Shimizu Kazuya, Matsuzawa Ryota, Nakamura Shinya, Murakawa Keita, Kawakami Hideo, Tabuchi Masaki, Ohnaka Motoaki, Matsumori Masamichi, Tamaki Akira
Department of Rehabilitation, Sumitomo Hospital, Osaka, Japan.
Course of Rehabilitation Science, Graduate School of Rehabilitation Science, Hyogo Medical University, Kobe, Japan.
J Cachexia Sarcopenia Muscle. 2024 Oct;15(5):1677-1686. doi: 10.1002/jcsm.13521. Epub 2024 Jun 19.
In the context of cardiovascular surgery, the foremost concern lies in delayed functional recovery, as typified by the acquisition of independent walking after surgery, among older patients with decline in skeletal muscle mass and quality. Computed tomography (CT), which is typically employed for the preoperative assessment of pathological conditions in patients undergoing cardiovascular surgery, is also suitable for screening for potential decline in skeletal muscle mass and quality. The aim of this study was to examine the predictive capabilities of CT-derived parameters such as muscle mass and muscle quality for the delayed acquisition of independent walking in the postoperative period.
This retrospective study enrolled consecutive Japanese patients who underwent elective cardiovascular surgery between May 2020 and January 2023. In total, 139 patients were included in the analyses. Based on the preoperative CT image, the psoas muscle volume index (PMVI) and psoas muscle attenuation (PMA) were calculated. Information on patient characteristics, including preoperative physical fitness such as handgrip strength/body mass index (GS/BMI), short physical performance battery (SPPB), and 6-min walking distance (6MWD), were obtained from the medical records. We defined delayed acquisition of independent walking after surgery as the inability to walk 100 m within 4 days after surgery.
The median age of the patients was 72 (interquartile: 64-78) years, and 74.8% (104/139) were men; 47.5% corresponded to the delayed group. The areas under the curves of SPPB, GS/BMI, 6MWD, PMVI, and PMA against delayed acquisition of independent walking after surgery were 0.68 [95% confidence interval (CI): 0.59 to 0.77], 0.72 (95% CI: 0.63 to 0.80), 0.73 (95% CI: 0.65 to 0.82), 0.69 (95% CI: 0.60 to 0.78), and 0.78 (95% CI: 0.70 to 0.85), respectively. In the multivariate logistic regression analysis, low PMA was significantly associated with delayed acquisition of independent walking even after adjustment for patient characteristics including physical fitness [model 1: SPPB (OR, 1.14; 95% CI: 1.03-1.25), model 2: GS/BMI (OR, 1.13; 95% CI: 1.03-1.25), and model 3: 6MWD (OR, 1.14; 95% CI: 1.03-1.25)], but PMVI was not.
Our study revealed a strong association between PMA, a marker of CT-derived muscle quality, and the postoperative delay in achieving independent walking in patients who underwent cardiovascular surgery. The technique to obtain information on muscle quality during the time period before surgery may be an option for timely therapeutic intervention in patients who may have delayed acquisition of independent walking after surgery.
在心血管外科手术的背景下，最主要的担忧在于功能恢复延迟，这在骨骼肌质量和质量下降的老年患者中表现为术后无法独立行走。计算机断层扫描（CT）通常用于心血管外科手术患者术前病理状况的评估，也适用于筛查骨骼肌质量和质量的潜在下降。本研究的目的是检查CT衍生参数（如肌肉质量和肌肉质量）对术后独立行走延迟获得的预测能力。
这项回顾性研究纳入了2020年5月至2023年1月期间连续接受择期心血管手术的日本患者。总共139名患者纳入分析。根据术前CT图像，计算腰大肌体积指数（PMVI）和腰大肌衰减（PMA）。从病历中获取患者特征信息，包括术前体能，如握力/体重指数（GS/BMI）、短身体性能电池测试（SPPB）和6分钟步行距离（6MWD）。我们将术后独立行走延迟获得定义为术后4天内无法行走100米。
患者的中位年龄为72岁（四分位间距：64-78岁），74.8%（104/139）为男性；47.5%属于延迟组。SPPB、GS/BMI、6MWD、PMVI和PMA针对术后独立行走延迟获得的曲线下面积分别为0.68 [95%置信区间（CI）：0.59至0.77]、0.72（95%CI：0.63至0.80）、0.73（95%CI：0.65至0.82）、0.69（95%CI：0.60至0.78）和0.78（95%CI：0.70至0.85）。在多因素逻辑回归分析中，即使在调整包括体能在内的患者特征后，低PMA仍与独立行走延迟获得显著相关[模型1：SPPB（比值比，1.14；95%CI：1.03-1.25），模型2：GS/BMI（比值比，1.13；95%CI：1.03-1.25），模型3：6MWD（比值比，1.14；95%CI：1.03-1.25）]，但PMVI并非如此。
我们的研究揭示了CT衍生的肌肉质量标志物PMA与心血管手术患者术后独立行走延迟之间的密切关联。在手术前阶段获取肌肉质量信息的技术可能是对术后可能出现独立行走延迟的患者进行及时治疗干预的一种选择。
