Dinges Christian, Hammerer Matthias, Schörghofer Nikolaos, Knapitsch Christoph, Hecke Gretha, Klaus Sophie, Steindl Johannes, Rezar Richard, Seitelberger Rainald, Hoppe Uta C, Hergan Klaus, Boxhammer Elke, Scharinger Bernhard
Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria.
Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria.
Diagnostics (Basel). 2024 Oct 10;14(20):2259. doi: 10.3390/diagnostics14202259.
Sarcopenia, characterized by the loss of skeletal muscle mass, is an emerging comorbidity associated with poor outcomes in cardiovascular surgery. Its impact on mortality in patients undergoing valve surgery for infective endocarditis (IE) remains underexplored. This study investigates the relationship between sarcopenia, measured by the Psoas muscle area index (PMAi), and mortality in patients with IE undergoing valve surgery. We retrospectively analyzed 68 patients with IE who underwent valve surgery at a tertiary care center from 2013 to 2021. Sarcopenia was defined as being in the lowest quartile of PMAi, measured via preoperative computed tomography (CT). Baseline characteristics, survival outcomes, and factors influencing mortality were analyzed using Kaplan-Meier survival curves and Cox proportional hazards regression. The predictive value of PMAi for 1-year and 3-year mortality was assessed via receiver operating characteristic (ROC) curves. Sarcopenia was strongly associated with increased mortality at both 1-year (HR: 0.378, = 0.010) and 3-year follow-ups (HR: 0.457, = 0.012). Female sex (OR: 275.748, < 0.001) and older age (OR: 9.995, = 0.003) were significant predictors of sarcopenia. Chronic kidney insufficiency (CKI) and the use of heart failure medication therapy also significantly impacted survival outcomes. Sarcopenia is a strong independent predictor of short- and mid-term mortality in patients undergoing valve surgery for IE. Routine radiological assessment of sarcopenia using PMAi could improve risk stratification and guide preoperative interventions. Tailored management strategies, especially in older women and patients with CKI, may enhance outcomes in this high-risk population.
肌肉减少症以骨骼肌质量丢失为特征，是一种与心血管手术不良预后相关的新出现的合并症。其对感染性心内膜炎（IE）瓣膜手术患者死亡率的影响仍未得到充分研究。本研究调查了通过腰大肌面积指数（PMAi）测量的肌肉减少症与接受瓣膜手术的IE患者死亡率之间的关系。我们回顾性分析了2013年至2021年在一家三级医疗中心接受瓣膜手术的68例IE患者。肌肉减少症定义为术前通过计算机断层扫描（CT）测量的PMAi处于最低四分位数。使用Kaplan-Meier生存曲线和Cox比例风险回归分析基线特征、生存结局和影响死亡率的因素。通过受试者工作特征（ROC）曲线评估PMAi对1年和3年死亡率的预测价值。肌肉减少症与1年随访（HR：0.378， = 0.010）和3年随访（HR：0.457， = 0.012）时死亡率增加密切相关。女性（OR：275.748， < 0.001）和老年（OR：9.995， = 0.003）是肌肉减少症的重要预测因素。慢性肾功能不全（CKI）和心力衰竭药物治疗的使用也显著影响生存结局。肌肉减少症是接受IE瓣膜手术患者短期和中期死亡率的强有力独立预测因素。使用PMAi对肌肉减少症进行常规影像学评估可改善风险分层并指导术前干预。量身定制的管理策略，尤其是在老年女性和CKI患者中，可能会改善这一高危人群的结局。
