Low muscle mass assessed by psoas muscle area is associated with clinical adverse events in elderly patients with heart failure

Abstract

Background Acute decompensated heart failure (ADHF) is a growing healthcare burden with increasing prevalence and comorbidities due to progressive aging society. Accumulating evidence suggest that low skeletal muscle mass has a negative impact on clinical outcome in elderly adult population. We sought to determine the significance of psoas muscle area as a novel index of low skeletal muscle mass in elderly patients with ADHF. Methods In this single-center retrospective observational study, we reviewed consecutive 865 elderly participants (65 years or older) who were hospitalized for ADHF and 392 were available for analysis (79 years [74–85], 56% male). Cross-sectional areas of psoas muscle at the level of fourth lumbar vertebra were measured by computed tomography and normalized by the square of height to calculate psoas muscle index (PMI, cm2/m2). Results Dividing the patients by the gender-specific quartile value (2.47 cm2/m2 for male and 1.68 cm2/m2 for female), we defined low PMI as the lowest gender-based quartile of PMI. Multiple linear regression analysis revealed female sex, body mass index (BMI), and E/e’, but not left ventricular ejection fraction, were independently associated with PMI. Kaplan-Meier analysis showed low PMI was associated with higher rate of composite endpoint of all-cause death and ADHF re-hospitalization (P = 0.033). Cox proportional hazard model analysis identified low PMI, but not BMI, was an independent predictor of the composite endpoint (Hazard ratio: 1.52 [1.06–2.16], P = 0.024). Conclusions PMI predicted future clinical adverse events in elderly patients with ADHF. Further studies are needed to assess whether low skeletal muscle mass can be a potential therapeutic target to improve the outcome of ADHF.

MICU3 regulates mitochondrial Ca2+-dependent antioxidant response in skeletal muscle aging

“…Loss of skeletal muscle mass and function is an important manifestation of aging. Age-related skeletal muscle disorder involving the accelerated loss of muscle mass and function is associated with falls, frailty, and mortality [ 2 , 3 ]. Studies have shown that insulin resistance, inflammation, denervation, and autophagy can cause skeletal muscle disorder [ 4 – 6 ].…”

The importance of body composition in patients with prostate cancer receiving radiotherapy

“…As the primary hip flexor and a stabilizer of the lumbar spine and sacroiliac joint, the psoas muscle is essential for walking, raising from a seated position, and maintaining balance. The specific association of sarcopenia with PMA has been described in previous studies 10,12 and may be a practical method to screen patients at risk before initiating treatment. For example, autosegmentation software can rapidly analyze a large number of scans and may even obviate the need for manual measurement, allowing for an automated work flow that requires only occasional review for quality assessment purposes 13 .…”

“…Estimates of lean muscle mass were based on a cross-sectional area of all skeletal muscle (skeletal muscle area) as well as the paired psoas muscles (psoas muscle area [PMA]), both of which have been used as surrogates for total lean muscle mass in a number of studies. 7,9,10 In a multivariate analysis of OS, they found that age, comorbidities, PMA, and baseline prostatespecific antigen were associated with overall mortality. These variables were fed as inputs for a recursive partitioning analysis using the RTOG 0126 cohort as the training set, which generated four prognostic groups primarily based on comorbidities in patients younger than age 70 years, and significantly, psoas area in patients aged 70 years and older.…”

“…They then examined whether these measurements of body composition, in addition to typical clincopathologic variables, were associated with treatment outcomes including overall survival (OS), prostate cancer–specific mortality, and freedom from biochemical failure. Estimates of lean muscle mass were based on a cross‐sectional area of all skeletal muscle (skeletal muscle area) as well as the paired psoas muscles (psoas muscle area [PMA]), both of which have been used as surrogates for total lean muscle mass in a number of studies 7,9,10 . In a multivariate analysis of OS, they found that age, comorbidities, PMA, and baseline prostate‐specific antigen were associated with overall mortality.…”

Modeling Low Muscle Mass Screening in Hemodialysis Patients

“…Table 1 shows the baseline characteristics of the overall study subjects, and the characteristics of the patients in the development and validation groups. Among the included patients, 366 (63%) were male, the average age was 69 years (12), and the dialysis history was 13 years (11). Of the 619 patients, 226 (37%) were diagnosed with low muscle mass.…”