Psoas muscle area: a new standard for frailty assessment in cardiac surgery?

Balsam, Leora B.

doi:10.21037/jtd.2018.10.96

Cited by 13 publications

(20 citation statements)

References 17 publications

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“…Frailty is characterized by physiological age-related decreases in energy, cognitive function, physical health, and other deficits that collectively make the patient more vulnerable to stressors, resulting in adverse outcomes [ 4 , 6 , 17 ]. Consensus on how best to define and measure frailty remains elusive [ 1 , 2 , 5 ]. Frailty has been measured using different methods in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…The term “sarcopenia” is used to indicate progressive low muscle mass, low muscle strength, and low function that affect older adults [ 11 , 16 , 28 ]. Sarcopenia is one element of frailty syndrome that is unaffected by acute changes in clinical status or patient effort [ 2 ]. Reduced grip strength of sarcopenia is common criteria in physical frailty [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…The term “sarcopenia” is used to indicate progressive reduced muscle mass, reduced muscle strength, and reduced function that affects older adults [ 10 , 28 ]. Recent studies have reported that central sarcopenia, as measured by psoas cross-sectional area, has been associated with adverse events after cardiovascular surgery [ 2 , 18 , 24 , 30 , 39 ]. However, the impact of central sarcopenia in spine surgery for elderly patients has not yet been well characterized.…”

Section: Introductionmentioning

confidence: 99%

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Central Sarcopenia, Frailty and Comorbidity as Predictor of Surgical Outcome in Elderly Patients with Degenerative Spine Disease

Kim

Park

Lee

et al. 2021

J Korean Neurosurg Soc

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Objective : People are living longer and the elderly population continues to increase. The incidence of degenerative spinal diseases (DSDs) in the elderly population is quite high. Therefore, we are facing more cases of DSD and offering more surgical solutions in geriatric patients. Understanding the significance and association of frailty and central sarcopenia as risk factors for spinal surgery in elderly patients will be helpful in improving surgical outcomes. We conducted a retrospective cohort analysis of prospectively collected data to assess the impact of preoperative central sarcopenia, frailty, and comorbidity on surgical outcome in elderly patients with DSD. Methods : We conducted a retrospective analysis of patients who underwent elective spinal surgery performed from January 1, 2019 to September 30, 2020 at our hospital. We included patients aged 65 and over who underwent surgery on the thoracic or lumbar spine and were diagnosed as DSD. Central sarcopenia was measured by the 50th percentile of psoas : L4 vertebral index (PLVI) using the cross-sectional area of the psoas muscle. We used the Korean version of the fatigue, resistance, ambulation, illnesses, and loss of weight (K-FRAIL) scale to measure frailty. Comorbidity was confirmed and scored using the Charlson Comorbidity Index (CCI). As a tool for measuring surgical outcome, we used the Clavien-Dindo (CD) classification for postoperative complications and the length of stay (LOS). Results : This study included 85 patients (35 males and 50 females). The mean age was 74.05±6.47 years. Using the K-FRAIL scale, four patients were scored as robust, 44 patients were pre-frail and 37 patients were frail. The mean PLVI was 0.61±0.19. According to the CD classification, 50 patients were classified as grade 1, 19 as grade 2, and four as grade 4. The mean LOS was 12.35±8.17 days. Multivariate stepwise regression analysis showed that postoperative complication was significantly associated with surgical invasiveness and K-FRAIL scale. LOS was significantly associated with surgical invasiveness and CCI. K-FRAIL scale showed a significant correlation with CCI and PLVI. Conclusion :The present study demonstrates that frailty, comorbidity, and surgical invasiveness are important risk factors for postoperative complications and LOS in elderly patients with DSD. Preoperative recognition of these factors may be useful for perioperative optimization, risk stratification, and patient counseling.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Central Sarcopenia, Frailty and Comorbidity as Predictor of Surgical Outcome in Elderly Patients with Degenerative Spine Disease

Kim

Park

Lee

et al. 2021

J Korean Neurosurg Soc

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“…It encompasses multiple clinical elements such as muscle mass, strength, malnutrition, and functional performance. 13 Sarcopenia is therefore a crucial element in the assessment of frailty. We hypothesised that Fontan patients, despite their young age, exhibit sarcopenia resembling that more often seen in elderly patients with cardiovascular comorbidities rather than in healthy agematched controls.At the McGill Adult Unit for Congenital Heart Disease (MAUDE clinic, Montreal, Canada), a total of 67 patients with Fontan are actively followed.…”

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confidence: 99%

Sarcopenia in Fontan patients: a sign of frailty-associated premature ageing?

et al. 2021

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On November 10, 1942, after winning the battle of Alamein, Winston Churchill delivered these famous words: "Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning."Adults living with CHD are a growing population, as they are now surviving into adulthood and even reaching geriatric ages thanks to the emergence of surgical and medical innovations. 1 In all adults with CHD, the fastest-growing population is the one with complex congenital lesions. 1 Fontan patients are among the most resource-intensive populations from a health service perspective. They experience multiple extracardiac complications that are mainly related to sustained decreased cardiac output and increased systemic venous pressure. 2 This means that Fontan patients are living with a lifespan state of compensated or decompensated heart failure. 2 The functional consequences of their singular cardiovascular physiology have been expressed as both a reduced life expectancy when compared to other CHD population 3 and a decreased exercise capacity. 4 Moreover, skeletal muscle strength has been shown to be similar to that of patients with advanced heart failure, 5 since they have increased adiposity and, as shown by Cordina et al., Fontan-associated myopenia. 6 The advent of the Fontan operation has certainly improved outcomes for patients with univentricular heart, but given the ensuing complications, treating physicians feel this is "the end of the beginning," to use Churchill's words.Psoas muscle area, an indicator of sarcopenia, has proven to be an important marker of worse cardiovascular outcomes and of increased risk of mortality in patients with long-standing heart failure and increased cardiovascular burden. [7][8][9][10][11] It has also been shown to be correlated with indicators of physical frailty such as low handgrip strength and short physical performance battery. 12 Frailty is a broad multidimensional syndrome that reflects a patient's vulnerability. It encompasses multiple clinical elements such as muscle mass, strength, malnutrition, and functional performance. 13 Sarcopenia is therefore a crucial element in the assessment of frailty. We hypothesised that Fontan patients, despite their young age, exhibit sarcopenia resembling that more often seen in elderly patients with cardiovascular comorbidities rather than in healthy agematched controls.At the McGill Adult Unit for Congenital Heart Disease (MAUDE clinic, Montreal, Canada), a total of 67 patients with Fontan are actively followed. Multiple imaging modalities are used as part of the routine screening for Fontan-associated liver disease, including abdominal ultrasound, CT, and magnetic resonance. In this setting, 17 out of 67 Fontan patients had a CT of the abdomen performed and thus were included in the study. The psoas muscle areas were measured on the CT scan using the validated web-based software Coreslicer.com. 14 Measurements were done in the axial plane, at the highest level of the L4 vertebrae. There is no gold standard numb...

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“…ТШХ обычно рекомендуется при невозможности выполнения классического нагрузочного теста (ВЭМпробы или на тредмиле) или наличии к нему противопоказаний [2]. Это касается больных со сни женной ФРС: среднего/старшего возраста, с серьезными ССЗ и коморбидными состояниями, после операций на сердце и сосудах и т. п. Доля таких, например, среди вовлекаемых в программы КР пос ле коронарного шунтирования (КШ), составляет от 25% до 50%, и по прогнозам будет увеличиваться [5,12]. С этим связан повышенный интерес к ТШХ, оценке его возможностей и ограничений, выработке единых методологических подходов к применению в области КР.…”

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Six-minute walk test in cardiac rehabilitation

Бубнова¹,

Персиянова-Дуброва²

2020

Cardiovasc Ther Prev

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Six-minute walk test (6MWT) is a simple and safe tool for assessing exercise tolerance in various categories of patients. Currently, 6MWT is used to assess the functional status of a patient and determine the strategy of increasing physical activity, primarily in patients with reduced exercise tolerance and contraindications for cardiopulmonary exercise test. The basic requirements for the 6MWT are presented, taking into account the factors affecting its informativeness and accuracy, as well as the interpretation of results. The diagnostic and prognostic value of 6MWT in different categories of patients are discussed. The prospects for 6MWT use in cardiac rehabilitation for planning rehabilitation program, prescribing exercises, determining the risk of complications, and evaluating the effectiveness are considered. The limitations of 6MWT and ways to overcome it, as well as directions for further research are presented.

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Psoas muscle area: a new standard for frailty assessment in cardiac surgery?

Cited by 13 publications

References 17 publications

Central Sarcopenia, Frailty and Comorbidity as Predictor of Surgical Outcome in Elderly Patients with Degenerative Spine Disease

Central Sarcopenia, Frailty and Comorbidity as Predictor of Surgical Outcome in Elderly Patients with Degenerative Spine Disease

Sarcopenia in Fontan patients: a sign of frailty-associated premature ageing?

Six-minute walk test in cardiac rehabilitation

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