Skeletal muscle quality affects patient outcomes in acute type A aortic dissection

Abstract

OBJECTIVES Although skeletal muscle quantity is linked to surgical outcomes, quality remains unexamined. In this study, we evaluated whether skeletal muscle quality and quantity could predict surgical outcomes in acute type A aortic dissection (ATAAD). METHODS Skeletal muscle quality and quantity were evaluated using computed tomography (CT) values and the psoas muscle mass index, respectively. From May 2004 to December 2017, 324 ATAAD patients underwent aortic replacement after CT scans and psoas muscle mass index measurements. Patients were grouped into intramuscular fat (IMF; n = 55) and non-IMF (n = 269) deposition groups. RESULTS The mean ages of the patients were 72.3 ± 9.7 and 66.8 ± 12.1 years (P = 0.002), and hospital mortality rates were 3.6% (2/55) and 7.4% (20/269; P = 0.393) for IMF and non-IMF deposition groups, respectively. IMF deposition was a risk factor for a deterioration in activities of daily living at discharge by multivariable analysis [odds ratio 0.33, 95% confidence interval (CI) 0.16–0.69; P = 0.003]. The mean follow-up was 43.9 ± 36.8 months. The 5-year survival was significantly worse for the IMF deposition group (IMF 73.8% vs non-IMF 88.2%; P = 0.010). The multivariable Cox proportional hazard analysis showed that IMF deposition significantly predicted poor survival (hazard ratio 3.26, 95% CI 1.47–7.24; P = 0.004), unlike psoas muscle mass index and age. CONCLUSIONS Skeletal muscle quality, defined by IMF deposition, was an independent predictor of overall survival and postoperative activities of daily living dependence risk in patients undergoing surgery for ATAAD. Thus, IMF deposition may be an additional risk factor for estimating late outcomes of ATAAD surgery.

Computed tomography measured epicardial adipose tissue and psoas muscle attenuation: new biomarkers to predict major adverse cardiac events and mortality in patients with heart disease and critically ill patients. Part II: Psoas muscle area and density

“…The 5-year survival was significantly worse for the group of patients with intramuscular fat (IMF) deposition (IMF 73.8% vs. non-IMF 88.2%; P = 0.010). The multivariable Cox analysis showed that IMF deposition was a statistically significant predictor of poor survival (HR = 3.26; P = 0.004), unlike PMI [63].…”

Preoperative Sarcopenia Assessment Using Pectoralis Muscle Mass Indicated Poor Mid-term Cardiac Surgery Prognosis

“…The criteria reported by the European Working Group on Sarcopenia in Older People (EWGSOP) can be used in diagnosing sarcopenia; however, the best method to assess sarcopenia remains a matter of debate [6,7]. It has already been reported that psoas muscle volume on abdominal computed tomography (CT) is associated with prognosis for aortic and off-pump coronary artery graft bypass and valve surgery [7][8][9][10][11] and is currently one of the most used evaluation methods. In contrast, pectoralis muscle mass has been used in predicting prognosis in case of respiratory diseases [12][13][14][15].…”

Comprehensive Validation of Automated Whole Body Skeletal Muscle, Adipose Tissue, and Bone Segmentation from 3D CT images for Body Composition Analysis: Towards Extended Body Composition

“…The study of body composition, namely the study of skeletal muscle (SKM), subcutaneous (SAT), visceral (VAT) and intramuscular (IMAT) adipose tissue, has been shown to drive clinical outcomes (toxicity, survival, infection, surgery, length of hospital stay). Specifically, SKM is an important prognostic factor for various outcomes such as cancer survival Penna et al (2019) and surgical outcomes Gomibuchi et al (2020); Nishimura et al (2019). For identical height and weight, SKM mass can vary substantially and for those outcomes that depend on skeletal mass (such as chemotoxicity), accurate measurement of the individual's SKM is very critically important.…”