Rationale and Objectives
This study aims to assess the use of skeletal muscle mass measurements at two thoracic levels to diagnose sarcopenia on computed tomography (CT) chest examinations and to analyze the impact of these measurements on clinical outcome parameters following transcatheter aortic valve replacement.
Materials and Methods
This study retrospectively included 157 patients who underwent preoperative CT examinations. The total muscle area was measured on transverse CT images at the 3rd lumbar and 7th and 12th thoracic levels with skeletal muscle indices (SMIs) calculated at each level. SMIs were then compared to clinical outcome parameters, and thoracic cutoff values for sarcopenia at the 7th and 12th thoracic levels were calculated.
Results
Correlation between SMIs at the third lumbar vertebra (L3) and the 12th thoracic vertebra (T12) was stronger ( r = 0.724, P < 0.001) than that between L3 and the seventh thoracic vertebra (T7) ( r = 0.594, P < 0.001). SMIs at L3 and T12 significantly correlated with prolonged length of stay. Thoracic cutoff values for the 12th thoracic level were 42.6 cm 2 /m 2 (men) and 30.6 cm 2 /m 2 (women), and those for the 7th thoracic level were 46.5 cm 2 /m 2 (men) and 32.3 cm 2 /m 2 (women).
Conclusions
Skeletal muscle measurements at the T12 level could permit the diagnosis of sarcopenia and could be used to correlate sarcopenia with outcome parameters in patients undergoing CT limited to the chest.
Introduction
Sarcopenia is a syndrome characterized by the generalized loss of skeletal muscle mass and a decrease in strength . Sarcopenia is a well-documented factor causing poor clinical outcomes in surgical, oncological, and cardiovascular patients with increased infection rate, prolonged hospital stay, higher risk of falling, and decreased overall survival .
Morphologically, with increasing age, sarcopenia causes progressive atrophy of type II muscle fibers and their replacement by connective tissue and fat . Comorbidities, poor nutrition, and reduced physical activity can accelerate the development of sarcopenia . Therefore, the assessment of body composition is important in the clinical evaluation of sarcopenia.
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Materials and Methods
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Patients and Methods Study Population
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CT Image Acquisition
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Image Evaluation
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Statistical Analysis
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Results
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TABLE 1
Baseline Characteristics of the Patient Population
All
n = 157 Gender_P_ Value Female
n = 78 Male
n = 79 Age (y) 82.3 ± 10.0 82.9 ± 8.8 81.7 ± 11.0 0.469 \* Height (cm) 165.5 ± 11.2 157.8 ± 7.9 173.1 ± 8.4 <0.001 \* Weight (kg) 62.4 ± 12.5 53.2 ± 4.5 72.8 ± 10.1 0.037 \* BMI (kg/m 2 ) 27.3 ± 6.1 29.01 ± 7.0 25.6 ± 4.3 <0.001 \* ≤20.0 8 (5%) 3 (4%) 5 (6%) >20.0–24.9 56 (36%) 24 (30%) 32 (41%) ≥25.0 93 (59%) 51 (55%) 42 (45%) STS score 7.1 ± 5.3 7.3 ± 5.7 6.9 ± 4.8 0.669 \* Diabetes 50 (32%) 18 (23%) 32 (41%) 0.025 †
BMI, body mass index; STS, Society for Thoracic Surgeons 2008 Cardiac Surgery Risk Models.
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TABLE 2
Computed Tomography Measurements, Skeletal Muscle Indices, and Amount of Sarcopenia
All
n = 157 Gender_P_ Value Female
n = 78 Male
n = 79 Total muscle area at L3 (cm 2 ) 138.9 ± 31.6 123.3 ± 26.7 154.4 ± 28.3 <0.001 \* Skeletal muscle index at L3 (cm 2 /m 2 ) 50.8 ± 10.7 49.8 ± 11.4 51.7 ± 9.8 0.271 \* Total muscle area at T7 (cm 2 ) 115.9 ± 33.8 93.8 ± 22.9 137.6 ± 28.3 <0.001 \* Skeletal muscle index at T7 (cm 2 /m 2 ) 42.0 ± 10.4 37.9 ± 9.7 46.0 ± 9.6 <0.001 \* Total muscle area at T12 (cm 2 ) 109.6 ± 31.4 93.0 ± 24.6 125.9 ± 28.9 <0.001 \* Skeletal muscle index at T12 (cm 2 /m 2 ) 39.8 ± 9.8 37.5 ± 9.8 42.1 ± 9.4 <0.001 \* Visceral fat area (cm 2 ) 43.7 ± 28.9 39.4 ± 26.8 47.8 ± 30.4 <0.001 \* Subcutaneous fat area (cm 2 ) 82.0 ± 50.8 106.5 ± 54.7 57.8 ± 31.8 <0.001 \* Sarcopenia, n (%) L3 53 (34) 12 (15) 41 (52) <0.001 † T7 62 (39) 19 (24) 43 (54) <0.001 † T12 58 (36) 16 (21) 42 (53) <0.001 †
L3, third lumbar vertebra; T7, seventh thoracic vertebra; T12, 12th thoracic vertebra.
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TABLE 3
Results of Logistic Regression Analysis for Outcome Parameters with Computed Tomography Measurements and BMI
SMI—L3 SMI—Th7 SMI—Th12 VF SC BMI OR (95% CI)P Value OR (95% CI)P Value OR (95% CI)P Value OR (95% CI)P Value OR (95% CI)P Value OR (95% CI)P Value Prolonged length of stay 0.95 (0.90–0.99) 0.013 0.95 (0.91–1.00) 0.065 0.95 (0.91–1.00) 0.032 1.00 (0.99–1.00) 0.809 1.00 (0.99–1.00) 0.532 0.99 (0.93–1.07) 0.923 Perioperative death 1.06 (0.96–1.19) 0.205 0.92 (0.81–1.06) 0.274 1.02 (0.91–1.14) 0.740 1.00 (0.99–1.02) 0.643 1.00 (0.99–1.01) 0.097 1.08 (0.93–1.25) 0.332 Postoperative renal failure 0.97 (0.92–1.02) 0.284 0.98 (0.93–1.03) 0.396 0.98 (0.93–1.03) 0.509 1.00 (0.99–1.00) 0.310 1.00 (0.99–1.00) 0.232 1.02 (0.94–1.09 0.696 Postoperative stroke 1.02 (0.96–1.08) 0.454 1.01 (0.95–1.07) 0.630 1.02 (0.97–1.08) 0.444 1.00 (0.99–1.00) 0.877 1.00 (0.99–1.00) 0.484 1.06 (0.97–1.15) 0.189 Postoperative bleeding 0.97 (0.93–1.00) 0.129 0.98 (0.95–1.02) 0.440 0.98 (0.94–1.02) 0.367 1.00 (0.99–1.00) 0.274 1.00 (0.99–1.00) 0.270 1.03 (0.97–1.15) 0.277 Mortality—30 d 0.97 (0.89–1.06) 0.563 1.01 (0.93–1.10) 0.667 0.99 (0.91–1.09) 0.979 1.01 (1.00–1.02) 0.015 1.00 (0.99–1.00) 0.532 1.09 (0.97–1.23) 0.137 Mortality—1 y 0.95 (0.90–1.00) 0.061 1.00 (0.95–1.06) 0.785 0.99 (0.95–1.05) 0.945 1.00 (1.00–1.01) 0.046 0.99 (0.99–1.00) 0.220 0.94 (0.85–1.03) 0.332
BMI, body mass index; CI, confidence interval; OR, odds ratio; SC, subcutaneous tissue area; SMI, skeletal muscle index; VF, visceral adipose tissue area.
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TABLE 4
Results of Logistic Regression Analysis for Outcome Parameter with Sarcopenia at L3 and T12 Levels
L3 OR (95% CI)P Value Th12 OR (95% CI)P Value Sarcopenia No sarcopenia Sarcopenia No sarcopenia Prolonged LOS 11/28 (39%) 42/129 (33%) 1.34 (0.57–3.11) 0.496 13/28 (46%) 45/129 (35%) 1.61 (0.71–3.69) 0.254 Perioperative death 0/52 (0%) 3/103 (3%) N/A \* 0.551 † 0/57 (0%) 3/98 (3%) N/A \* 0.298 † Postoperative renal failure 7/53 (13%) 11/103 (11%) 1.27 (0.46–3.49) 0.640 8/58 (14%) 10/98 (10%) 1.41 (0.52–3.79) 0.499 Postoperative stroke 1/53 (2%) 11/103 (11%) 0.16 (0.20–1.28) 0.084 1/58 (2%) 11/98 (11%) 0.14 (0.17–1.10) 0.062 Postoperative bleeding 10/53 (19%) 21/103 (20%) 0.91 (0.39–2.10) 0.822 11/58 (19%) 20/98 (20%) 0.91 (0.40–2.07) 0.827 Mortality—30 d 2/53 (4%) 3/103 (3%) 1.31 (0.21–8.07) 0.773 2/58 (3%) 3/98 (3%) 1.13 (0.18–6.98) 0.895 Mortality—1 y 8/29 (28%) 9/66 (14%) 2.41 (0.82–7.07) 0.109 7/37 (19%) 10/58 (17%) 1.12 (0.38–3.26) 0.835
CI, confidence interval; L3, third lumbar vertebra; LOS, length of stay; OR, odds ratio; T12, 12th thoracic vertebra.
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Discussion
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Acknowledgment
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