Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center-NewYork-Presbyterian Hospital, New York, NY.
Department of Medicine, Columbia University Irving Medical Center- NewYork-Presbyterian Hospital, New York, NY.
J Card Fail. 2024 Nov;30(11):1462-1468. doi: 10.1016/j.cardfail.2024.03.012. Epub 2024 Apr 13.
Sarcopenia is underappreciated in advanced heart failure and is not routinely assessed. In patients receiving a left ventricular assist device, preoperative sarcopenia, defined by using computed-tomography (CT)-derived pectoralis muscle-area index (muscle area indexed to body-surface area), is an independent predictor of postoperative mortality. The association between preoperative sarcopenia and outcomes after heart transplant (HT) is unknown.
The primary aim of this study was to determine whether preoperative sarcopenia, diagnosed using the pectoralis muscle-area index, is an independent predictor of days alive and out of the hospital (DAOHs) post-transplant.
Patients who underwent HT between January, 2018, and June, 2022, with available preoperative chest CT scans were included. Sarcopenia was diagnosed as pectoralis muscle-area index in the lowest sex-specific tertile. The primary endpoint was DAOHs at 1 year post-transplant.
The study included 169 patients. Patients with sarcopenia (n = 55) had fewer DAOHs compared to those without sarcopenia, with a median difference of 17 days (320 vs 337 days; P = 0.004). Patients with sarcopenia had longer index hospitalizations and were also more likely to be discharged to a facility other than home. In a Poisson regression model, sarcopenia was a significant univariable and the strongest multivariable predictor of DAOHs at 1 year (parameter estimate = -0.17, 95% CI -0.19 to -14; P = < 0.0001).
Preoperative sarcopenia, diagnosed using the pectoralis muscle-area index, is an independent predictor of poor outcomes after HT. This parameter is easily measurable from commonly obtained preoperative CT scans and may be considered in transplant evaluations.
在晚期心力衰竭中，肌肉减少症未得到充分重视，也未常规评估。在接受左心室辅助装置治疗的患者中，术前肌肉减少症（通过使用计算机断层扫描 [CT] 得出的胸肌面积指数 [肌肉面积与体表面积的比值] 定义）是术后死亡率的独立预测因子。术前肌肉减少症与心脏移植（HT）后结局之间的关系尚不清楚。
本研究的主要目的是确定术前肌肉减少症（通过胸肌面积指数诊断）是否是移植后存活和出院天数（DAOHs）的独立预测因子。
纳入 2018 年 1 月至 2022 年 6 月期间接受 HT 治疗且术前胸部 CT 扫描可用的患者。将胸肌面积指数最低的性别特定三分位组诊断为肌肉减少症。主要终点是移植后 1 年的 DAOHs。
本研究纳入了 169 例患者。与无肌肉减少症的患者相比，肌肉减少症患者（n=55）的 DAOHs 更少，中位数差异为 17 天（320 天 vs. 337 天；P=0.004）。肌肉减少症患者的住院时间更长，也更有可能出院到非家庭护理机构。在泊松回归模型中，肌肉减少症是 1 年 DAOHs 的显著单变量和最强多变量预测因子（参数估计值=-0.17，95%CI -0.19 至-14；P<0.0001）。
使用胸肌面积指数诊断的术前肌肉减少症是 HT 后不良结局的独立预测因子。该参数可从常用的术前 CT 扫描中轻松测量，可在移植评估中考虑。
