Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.
Department of Cardiac Surgery, University Hospital Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
J Cardiothorac Surg. 2024 Feb 9;19(1):76. doi: 10.1186/s13019-024-02547-8.
Left ventricular assist devices (LVAD) are an established treatment for end-stage left ventricular heart failure. Parameters are needed to identify the most appropriate patients for LVADs. This study aimed to evaluate pectoral muscle mass and density as prognostic parameters.
This single-center study included all patients with LVAD implantation between January 2010 and October 2017 and a preoperative chest CT scan. Pectoral muscle mass was assessed using the Pectoralis Muscle Index (PMI, surface area indexed to height, cm/m) and pectoral muscle density by Hounsfield Units (HU). Overall mortality was analyzed with Kaplan-Meier survival analysis and 1-year and 3-year mortality with receiver operating characteristic (ROC) curves and Cox regression models.
57 patients (89.5% male, mean age 57.8 years) were included. 64.9% of patients had end-stage left ventricular failure due to ischemic heart disease and 35.1% due to dilated cardiomyopathy. 49.2% of patients had preoperative INTERMACS profile of 1 or 2 and 33.3% received mechanical circulatory support prior to LVAD implantation. Total mean PMI was 4.7 cm/m (± 1.6), overall HU of the major pectoral muscle was 39.0 (± 14.9) and of the minor pectoral muscle 37.1 (± 16.6). Mean follow-up was 2.8 years (± 0.2). Mortality rates were 37.5% at 1 year and 48.0% at 3 years. Neither PMI nor HU were significantly associated with overall mortality at 1-year or 3-year.
The results of our study do not confirm the association between higher pectoral muscle mass and better survival after LVAD implantation previously described in the literature.
左心室辅助装置（LVAD）是治疗终末期左心室心力衰竭的一种成熟治疗方法。需要参数来识别最适合接受 LVAD 治疗的患者。本研究旨在评估胸大肌质量和密度作为预测参数。
本单中心研究纳入了 2010 年 1 月至 2017 年 10 月间所有接受 LVAD 植入术的患者，并进行了术前胸部 CT 扫描。使用胸大肌指数（PMI，表面积与身高之比，cm/m）评估胸大肌质量，使用亨氏单位（HU）评估胸大肌密度。采用 Kaplan-Meier 生存分析评估总死亡率，并采用受试者工作特征（ROC）曲线和 Cox 回归模型评估 1 年和 3 年死亡率。
共纳入 57 例患者（89.5%为男性，平均年龄 57.8 岁）。64.9%的患者因缺血性心脏病导致终末期左心室衰竭，35.1%因扩张型心肌病导致终末期左心室衰竭。49.2%的患者术前 INTERMACS 分级为 1 级或 2 级，33.3%的患者在植入 LVAD 前接受了机械循环支持。总平均 PMI 为 4.7 cm/m（±1.6），主要胸大肌的总体 HU 为 39.0（±14.9），次要胸大肌的 HU 为 37.1（±16.6）。平均随访时间为 2.8 年（±0.2）。1 年和 3 年的死亡率分别为 37.5%和 48.0%。PMI 和 HU 均与 1 年和 3 年的总死亡率无显著相关性。
本研究结果与文献中先前描述的 LVAD 植入后胸大肌质量较高与生存率提高之间的相关性不相符。
