From the University of Glasgow, Glasgow (NAB, JM, CSDR, DCM, GJKG) and NHS Tayside, Dundee, UK (CB).
Eur J Anaesthesiol. 2024 Jul 1;41(7):490-499. doi: 10.1097/EJA.0000000000002004. Epub 2024 May 16.
Cardio-pulmonary exercise testing (CPEX) is selectively used before intervention for abdominal aortic aneurysm (AAA). Sarcopenia, a chronic condition defined by reduced skeletal muscle function and volume, can be assessed radiologically by computed tomography (CT)-derived body composition analysis (CT-BC), and is associated with systemic inflammation.
The aim was to describe the association between CT-BC, CPEX, inflammation and survival in patients undergoing elective intervention for AAA.
Patients were recruited retrospectively from a single, secondary-care centre-operative database. Cases undergoing elective endovascular aneurysm repair (EVAR) and open surgical repair (OSR) between 31 March 2015 and 25 June 2020 were included.
There were 176 patients (130 EVAR, 46 OSR) available for analysis in the final study; median (interquartile range [IQR]) follow-up was 60.5 [27] months, and all completed a minimum of 2 years follow-up.
Preoperative CPEX tests were recorded. CT sarcopenia score [CT-SS, range 0 to 2, calculated based on normal/low SMI (0/1) and normal/low SMD (0/1)] assessed radiological sarcopenia. Preoperative modified Glasgow Prognostic score (mGPS) was used to assess systemic inflammation.
Mean [95% confidence interval (CI) survival in the CT-SS 0 vs. CT-SS 1 vs. CT-SS 2 subgroups was 80.1 (73.6 to 86.6) months vs. 70.3 (63.5 to 77.1) months vs. 63.8 (53.4 to 74.2) months] ( P = 0.01). CT-SS was not associated with CPEX results ( P > 0.05). Elevated CT-SS [hazard ratio (HR) 1.83, 95% CI, 1.16 to 2.89, P < 0.01] was independently associated with increased hazard of long-term mortality; however, CPEX results were not ( P > 0.05).
CPEX test results were not consistently associated with body composition and did not have significant prognostic value in patients undergoing elective treatment for AAA.
心肺运动测试（CPEX）选择性地用于腹主动脉瘤（AAA）的干预前。肌少症是一种以骨骼肌功能和体积减少为特征的慢性疾病，可以通过计算机断层扫描（CT）衍生的身体成分分析（CT-BC）进行放射学评估，并且与全身炎症有关。
描述 CT-BC、CPEX、炎症与接受择期 AAA 干预治疗的患者生存之间的关系。
从单一的二级保健中心手术数据库中回顾性招募患者。纳入 2015 年 3 月 31 日至 2020 年 6 月 25 日期间接受择期血管内修复术（EVAR）和开放手术修复术（OSR）的患者。
最终研究中共有 176 例患者（EVAR 130 例，OSR 46 例）可供分析；中位（四分位间距[IQR]）随访时间为 60.5[27]个月，所有患者均完成至少 2 年的随访。
记录术前 CPEX 检查。CT 肌肉减少评分[CT-SS，范围 0 至 2，根据正常/低骨骼肌指数（0/1）和正常/低骨骼肌密度（0/1）计算]评估放射学肌少症。术前改良格拉斯哥预后评分（mGPS）用于评估全身炎症。
CT-SS 0 与 CT-SS 1 与 CT-SS 2 亚组的平均[95%置信区间（CI）生存率分别为 80.1（73.6 至 86.6）个月、70.3（63.5 至 77.1）个月和 63.8（53.4 至 74.2）个月]（P = 0.01）。CT-SS 与 CPEX 结果无关（P > 0.05）。升高的 CT-SS[风险比（HR）1.83，95%CI，1.16 至 2.89，P < 0.01]与长期死亡率增加的风险独立相关；然而，CPEX 结果则不然（P > 0.05）。
CPEX 测试结果与身体成分不一致，并且在接受择期 AAA 治疗的患者中没有显著的预后价值。
