Skeletal muscle quality affects patient outcomes in acute type A aortic dissection

Abstract OBJECTIVES Although skeletal muscle quantity is linked to surgical outcomes, quality remains unexamined. In this study, we evaluated whether skeletal muscle quality and quantity could predict surgical outcomes in acute type A aortic dissection (ATAAD). METHODS Skeletal muscle quality and quantity were evaluated using computed tomography (CT) values and the psoas muscle mass index, respectively. From May 2004 to December 2017, 324 ATAAD patients underwent aortic replacement after CT scans and psoas muscle mass index measurements. Patients were grouped into intramuscular fat (IMF; n = 55) and non-IMF (n = 269) deposition groups. RESULTS The mean ages of the patients were 72.3 ± 9.7 and 66.8 ± 12.1 years (P = 0.002), and hospital mortality rates were 3.6% (2/55) and 7.4% (20/269; P = 0.393) for IMF and non-IMF deposition groups, respectively. IMF deposition was a risk factor for a deterioration in activities of daily living at discharge by multivariable analysis [odds ratio 0.33, 95% confidence interval (CI) 0.16–0.69; P = 0.003]. The mean follow-up was 43.9 ± 36.8 months. The 5-year survival was significantly worse for the IMF deposition group (IMF 73.8% vs non-IMF 88.2%; P = 0.010). The multivariable Cox proportional hazard analysis showed that IMF deposition significantly predicted poor survival (hazard ratio 3.26, 95% CI 1.47–7.24; P = 0.004), unlike psoas muscle mass index and age. CONCLUSIONS Skeletal muscle quality, defined by IMF deposition, was an independent predictor of overall survival and postoperative activities of daily living dependence risk in patients undergoing surgery for ATAAD. Thus, IMF deposition may be an additional risk factor for estimating late outcomes of ATAAD surgery.

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Is extended arch replacement for acute type a aortic dissection an additional risk factor for mortality?

The Annals of Thoracic Surgery ◽

10.1016/s0003-4975(03)00726-4 ◽

2003 ◽

Vol 76 (4) ◽

pp. 1209-1214 ◽

Cited By ~ 37

Author(s):

M.Erwin S.H Tan ◽

Karl M.E Dossche ◽

Wim J Morshuis ◽

Johannes C Kelder ◽

Frans G.J Waanders ◽

...

Keyword(s):

Risk Factor ◽

Aortic Dissection ◽

Type A ◽

Additional Risk Factor ◽

Acute Type ◽

Additional Risk ◽

Type A Aortic Dissection

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Metabolic Syndrome and Its Components Are Associated With Hypoxemia After Surgery for Acute Type A Aortic Dissection: an Observational Study

10.21203/rs.3.rs-900428/v1 ◽

2021 ◽

Author(s):

Like Zhang ◽

Lei Zhang ◽

Zengren Zhao ◽

Yun Liu ◽

Juzeng Wang ◽

...

Keyword(s):

Metabolic Syndrome ◽

Regression Analysis ◽

Risk Factor ◽

Aortic Dissection ◽

Receiver Operating Characteristic ◽

Operating Characteristic ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

Receiver Operating

Abstract Background: The aim of this study was to explore whether or to what extent metabolic syndrome (METs) and its components were associated with hypoxemia in acute type A aortic dissection (ATAAD) patients after surgery.Methods: This study involved 271 inpatients who underwent surgery. Demographic and clinical data were collected. Subgroup analysis, mixed model regression analysis, and receiver operating characteristic (ROC) curve analysis were performed, and a scoring system was evaluated.Results: The 271 inpatients were assigned to the hypoxemia group (n = 48) or no hypoxemia group (n = 223) regardless of METs status. Compared to the no hypoxemia group, the hypoxemia group had a higher incidence of METs. Hypoxemia was present in 0%, 3.7%, 19.8%, 51.5%, 90.0% and 100% in the groups of individuals who met the diagnostic criteria of MetS 0, 1, 2, 3, 4 and 5 times, respectively. In the multivariable logistic regression analysis, BMI quartile was still a risk factor for hypoxemia after adjustment for other risk factors. After adjustment for potential confounding factors, METs was an independent risk factor for hypoxemia in several models. After assigning a score for each METs component present, the AUCs were 0.852 (95% CI: 0.789–0.914) in all patients, 0.728 (95% CI: 0.573–0.882) in patients with METs and 0.744 (95% CI: 0.636–0.853) in patients without METs according to receiver operating characteristic analysis.Conclusions: METs, especially body mass index, confers a greater risk of hypoxemia in ATAAD after surgery.

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Supracoronary aortic replacement for acute type A aortic dissection: A risk-factor for developing a late aortic root aneurysm?

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0032-1332431 ◽

2013 ◽

Vol 61 (S 01) ◽

Author(s):

J Brickwedel ◽

M Coutandin ◽

AM Bernhardt ◽

H Reichenspurner ◽

C Detter

Keyword(s):

Risk Factor ◽

Aortic Dissection ◽

Aortic Root ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

Aortic Root Aneurysm ◽

Aortic Replacement

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Risk factor analysis for proximal and distal reoperations after surgery for acute type A aortic dissection

Journal of Thoracic and Cardiovascular Surgery ◽

10.1067/mtc.2002.119702 ◽

2002 ◽

Vol 123 (2) ◽

pp. 318-325 ◽

Cited By ~ 115

Author(s):

Matthias Kirsch ◽

Céline Soustelle ◽

Rémi Houël ◽

Marie Line Hillion ◽

Daniel Loisance

Keyword(s):

Factor Analysis ◽

Risk Factor ◽

Aortic Dissection ◽

Type A ◽

Risk Factor Analysis ◽

Acute Type ◽

Type A Aortic Dissection

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Is previous cardiac surgery a risk factor for open repair of acute type A aortic dissection?

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2019.07.093 ◽

2020 ◽

Vol 160 (1) ◽

pp. 8-17.e1 ◽

Cited By ~ 3

Author(s):

Elizabeth L. Norton ◽

Carlo Maria Rosati ◽

Karen M. Kim ◽

Xiaoting Wu ◽

Himanshu J. Patel ◽

...

Keyword(s):

Cardiac Surgery ◽

Risk Factor ◽

Aortic Dissection ◽

Open Repair ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection

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Simple Age Specific Cutoff Value for Sarcopenia Evaluated by Computed Tomography

Annals of Nutrition and Metabolism ◽

10.1159/000480407 ◽

2017 ◽

Vol 71 (3-4) ◽

pp. 157-163 ◽

Cited By ~ 6

Author(s):

Ji Sun Kim ◽

Won Young Kim ◽

Hyun Kyung Park ◽

Myung Chun Kim ◽

Woong Jung ◽

...

Keyword(s):

Computed Tomography ◽

Skeletal Muscle ◽

Muscle Mass ◽

Skeletal Muscle Mass ◽

Psoas Muscle ◽

Health Screening ◽

Healthy Adults ◽

Cutoff Value ◽

Cutoff Values ◽

The Mean

Objective: Until now, cutoff values of low skeletal muscle mass using computed tomography (CT) were driven by optimal stratification to predict mortality in cancer patients. The aim of the present study was to investigate the simple, age-specific, cutoff value of low skeletal muscle mass by CT in healthy adults. Design: This is a retrospective, observational, single-center study. Setting: This study was performed in the health screening department of a university-affiliated hospital during a 10-year period. Patients: Medical records of 1,422 patients presenting to the health screening department were reviewed. Cross-sectional area of psoas muscle at the level of the third lumbar vertebra on abdominal CT was measured and adjusted by height (mm2/m2). This value (psoas muscle index [PMI]) was assumed to represent whole skeletal muscle mass. We divided the patients according to age, sex, and defined cutoff value of low skeletal muscle mass as 2 SDs below the mean. Intervention: None. Measurements and Main Results: Among 1,422 patients, 550 patients (38.6%) were male. The mean PMI was 896.60 (mm2/m2) for men and 570.54 (mm2/m2) for women. Cutoff values of PMI for men were 592.3 mm2/m2 for 20-39 years, 474.0 mm2/m2 for 40-49 years, 422.2 mm2/m2 for 50-59 years, 374.4 mm2/m2 for 60-69 years, and 331.5 mm2/m2 for 70-89 years. The values for women were 399.9 mm2/m2 for 20-39 years, 287.7 mm2/m2 for 40-49 years, 242.5 mm2/m2 for 50-59 years, 220.4 mm2/m2 for 60-69 years, and 147.6 mm2/m2 for 70-89 years. Conclusions: Cutoff values of low skeletal muscle mass using CT differed in healthy adults as age increased. Further studies on the effect of sarcopenia intervention using this cutoff value are needed.

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Physical activities and surgical outcomes in elderly patients with acute type A aortic dissection

10.22541/au.160830113.39968007/v1 ◽

2020 ◽

Author(s):

Yasushi Tashima ◽

Yurie Toyoshima ◽

Kota Chiba ◽

Noriyuki Nakamura ◽

Koichi Adachi ◽

...

Keyword(s):

Risk Factor ◽

Aortic Dissection ◽

Elderly Patients ◽

Surgical Outcomes ◽

Independent Risk Factor ◽

Physical Activities ◽

Acute Type ◽

Type A Aortic Dissection ◽

Late Mortality ◽

Walking Difficulty

Objective: Although elderly patients undergoing surgery for acute type A aortic dissection (ATAAD) is increasing, their physical activities are not fully understood. We report the physical activities and surgical outcomes in the elderly patients who underwent ATAAD. Methods: From 2009 to 2019, 103 consecutive patients underwent surgery for ATAAD at our institution. Surgical outcomes along with pre- and postoperative physical activities in 52 elderly patients (≥70 years old) were compared with those in 51 younger patients (<70 years old). Postoperative walking difficulty was defined as taking ≥30 days to regain the ability to walk 200 m postoperatively or as the inability to walk at discharge. Results: It took longer for elderly patients to regain the ability to walk 100 or 200 m postoperatively. ROC analysis revealed the AUC of the duration for walking 200 m postoperatively as a prognostic indicator for late deaths was 0.878, with the highest accuracy at 30 days (sensitivity = 83.3%, specificity = 91.8%). Hospital mortality within 30 days was 3.8%, and 1-, 3-, and 5-years survival rates were 92%, 84.7%, 84.7%, respectively, for elderly patients, with no significant differences between groups. Cox proportional hazard analysis showed postoperative walking difficulty was an independent risk factor for late mortality in all cohorts (P = 0.017). Conclusions: Elderly patients undergoing surgical ATAAD repair showed acceptable surgical outcomes. However, they were more likely to decrease their physical activities postoperatively. Postoperative difficulty in walking was an independent risk factor for the late mortality in patients with ATAAD.

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Risk Factor Analysis of Surgical and Long-term Results in Patients with Acute Type A Aortic Dissection

Recent Advances in Acute Type A Aortic Dissection ◽

10.2174/9781681080888115010015 ◽

2015 ◽

pp. 265-285

Keyword(s):

Factor Analysis ◽

Risk Factor ◽

Aortic Dissection ◽

Type A ◽

Risk Factor Analysis ◽

Long Term Results ◽

Acute Type ◽

Type A Aortic Dissection

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Marijuana: An Underappreciated Risk Factor for Acute Type A Aortic Dissection?

The Heart Surgery Forum ◽

10.1532/hsf.3409 ◽

2021 ◽

Vol 24 (1) ◽

pp. E137-E142

Author(s):

Iam Claire Sarmiento ◽

Ashley Giammarino ◽

S Jacob Scheinerman ◽

Antonio Guirola ◽

Alan Hartman ◽

...

Keyword(s):

United States ◽

Risk Factors ◽

Risk Factor ◽

Aortic Dissection ◽

Type A ◽

The United States ◽

Acute Type ◽

Type A Aortic Dissection ◽

Urine Toxicology ◽

Toxicology Screening

Background: Stimulants such as cocaine and amphetamines are well-established risk factors for acute aortic dissection. Despite the fact that marijuana is the most commonly used illicit drug in the United States, its relationship to acute aortic syndromes has not been well studied. Methods: A comprehensive retrospective review was undertaken of all consecutive patients who presented with acute Stanford type A aortic dissection from January 2017 to December 2019. Of 152 patients identified, 51 (33.6%) underwent comprehensive urine toxicology screening at clinical presentation. The characteristics and outcomes of the patients with urine results positive for tetrahydrocannabinol (THC) (n = 9, 17.6%) were compared with the 42 patients who had no evidence of recent marijuana consumption. Results: Of the 51 dissection patients who underwent broad-spectrum urine toxicology screening upon presentation, 9 (17.6%) returned positive results for THC, a proportion higher than would be expected for the general population. All THC patients were male; 3 concurrently tested positive for cocaine, and 3 others had evidence of recent amphetamine use. The THC patients were significantly younger than the non-THC patients (mean ± standard deviation age 48 ± 11.3 versus 61.4 ± 12.3 years, respectively, P = .004). A greater proportion of the THC cohort had a known diagnosis of aortic aneurysm before the dissection (44.4% versus 4.8%, P = .006). All patients underwent expeditious surgical repair. Thirty-day mortality for the entire cohort of 51 patients was 19.6% (10 deaths); for the THC group, it was 11.1% (1 death). There was no difference in the incidence of major postoperative complications between the 2 groups. Conclusion: Marijuana is the third most commonly used substance in the United States, after alcohol and tobacco. Although marijuana use is understudied, our results suggest that marijuana may be a contributing risk factor for acute type A aortic dissection, particularly in patients with other predisposing risk factors. Given the recent national trend to legalize marijuana, with the concomitant potential for exponential increases in its consumption, we suggest that the diagnosis of aortic dissection be considered earlier in any younger patient who presents with suggestive symptoms, especially if there is a history of recent marijuana use.

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