Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, QC; Division of Experimental Medicine, McGill University, Montreal, QC.
Division of Nuclear Medicine, Jewish General Hospital, McGill University, Montreal, QC.
Am Heart J. 2021 Sep;239:52-58. doi: 10.1016/j.ahj.2021.04.008. Epub 2021 May 4.
To determine the prevalence and prognostic value of sarcopenia measured by dual x-ray absorptiometry (DXA) and physical performance tests in patients undergoing coronary artery bypass surgery or heart valve procedures.
Adults undergoing cardiac surgery were prospectively enrolled and completed a questionnaire, physical performance battery, and a DXA scan (GE Lunar) to measure appendicular muscle mass indexed to height (AMMI). Patients were categorized as sarcopenic based on European Working Group 2 guidelines if they had low AMMI defined as <7 kg/m for men or <5.5 kg/m for women, and low muscle strength defined as 5 chair rise time ≥15 seconds. Cox proportional hazards regression was used to test the association between sarcopenia and all-cause mortality over a median follow-up of 4.3 years.
The cohort consisted of 141 patients with a mean age of 69.7 ± 10.0 years and 21% females. The prevalence rates of low AMMI, slow chair rise time, and sarcopenia (low AMMI and slow chair rise time) were 24%, 57%, 13%, respectively. The 4-year survival rate was 79% in the non-sarcopenic group as compared to 56% in the sarcopenic group (Log-rank P = 0.01). In the multivariable model, each standard deviation of decreasing AMMI and increasing chair rise time was associated with a hazard ratio for all-cause mortality of 1.84 (95% CI 1.18, 2.86) and 1.79 (95% CI 1.26, 2.54), respectively.
Lower-extremity muscle strength and DXA-based muscle mass are objective indicators of sarcopenia that are independently predictive of all-cause mortality in older cardiac surgery patients.
通过双能 X 线吸收法（DXA）和体能测试来确定接受冠状动脉旁路手术或心脏瓣膜手术的患者中肌少症的患病率和预后价值。
前瞻性纳入接受心脏手术的成年人，并完成问卷调查、体能测试和 DXA 扫描（GE Lunar），以测量四肢肌肉质量与身高的比值（AMMI）。根据欧洲工作组 2 指南，如果患者的 AMMI 较低（男性<7kg/m，女性<5.5kg/m）且肌肉力量较低（5 次椅子起身时间≥15 秒），则将其归类为肌少症。使用 Cox 比例风险回归来测试肌少症与全因死亡率之间的关联，中位随访时间为 4.3 年。
该队列包括 141 名平均年龄为 69.7±10.0 岁且 21%为女性的患者。低 AMMI、慢椅子起身时间和肌少症（低 AMMI 和慢椅子起身时间）的患病率分别为 24%、57%和 13%。非肌少症组的 4 年生存率为 79%，而肌少症组为 56%（对数秩 P=0.01）。在多变量模型中，AMMI 每降低一个标准差和椅子起身时间每增加一个标准差，全因死亡率的风险比分别为 1.84（95%CI 1.18，2.86）和 1.79（95%CI 1.26，2.54）。
下肢肌肉力量和基于 DXA 的肌肉质量是肌少症的客观指标，可独立预测老年心脏手术患者的全因死亡率。
