single-center retrospective observational study, we reviewed consecutive 865 elderly participants (65 years or older) who were hospitalized for ADHF and 392 were available for analysis (79 years [74–85], 56% male). Cross-sectional areas of psoas muscle at the level of fourth lumbar vertebra were measured by computed tomography and normalized by the square of height to calculate psoas muscle index (PMI, cm2/m2). Results Dividing the patients by the gender-specific quartile value (2.47 cm2/m2 for male and 1.68 cm2/m2 for female), we defined low PMI as the lowest gender-based quartile of PMI. Multiple linear regression analysis revealed female sex, body mass index (BMI), and E/e’, but not left ventricular ejection fraction, were independently associated with PMI. Kaplan-Meier analysis showed low PMI was associated with higher rate of composite endpoint of all-cause death and ADHF re-hospitalization (P = 0.033). Cox proportional hazard model analysis identified low PMI, but not BMI, was an independent predictor of the composite endpoint (Hazard ratio: 1.52 [1.06–2.16], P = 0.024). Conclusions PMI predicted future clinical adverse events in elderly patients with ADHF. Further studies are needed to assess whether low skeletal muscle mass can be a potential therapeutic target to improve the outcome of ADHF.

Abstract MP047: Abdominal Skeletal Muscle Density is Significantly Associated With Selected Measures of Adiposity Associated Inflammation: the Multi-Ethnic Study of Atherosclerosis

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Rachel Van Hollebeke ◽  
Mary Cushman ◽  
Matthew A Allison
Keyword(s):  
Skeletal Muscle ◽  
Interleukin 6 ◽  
Subcutaneous Fat ◽  
Psoas Muscle ◽  
Abdominal Muscle ◽  
Muscle Area ◽  
Muscle Density ◽  
Ethnic Study ◽  
The Mean ◽  
Muscle Groups

Background: Excess adiposity is associated with higher levels of certain inflammatory markers that have been linked to cardiometabolic disease. Lean skeletal muscle is the largest regulator of glucose metabolism but few population-based studies have examined the associations between muscle and inflammation. Therefore, we studied the relationships between abdominal muscle mass [area] and density with selected measures of adiposity-associated inflammation. Methods: Nearly 2,000 subjects enrolled in the Multi-Ethnic Study of Atherosclerosis underwent computed tomography (CT) of the abdomen and had venous fasting blood drawn concomitantly. The CT scans were interrogated for visceral and subcutaneous fat, as well as lean muscle areas and densities in the rectus abdominus, obliques, paraspinus and psoas muscle groups. We then categorized the muscle in locomotion (psoas) and stabilization groups (rectus, obliques and paraspinus). The blood samples were assayed for interleukin-6, resistin, C-reactive protein, and tumor necrosis factor - alpha. Multivariable linear regression was used to determine the independent associations between muscle area and density with each of the aforementioned adipokines. Results: The mean age was 64.7 years and 49% were female. Forty percent were non-Hispanic White, 26% were Hispanic/ Latino American, 21% were African American, 13% were Chinese American. The mean BMI was 28.0 kg/m 2 and 30% were obese (BMI > 30 kg/m 2 ). With adjustment for age, gender, race, dyslipidemia, diabetes, hypertension, eGFR, coronary artery calcium, physical activity, sedentary behavior, selected adipokines and both subcutaneous and visceral fat, a 1-SD increment in the mean densities for total abdominal muscle, total stabilization muscle and total locomotive muscle were each significantly associated with lower levels of interleukin-6 (-15%, -15% and -9%, p < 0.01 for all) and resistin (-0.11, -0.11 and -0.07 ng/mL, p < 0.02 for all), but not CRP or TNF-alpha. These associations remained significant after additional adjustment for muscle area in the corresponding muscle group. Conversely, the areas of the muscle variables were not independently associated with any of the adipokines, especially after adjustment for muscle density. There were no significant interactions between ethnicity and both muscle area and density for any of the adipokines. Conclusions: Higher densities of several muscle groups in the abdomen are significantly associated with lower interleukin-6 and resistin levels, independent of the muscle area in these groups. Techniques that either enhance or maintain muscle density levels may reduce the risk of cardiometabolic diseases linked to adverse levels of inflammation.

Baseline skeletal muscle density and adverse outcomes during chemotherapy for early breast cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e12506-e12506
Author(s):  
Gabriel Aleixo ◽  
Allison Mary Deal ◽  
Kirsten A. Nyrop ◽  
Hyman B. Muss ◽  
Grant Richard Williams ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Skeletal Muscle ◽  
Adverse Events ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Adverse Outcomes ◽  
Cut Points ◽  
Muscle Density ◽  
Axial Ct ◽  
The Mean

e12506 Background: Skeletal Muscle Density (SMD) is the amount of fat infiltration in the muscle, Low SMD (myosteatosis), is associated with chemotherapy toxicity in women with breast cancer (BC); however, cut points are not consistent across studies. We investigated the association of alternative cut-points for low SMD at BC diagnosis and adverse outcomes during chemotherapy in women with early BC. Methods: This is a retrospective chart review. Axial CT images were evaluated at the L3 level to calculate average SMD in Hounsfield Units (HU). Three cut points (Table) classified patients as low versus normal SMD. T-test was used to calculate the relative risk (RR) for adverse events. Results: In 340 patients, the mean age was 51. Table shows RR for three adverse events (dose reduction, early treatment discontinuation, hospitalization) for each of the three cut points. Conclusions: All three cut-points described in the literature are reliable for stratification of patients with EBC for myosteatosis and associated chemotherapy-related adverse events. [Table: see text]

PSOAS AND PARASPINOUS MUSCLE MEASUREMENTS ON COMPUTED TOMOGRAPHY PREDICT MORTALITY IN EUROPEAN AMERICANS WITH TYPE 2 DIABETES MELLITUS

2019 ◽  
pp. 1-7
Author(s):  
B.M. TUCKER ◽  
F.C. HSU ◽  
T.C. REGISTER ◽  
J. XU ◽  
S.C. SMITH ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Computed Tomography ◽  
Type 2 Diabetes ◽  
Skeletal Muscle ◽  
Psoas Muscle ◽  
Muscle Density ◽  
European Americans ◽  
Adjusted Model ◽  
Paraspinous Muscle

Background: Appendicular skeletal muscle mass index and muscle attenuation (density) are negatively associated with mortality in European-derived populations. Objectives: The present analyses assessed association between axial skeletal muscle density and muscle index with mortality in European Americans with type 2 diabetes mellitus (T2D). Design: Single-center observational study. Setting: Diabetes Heart Study. Participants: 839 European Americans with T2D. Methods: Computed tomography-measured psoas and paraspinous muscle mass index (cross sectional area/height2) and radiographic density (Hounsfield Units) were assessed in all participants. A Cox proportional hazards model was computed. The fully-adjusted model included covariates age, sex, body mass index, smoking, alcohol use, diabetes duration, insulin use, hormone replacement therapy (women), prevalent cardiovascular disease (CVD), hypertension, and coronary artery calcified atherosclerotic plaque mass score. Deaths were recorded in the National Death Index data through December 31, 2015. Results: Participants included 428 women and 411 men with median (25th, 75th quartile) age 62.8 (56.1, 69.1) years and diabetes duration 8.0 (5.0, 14.0) years. After 11.9 (9.4, 13.3) years of follow-up, 314 (37.4%) of participants were deceased. In the fully-adjusted model, psoas muscle density (hazard ratio [HR] 0.81, p<0.001), psoas muscle index (HR 0.82, p=0.008), and paraspinous muscle density (HR 0.85, p=0.003) were inversely associated with mortality. Paraspinous muscle index was not significantly associated with mortality (HR 0.90, p=0.08). Results did not differ significantly between men and women. Conclusions: In addition to established risk factors for mortality and CVD, higher psoas muscle index, psoas muscle density, and paraspinous muscle density were significantly associated with lower all-cause mortality in European Americans with T2D.

scholarly journals P01.08 Sarcopenia as biomarker for immunotherapy outcomes and immune-related adverse events – a systematic review and meta-analysis

2021 ◽  
Vol 9 (Suppl 1) ◽  
pp. A7.1-A7
Author(s):  
S Günther ◽  
P Trinkner ◽  
M von Bergwelt ◽  
D Cordas dos Santos ◽  
S Theurich
Keyword(s):  
Systematic Review ◽  
Skeletal Muscle ◽  
Risk Factor ◽  
Adverse Events ◽  
Cancer Patients ◽  
Meta Analysis ◽  
Lumbar Vertebrae ◽  
Psoas Muscle ◽  
Skeletal Muscle Index ◽  
The Impact

BackgroundSarcopenia is an established risk factor for oncologic treatments like surgical interventions and conventional chemotherapy. However, the impact of sarcopenia on treatment and immune-related adverse events (irAEs) of cancer patients treated with immune checkpoint inhibitors (ICIs) continues to be debated. Therefore, we performed a systematic review and meta-analysis of all published articles evaluating the effects of sarcopenia on survival outcomes and irAEs of patients undergoing ICI treatment.Materials and MethodsIn analogy to the Cochrane guidelines for systematic reviews, we performed a systematic literature search including all published articles in PubMed until February 2021 for the key terms ‘sarcopenia’ or ‘sarcopenic obesity’ in combination with several terms for ICI treatments, irrespective of cancer entity and ICI used. Further selection criteria for meta-analysis included defined cut-offs for sarcopenia. Reported outcomes included progression-free survival (PFS), overall survival (OS) and the frequency of irAEs. For the random effects meta-analysis, we used Hazard Ratios (HR) for OS and PFS and Odds Ratios (OR) for occurrence of irAEs with corresponding 95% confidence intervals (95%CI), respectively.ResultsA total of 15 studies with 1,428 patients were selected to be eligible for meta-analysis. To evaluate muscle mass, all studies used CT-derived body composition parameters at the third lumbar vertebrae level and defined sarcopenia by using skeletal muscle index (SMI), psoas muscle index (PMI) or skeletal muscle density (SMD). Sarcopenic patients showed an inferior survival compared to non-sarcopenic patients with a combined HR for PFS with 1.53 (95%CI 1.23-1.91, p= 0.0001) and for OS with 1.6 (95% CI 1.23-2.09, p= 0,0005). Frequency of irAEs did not differ between sarcopenic and non-sarcopenic patients regardless of irAE grade (irAEs of grade≥3: OR 1.14, 95%CI 0.65-2.01, p = 0.64, irAEs of any grade: OR 0.96, 95%CI 0.65-1.42, p = 0.85).ConclusionsThis is the first meta-analysis that assessed sarcopenia in a mixed cohort of cancer patients. It revealed that sarcopenia is an adverse risk factor for survival of patients undergoing ICI treatment without affecting the risk of developing irAEs. Future studies may address sarcopenia as a patient-derived risk factor emphasizing the importance of nutrition and physical activity interventions.Disclosure InformationS. Günther: None. P. Trinkner: None. M. von Bergwelt: None. D. Cordas dos Santos: None. S. Theurich: None.

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