Decreased Psoas Muscle Computed Tomography Value Predicts Poor Outcome in Peripheral Artery Disease

Sugai, Takayuki; Watanabe, Tetsu; Otaki, Yoichiro; Goto, Jun; Watanabe, Ken; Toshima, Taku; Takahashi, Toshio; Yokoyama, Masahiro; Tamura, H.; Nishiyama, Satoshi; Arimoto, Takanori; Takahashi, Hiroki; Shishido, Tetsuro; Watanabe, Masafumi

doi:10.1253/circj.cj-18-0726

Cited by 34 publications

(27 citation statements)

References 34 publications

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“…Based on the strong association between MRA and CVD observed in non-CKD individuals (Brumbaugh et al, 2012;Therkelsen et al, 2013;Lim and Meigs, 2014;Miljkovic et al, 2015;Zhao et al, 2016;Sugai et al, 2018), we tested whether baseline MRA reliably identifies patients with kidney failure at risk for subsequent CVD.…”

Section: Fat Accumulation In Skeletal Muscle Is Independently Associamentioning

confidence: 99%

“…The development of highly sensitive imaging-based methods to quantify fat distribution, and their application to large cohorts of non-CKD individuals uncovered a strong association between ectopic fat accumulation and insulin resistance, atherogenic dyslipidemia, hypertension, and CVD (Neeland et al, 2018(Neeland et al, , 2019. In particular, decreased muscle radiation attenuation (MRA) on computed tomography reflects excessive fat deposition in the tissue and is associated with poor cardiovascular outcome (Brumbaugh et al, 2012;Therkelsen et al, 2013;Lim and Meigs, 2014;Miljkovic et al, 2015;Zhao et al, 2016;Sugai et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

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Non-invasive Quantification of Fat Deposits in Skeletal Muscle Predicts Cardiovascular Outcome in Kidney Failure

et al. 2020

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Fat accumulation in skeletal muscle was recently established as a major risk factor for cardiovascular disease (CVD) in the general population, but its relevance for patients with kidney failure is unknown. Here we examined the potential association between muscle radiation attenuation (MRA), a non-invasive indicator of fat deposits in muscle, and cardiovascular events in patients with kidney failure treated with peritoneal dialysis (PD) and investigated dynamic changes and determinants of MRA in this population. We retrospectively assessed MRA on computed tomography images collected yearly in 101 incident patients with kidney failure starting PD between January 2006 and December 2015. After a median of 21 months on dialysis, 34 patients had 58 non-fatal cardiovascular events, and 22 patients had died. Baseline MRA was associated with cardiovascular events during time on dialysis, and patients with higher MRA (reflecting lower amounts of fat in muscle) showed a reduced incidence of CVD, independently of traditional risk factors (adjusted HR, 0.91; 95% CI, 0.86-0.97, P = 0.006). Multivariate regression analysis identified old age, female gender, visceral fat area, and low residual urine volume as independent determinants of MRA. As compared with reference values from a healthy population, patients with kidney failure had lower MRA (i.e., increased fat accumulation), independently of age, gender, and body-mass index. The subset of patients who underwent kidney transplantation showed a significant increase in MRA after restoration of kidney function. These observations expand the association between ectopic fat accumulation and CVD to the population on dialysis, and suggest that kidney failure is reversibly associated with fatty muscle infiltration.

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Section: Fat Accumulation In Skeletal Muscle Is Independently Associamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Non-invasive Quantification of Fat Deposits in Skeletal Muscle Predicts Cardiovascular Outcome in Kidney Failure

et al. 2020

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“…In a 48-month longitudinal study, a reduction in calf muscle density, lower limb extension/flexion power, and hand grip strength was shown to be associated with an increase in mortality in 434 PAD patients. 17 Interestingly, this conclusion was also reached when only one parameter of sarcopenia was measured (muscle quantity 18 or muscle strength 19 ). Indeed, in a retrospective study of 327 patients with PAD followed for up to 30 months, Sugai et al found an independent link between low psoas muscle area and major adverse cardiovascular and limb events.…”

Section: Resultsmentioning

confidence: 84%

“…Data extraction led to the evaluation of 140 publications, of which 87 met the inclusion criteria, and 79 were included in the final review. Of these, 18 gave sufficient data for epidemiological analysis and diagnostic criteria, [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] 33 gave sufficient data for mechanistical analysis, and 28 gave sufficient data for therapeutic approaches. 1/Epidemiological data: Is sarcopenia a rare condition in patients with PAD?…”

Section: Resultsmentioning

confidence: 99%

Sarcopenia and peripheral arterial disease: a systematic review

Pizzimenti

Meyer

Charles

et al. 2020

J cachexia sarcopenia muscle

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Background Patients with lower extremity peripheral arterial disease (PAD) and sarcopenia are a population at risk requiring specific and targeted care. The aim of this review is to gather all relevant studies associating sarcopenia and PAD and to identify the underlying pathophysiological mechanisms as well as potential therapeutic strategies to improve skeletal muscle function. Methods A systematic review was carried out following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results Data extraction allowed the evaluation of 140 publications; 87 met the inclusion criteria; of which 79 were included in the final review, reporting sufficient data for epidemiological and diagnostic criteria, mechanical analysis, and therapeutic approaches. Epidemiological analysis and diagnostic criteria were based on 18 studies following 2362 PAD patients [31.39% (SD 7.61) women], aged 72.42 (SD 2.84); sarcopenia was present in 34.63% (SD 12.86) of the patients. Mechanical and pathway analysis were based on five animal studies and 29 clinical reports, showing significantly altered muscle strength and function in 1352 PAD patients [26.49% (SD 17.32) women], aged 67.67 (SD 5.14) years; impaired muscle histology in 192 PAD patients (9.2% (SD 11.22) women), aged 64.3 (SD 0.99) years; +58.63% (SD 25.48) of oxidative stress in 69 PAD patients [16.96% (SD 8.10) women], aged 63.17 (SD 1.43) years; mitochondriopathy in 153 PAD patients [29.39% (SD 28.27) women], aged 63.50 (SD 1.83) years; +15.58% (SD 7.41) of inflammation in 900 PAD patients [40.77% (SD 3.71) women], aged 74.88 (SD 2.76) years; and altered signalling pathways in 51 PAD patients [34.45% (SD 32.23) women], aged 72.25 (SD 5.25) years. Therapeutic approaches analysis was based on seven animal studies and 21 clinical reports. In total, 884 patients followed an exercise therapy, and 18 received an angiogenesis treatment; 30.84% (SD 17.74) were women. Mean ages of patients studied were 66.85 (SD 3.96). Conclusions Sarcopenia and lower extremity PAD have musculoskeletal consequences that directly impair patients' quality of life and prognosis. Although PAD is primarily a vascular disease, all etiological factors of sarcopenia identified so far are present in PAD. Indeed, both sarcopenia and PAD are accompanied by oxidative stress, skeletal muscle mitochondrial impairments, inflammation, inhibition of specific pathways regulating muscle synthesis or protection (i.e. IGF-1, RISK, and SAFE), and activation of molecules associated with muscle degradation. To date, besides revascularization, the best therapeutic strategy includes exercise, but approaches targeting the underlying mechanisms still deserve further studies.

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“…Our data suggest that OS was largely defined by patient background (including underlying diseases, comorbidities, and dialysis), but not by lesion location alone. Although we did not investigate lower limb muscle strength and activities of daily living, patients with multiple and widespread PAD lesions from the AI area to the BTK area are considered to have considerably impaired muscle strength and activities of daily living, which may adversely affect the patient's prognosis 16 , 17 ) .…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcome and Diverse Risk Factors for Different Therapeutic Target Locations of Peripheral Artery Disease

Higashitani

Uemura

et al. 2020

JAT

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Aim: Previous studies on peripheral artery disease (PAD) only enrolled patients with atherosclerotic lesion limited to any one of isolated locations (aortoiliac [AI], femoropopliteal [FP], and below the knee [BTK]). However, the interventions for PAD in a real-world clinical setting are often simultaneously performed for several different locations. Methods: We conducted a prospective multicenter study that included 2,230 patients with PAD who received intervention for lower extremity lesions in each area and across different areas. Patients were divided into 7 groups according to the combination of treatment locations. Overall survival (OS), major adverse limb events (MALEs), and risk factors for OS and MALEs were statistically analyzed. Results: After adjustment for confounding factors, the attributable risk for OS was similar among isolated AI, FP, and BTK treatments. MALEs increased in correlation with the number of treatment locations. Dialysis and critical limb ischemia were the common risk factors for OS and MALEs. However, the contribution of other factors such as type of drug usage was different according to treatment locations. Conclusions: In patients with PAD, OS was largely defined by comorbidities but not by lesion location. The background risk factors, underlying comorbidities, and event rates were different according to PAD location, suggesting that stratified treatment should be established for different patient populations.

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Decreased Psoas Muscle Computed Tomography Value Predicts Poor Outcome in Peripheral Artery Disease

Cited by 34 publications

References 34 publications

Non-invasive Quantification of Fat Deposits in Skeletal Muscle Predicts Cardiovascular Outcome in Kidney Failure

Non-invasive Quantification of Fat Deposits in Skeletal Muscle Predicts Cardiovascular Outcome in Kidney Failure

Sarcopenia and peripheral arterial disease: a systematic review

Clinical Outcome and Diverse Risk Factors for Different Therapeutic Target Locations of Peripheral Artery Disease

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