Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
J Cardiovasc Surg (Torino). 2024 Jun;65(3):256-264. doi: 10.23736/S0021-9509.23.12821-7. Epub 2023 Nov 21.
Sarcopenia is identified as a predictive factor for adverse outcomes after complex endovascular aortic repair (complex EVAR). Consensus on preferred parameters for sarcopenia is not yet reached. The current study compares three CT-assessed parameters on their association with adverse outcomes after complex EVAR.
This was a single-center retrospective cohort study. Psoas Muscle Index (PMI), Skeletal Muscle Index (SMI), and lean psoas muscle area (LPMA) were examined by CT-segmentation. PMI, SMI, and LPMA were analyzed as continuous variables. In addition, cut-off values from previous research were used to diagnose patients as sarcopenic or non-sarcopenic. Outcomes were: all-cause mortality, major adverse events (MAE), length of hospital stay, and non-home discharge. A sub-analysis was made for severe sarcopenia; sarcopenia combined with low physical performance (gait speed, Time Up and Go test, Metabolic Equivalent of Task-score).
We included 101 patients. A higher PMI (HR=0.590, CI: 0.374-0.930, P=0.023), SMI (HR=0.453, CI: 0.267-0.768, P=0.003), and LPMA (HR=0.559, CI: 0.333-0.944, P=0.029) were associated with a lower risk of mortality. Sarcopenia based on cut-off values for PMI and LPMA was not significantly associated with survival. Sarcopenia based on SMI did present a higher mortality risk (P=0.017). A sub-analysis showed that severely sarcopenic patients were at even higher risk of mortality (P=0.036). None of the parameters were significantly associated with the other outcomes.
SMI had a slightly stronger association with mortality compared to PMI and LPMA. High-risk patients were selected by adding physical performance scores. Future research could focus on complex EVAR-specific PMI and LPMA cut-off values.
肌少症被确定为复杂血管内修复术（复杂 EVAR）后不良结局的预测因素。目前尚未就肌少症的首选参数达成共识。本研究比较了三种 CT 评估参数与复杂 EVAR 后不良结局的相关性。
这是一项单中心回顾性队列研究。通过 CT 分段检查竖脊肌指数（PMI）、骨骼肌指数（SMI）和瘦竖脊肌面积（LPMA）。PMI、SMI 和 LPMA 作为连续变量进行分析。此外，还使用以前研究的截止值来诊断患者是否为肌少症或非肌少症。结局包括全因死亡率、主要不良事件（MAE）、住院时间和非家庭出院。对严重肌少症进行了亚分析；肌少症合并低身体机能（步态速度、起立-行走测试、代谢当量评分）。
共纳入 101 例患者。较高的 PMI（HR=0.590，CI：0.374-0.930，P=0.023）、SMI（HR=0.453，CI：0.267-0.768，P=0.003）和 LPMA（HR=0.559，CI：0.333-0.944，P=0.029）与较低的死亡率风险相关。基于 PMI 和 LPMA 截止值的肌少症与生存无显著相关性。基于 SMI 的肌少症则表现出更高的死亡率风险（P=0.017）。亚分析显示，严重肌少症患者的死亡率风险更高（P=0.036）。这些参数均与其他结局无显著相关性。
SMI 与死亡率的相关性略高于 PMI 和 LPMA。通过添加身体机能评分，可以选择高危患者。未来的研究可以集中于复杂 EVAR 特异性的 PMI 和 LPMA 截止值。
