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Vaccarino R, Wachtmeister M, Karelis A, Marinko E, Sun J, Resch T, Sonesson B, Dias NV. The role of CT-assessed sarcopenia and visceral adipose tissue in predicting long-term survival in patients undergoing elective endovascular infrarenal aortic repair. Br J Radiol 2024; 97:1461-1466. [PMID: 38848475 PMCID: PMC11256935 DOI: 10.1093/bjr/tqae114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/22/2024] [Accepted: 05/31/2024] [Indexed: 06/09/2024] Open
Abstract
OBJECTIVES To evaluate if ileo-psoas muscle size and visceral adipose tissue (VAT) can predict long-term survival after endovascular aneurysm repair (EVAR). METHODS Patients who underwent EVAR between 2004 and 2012 in a single centre were included. Total psoas muscle area (TPA), abdominal VAT area, subcutaneous adipose tissue (SAT), and total adipose tissue were measured on the preoperative CT. Primary endpoint was all-cause mortality. Values are presented as median and interquartile range or absolute number and percentage. Cox regression analyses were performed to assess the associations with mortality. RESULTS Two hundred and eighty-four patients could be included in the study. During a median follow-up of 8 (4-11) years, 223 (79.9%) patients died. Age (P ≤ .001), cardiovascular (P = .041), cerebrovascular (P = .009), renal diseases (P = .002), and chronic obstructive pulmonary disease (P ≤ .001) were independently associated with mortality. TPA was associated with mortality in a univariate (P = .040), but not in a multivariate regression model (P = .764). No significant association was found between mortality and TPA index (P = .103) or any of the adiposity measurements with the exception of SAT (P = .040). However, SAT area loss in a multivariate analysis (P = .875). CONCLUSIONS Assessment of core muscle size and VAT did not contribute to improving the prediction of long-term survival after EVAR. ADVANCES IN KNOWLEDGE The finding of this study contradicts the previously claimed utility of core muscle size and VAT in predicting long-term survival after EVAR.
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Affiliation(s)
- Roberta Vaccarino
- Department of Clinical Sciences Malmö, Lund University, Malmö 21428, Sweden
| | | | - Angelos Karelis
- Department of Clinical Sciences Malmö, Lund University, Malmö 21428, Sweden
- Department of Thoracic Surgery and Vascular Diseases, Vascular Center, Skane University Hospital, Malmö 21428, Sweden
| | - Elisabet Marinko
- Department of Clinical Sciences Malmö, Lund University, Malmö 21428, Sweden
| | - Jianming Sun
- Department of Clinical Sciences Malmö, Lund University, Malmö 21428, Sweden
| | - Timothy Resch
- Department of Clinical Sciences Malmö, Lund University, Malmö 21428, Sweden
- Department of Vascular Surgery, Rigshospitalet, Copenhagen 2100, Denmark
- Department of Health and Medical Sciences, University of Copenhagen, Copenhagen 2100, Denmark
| | - Björn Sonesson
- Department of Clinical Sciences Malmö, Lund University, Malmö 21428, Sweden
- Department of Thoracic Surgery and Vascular Diseases, Vascular Center, Skane University Hospital, Malmö 21428, Sweden
| | - Nuno V Dias
- Department of Clinical Sciences Malmö, Lund University, Malmö 21428, Sweden
- Department of Thoracic Surgery and Vascular Diseases, Vascular Center, Skane University Hospital, Malmö 21428, Sweden
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Fereydooni A, Johnson CE, Brooke BS, Arya S. Decision making in the frail vascular surgery patient: A scoping review. Semin Vasc Surg 2024; 37:224-239. [PMID: 39152001 DOI: 10.1053/j.semvascsurg.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/16/2024] [Accepted: 04/18/2024] [Indexed: 08/19/2024]
Abstract
Increasing evidence highlights the adverse impact of frailty and reduced physiologic reserve on surgical outcomes. Therefore, identification of frailty is essential for older adults being evaluated for vascular surgery procedures. Numerous frailty assessment tools are available to quantify the level of frailty and assist in preoperative decision making for these older patients. This review evaluates traditional and novel frailty metrics for their scientific validation, limitations, and clinical utility in vascular surgery decision-making.
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Affiliation(s)
- Arash Fereydooni
- Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, 780 Welch Road, Cj350i, MC 5639, Palo Alto, CA, 94304
| | - Cali E Johnson
- Division of Vascular Surgery, Department of Surgery, University of Utah Health, Salt Lake City, UT
| | - Benjamin S Brooke
- Division of Vascular Surgery, Department of Surgery, University of Utah Health, Salt Lake City, UT
| | - Shipra Arya
- Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, 780 Welch Road, Cj350i, MC 5639, Palo Alto, CA, 94304; Surgery Service Line, Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA.
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Sachsamanis G, Stahl J, Pfister K, Schierling W, Betz T, Jage S. The Impact of Sarcopenia in the Long-Term Survival of Patients following Complex Endovascular Aortic Surgery for Thoracoabdominal Aortic Aneurysms. Diagnostics (Basel) 2024; 14:751. [PMID: 38611664 PMCID: PMC11011763 DOI: 10.3390/diagnostics14070751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/25/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
OBJECTIVES Image-based sarcopenia has been the subject of recent studies, hypothesized as a prognostic factor for patients with thoracoabdominal aortic aneurysms. METHODS AND MATERIALS We conducted a single-center retrospective analysis of patients who underwent complex endovascular repair for thoracoabdominal aortic aneurysms between 2008 and 2016. CT image assessment was performed and patients were classified as sarcopenic and non-sarcopenic using two stratification methods: skeletal mass index (SMI) and total psoas muscle index (TPMI). According to sex, each patient was defined as sarcopenic if their SMI or TPMI was in the lowest third of the study group. The primary endpoint was impact of sarcopenia on perioperative mortality and long-term survival. Secondary endpoints were perioperative complications. RESULTS From a total of 155 patients, 135 were eligible for study. Overall, in-hospital mortality was 5.9% (8/135). The 30-day, 1-year, 3-year and 5-year mortality was 10.4% (14/135), 20% (27/135), 28.1% (38/135) and 31.1% (42/135), respectively. There was no difference in the long-term mortality rates between sarcopenic and non-sarcopenic patients regardless of the stratification method used (p = 0.4 for SMI and p = 0.2 for TPMI). According to SMI, 30-day mortality of sarcopenic patients was significantly lower in comparison to non-sarcopenic patients (1/45, 2.2% vs. 13/90, 14.4%, p = 0.028). Based on the total psoas muscle index, sarcopenic patients were at higher risk for development of pulmonary complications in comparison to non-sarcopenic patients postoperatively (p = 0.03). CONCLUSION Using SMI and TPMI, sarcopenia was not associated with reduced long-term survival in patients undergoing complex endovascular repair for thoracoabdominal aortic aneurysms.
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Affiliation(s)
- Georgios Sachsamanis
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (J.S.); (K.P.); (W.S.); (T.B.)
| | - Judith Stahl
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (J.S.); (K.P.); (W.S.); (T.B.)
| | - Karin Pfister
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (J.S.); (K.P.); (W.S.); (T.B.)
| | - Wilma Schierling
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (J.S.); (K.P.); (W.S.); (T.B.)
| | - Thomas Betz
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (J.S.); (K.P.); (W.S.); (T.B.)
| | - Simon Jage
- Department of Radiology, University Medical Center Regensburg, 93053 Regensburg, Germany;
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Bradley NA, Walter A, Dolan R, Wilson A, Siddiqui T, Roxburgh CS, McMillan DC, Guthrie GJ. Evaluation of the prognostic value of computed tomography-derived body composition in patients undergoing endovascular aneurysm repair. J Cachexia Sarcopenia Muscle 2023; 14:1836-1847. [PMID: 37221439 PMCID: PMC10401537 DOI: 10.1002/jcsm.13262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 01/23/2023] [Accepted: 04/24/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Endovascular aneurysm repair (EVAR) is the most common mode of repair of abdominal aortic aneurysms (AAA) in the UK. EVAR ranges from standard infrarenal repair to complex fenestrated and branched EVAR (F/B-EVAR). Sarcopenia is defined by lower muscle mass and function, which is associated with inferior perioperative outcomes. Computed tomography-derived body composition analysis offers prognostic value in patients with cancer. Several authors have evaluated the role of body composition analysis in predicting outcomes in patients undergoing EVAR; however, the evidence base is limited by heterogeneous methodology. METHODS Six hundred seventy-four consecutive patients (58 (8.6%) female, mean (SD) age 74.4 (6.8) years) undergoing EVAR and F/B-EVAR at three large tertiary centres were retrospectively recruited. Subcutaneous and visceral fat indices (SFI and VFI), psoas and skeletal muscle indices, and skeletal muscle density were measured at the L3 vertebral level from pre-operative computed tomographies. The maximally selected rank statistic technique was used to define optimal thresholds to predict mortality. RESULTS There were 191 deaths during the median follow-up period of 60.0 months. Mean (95% CI) survival in the low SMI versus high SMI subgroups was 62.6 (58.5-66.7) versus 82.0 (78.7-85.3) months (P < 0.001). Mean (95% CI) survival in the low SFI versus high SFI subgroups was 56.4 (48.2-64.7) versus 77.1 (74.2-80.1) months (P < 0.001). One-year mortality in the low SMI versus high SMI subgroups was 10% versus 3% (P < 0.001). Low SMI was associated with increased odds of one-year mortality (OR 3.19, 95% CI 1.60-6.34, P < 0.001). Five-year mortality in the low SMI versus high SMI subgroups was 55% versus 28% (P < 0.001). Low SMI was associated with increased odds of five-year mortality (OR 1.54, 95% CI 1.11-2.14, P < 0.01). On multivariate analysis of all patients, low SFI (HR 1.90, 95% CI 1.30-2.76, P < 0.001) and low SMI (HR 1.88, 95% CI 1.34-2.63, P < 0.001) were associated with poorer survival. On multivariate analysis of asymptomatic AAA patients, low SFI (HR 1.54, 95% CI 1.01-2.35, P < 0.05) and low SMI (HR 1.71, 95% CI 1.20-2.42, P < 0.01) were associated with poorer survival. CONCLUSIONS Low SMI and SFI are associated with poorer long-term survival following EVAR and F/B-EVAR. The relationship between body composition and prognosis requires further evaluation, and external validation of the thresholds proposed in patients with AAA is required.
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Geng D, Wu X, Wang Y, He J, Hu X. Sarcopenia defined by the psoas muscle mass or quality is associated with poor survival in patients with aortic aneurysm undergoing surgery: A meta-analysis. Ageing Res Rev 2023; 88:101964. [PMID: 37247820 DOI: 10.1016/j.arr.2023.101964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/10/2023] [Accepted: 05/26/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND The impact of sarcopenia estimated by the skeletal muscle mass or quality on survival remains controversial in patients with aortic aneurysm. This meta-analysis aimed to assess the association between sarcopenia defined by the psoas muscle mass or quality and all-cause mortality in patients with aortic aneurysm. METHODS We comprehensively searched PubMed, Web of Science, and Embase databases until December 31, 2022. Studies investigating the association of CT-derived psoas muscle mass (psoas muscle area [PSA] and psoas muscle index [PMI]) or quality (lean PSA [LPSA]) with all-cause mortality in patients with aortic aneurysm undergoing surgery were included. RESULTS Eighteen studies reporting on 19 articles, enrolling 4767 patients were identified. A comparison of the bottom with the top psoas muscle mass, the pooled adjusted hazard ratios (HR) of all-cause mortality was 2.34 (95% confidence intervals [CI] 1.58-3.47). Low psoas muscle mass was associated with an increased risk of all-cause mortality when defined by the PSA (HR 2.01; 95% CI 1.42-2.75) or PMI (HR 2.37; 95% CI 1.24-4.55). Per 1 cm2 PMA increase conferred a 10% reduction in all-cause mortality. Patients with bottom LPMA had an increased risk of all-cause mortality (HR 3.27; 95% CI 1.90-5.60). Each 100 cm2 × HU LPMA increase conferred a 15% reduction in all-cause mortality. CONCLUSIONS Sarcopenia defined by the low psoas muscle mass or quality independently predicts all-cause mortality in patients with aortic aneurysm. However, the overall certainty of evidence for the categorical analysis of psoas muscle mass was downgraded by the presence of publication bias and significant heterogeneity.
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Affiliation(s)
- Donghua Geng
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Xinyue Wu
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang 110001, China
| | - Yuxin Wang
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang 110001, China
| | - Jiaan He
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang 110001, China
| | - Xinhua Hu
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang 110001, China.
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Pandit V, Aziz H. Reassessing the Role of Sarcopenia for Predicting Long-Term Survival After Abdominal Aortic Aneurysm Repair. World J Surg 2023; 47:1080-1081. [PMID: 36683087 DOI: 10.1007/s00268-023-06902-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2023] [Indexed: 01/23/2023]
Affiliation(s)
- Viraj Pandit
- Department of Surgery, Central California Veterans Affair Health Care, Fresno, CA, USA.
| | - Hassan Aziz
- Department of Surgery, University of Iowa Hospital and Clinic, Iowa City, IA, USA
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Forte-Genescà P, Casajuana Urgell E, Díaz-Duran C, Romero-Montaña L, Paredes-Mariñas E, Clarà-Velasco A. Comparison Between Several CT-Derived Psoas Muscle Sarcopenia Markers for Predicting Survival After Abdominal Aortic Aneurysm Repair. World J Surg 2023; 47:1073-1079. [PMID: 36611098 DOI: 10.1007/s00268-022-06868-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Multiple CT-derived measurements of sarcopenia have been described yet their relationship with survival after abdominal aortic aneurysm (AAA) repair has not been properly assessed. We aimed to define and compare the relationship between several psoas CT-derived measurements and the 5-year survival after AAA repair and to evaluate their potential contribution to survival prediction. METHODS Preoperative CT area (TPA) and density (MTPD) of the psoas muscle at L3 were measured in 218 consecutive AAA patients electively intervened. Additional measurements were obtained by normalizing TPA by anthropometric data or L3-vertebra surface or by TPAxMTPD multiplication (lean psoas muscle area-LPMA). The association of sarcopenia markers with survival was evaluated with Cox models adjusted by age, sex, type of intervention and the Charlson Comorbidity Index, and their contribution to survival prediction assessed with the C-statistic and the Continuous Net Reclassification Index (c-NRI). RESULTS Sixty patients (27.5%) died during the first 5 years after surgery. There was a statistically significant and linear (spline analysis) relationship of sarcopenia markers with 5-year survival in all multivariate models, except that including LPMA. Despite this association, the inclusion of sarcopenia markers did not improve the C-statistic and moderately increased the c-NRI. None normalized sarcopenia markers performed better than TPA. CONCLUSION The majority of CT-derived psoas muscle measurements of sarcopenia showed a significant and independent relationship with survival after elective AAA repair. Despite this association, they did not appear to improve sufficiently our survival prediction ability to become an efficient tool for decision-making.
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Affiliation(s)
- Pau Forte-Genescà
- Department of Vascular and Endovascular Surgery, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Eduard Casajuana Urgell
- Department of Vascular and Endovascular Surgery, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.,Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carles Díaz-Duran
- Department of Vascular and Endovascular Surgery, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Lorena Romero-Montaña
- Department of Vascular and Endovascular Surgery, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Ezequiel Paredes-Mariñas
- Department of Vascular and Endovascular Surgery, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Albert Clarà-Velasco
- Department of Vascular and Endovascular Surgery, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain. .,Department of Life and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain. .,CIBER Cardiovascular, IMIM - Parc de Salut Mar, Barcelona, Spain.
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Chen J, Xia Y, Liu Y, Zhu H. Effect of low skeletal muscle mass on long-term mortality after abdominal aortic aneurysm repair: A meta-analysis. Pak J Med Sci 2023; 39:587-594. [PMID: 36950390 PMCID: PMC10025718 DOI: 10.12669/pjms.39.2.7366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/16/2022] [Accepted: 01/18/2023] [Indexed: 02/05/2023] Open
Abstract
Objective This meta-analysis was designed to assess if pre-operative low skeletal muscle mass impacts mortality rates of patients undergoing abdominal aortic aneurysm (AAA) repair. Methods Datasets of PubMed, CENTRAL, ScienceDirect, Embase, and Google Scholar were searched from 1st January 1980 to 15th December 2021 for studies assessing the role of low skeletal muscle mass on mortality rates of AAA repair. Studies measuring skeletal muscle mass on computed tomography scans and reporting long-term mortality (>1 year) were included. Multivariable adjusted ratios were combined in a random-effects model. Results Fifteen studies with 3776 patients were included. Meta-analysis showed a statistically significant increased risk of all-cause mortality in patients with low skeletal muscle mass (HR: 2.07 95% CI: 1.56, 2.74 I2=65% p<0.00001) as compared to normal muscle mass patients. Pooled data indicated that low skeletal muscle mass was associated with statistically significant increased risk of mortality in studies on endovascular repair (HR: 2.86 95% CI: 1.95, 4.20 I2=58% p<0.00001) as well as those including a mixed group of patients (HR: 1.39 95% CI: 1.06, 1.82 I2=31% p=0.02). Conclusion Low skeletal muscle mass in AAA patients undergoing surgical repair is associated with increased risk of long-term mortality. Current evidence is limited by the retrospective nature of data and variability in defining and measuring low skeletal muscle mass. There is a need for future prospective studies defining the optimal cut-off of low skeletal muscle mass in different populations.
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Affiliation(s)
- Junjing Chen
- Junjing Chen, Department of Thyroid Surgery and Vascular Surgery, Huzhou Central Hospital, Affiliated Central Hospital HuZhou University, Huzhou 313000, Zhejiang Province, P.R. China
| | - Yanfen Xia
- Yanfen Xia, Department of Thyroid Surgery and Vascular Surgery, Huzhou Central Hospital, Affiliated Central Hospital HuZhou University, Huzhou 313000, Zhejiang Province, P.R. China
| | - Yi Liu
- Yi Liu, Department of Thyroid Surgery and Vascular Surgery, Huzhou Central Hospital, Affiliated Central Hospital HuZhou University, Huzhou 313000, Zhejiang Province, P.R. China
| | - Huifang Zhu
- Huifang Zhu, Department of Thyroid Surgery and Vascular Surgery, Huzhou Central Hospital, Affiliated Central Hospital HuZhou University, Huzhou 313000, Zhejiang Province, P.R. China
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Nimura M, Lane T, Rawashdeh M, Onida S, Javed A, Sritharan G, Reese G, Hrouda D, Davies AH. Study protocol for neuromuscular stimulation for rehabilitation after general and vascular surgery: a pilot randomised clinical study. BMJ Open 2023; 13:e061800. [PMID: 36797015 PMCID: PMC9936270 DOI: 10.1136/bmjopen-2022-061800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
OBJECTIVES To investigate the acceptability and safety of neuromuscular stimulation (NMES) as an adjunct for rehabilitation after vascular and general surgery. METHODS AND ANALYSIS Prospective, single-centre, single-blind, parallel group, randomised controlled study. This study will be conducted in a single-centre, secondary care setting (National Healthcare Service Hospital) in the UK. All patients aged over 18 years undergoing vascular or general surgery with Rockwood Frailty Score of 3 or above on admission. Exclusion is inability or unwillingness to participate in trial, implanted electrical device, pregnancy and acute deep vein thrombosis. Target number of recruitment is 100. Participants will be randomly assigned to active NMES group (group A) or placebo NMES group (group B) prior to surgery. Participants will be blinded and asked to use the NMES device, 1-6 sessions daily (30 min per session) after surgery in addition to standard National Health Service rehabilitation care until discharge. The primary study outcomes are acceptability and safety of NMES assessed by the device satisfaction questionnaire on discharge and adverse events recorded during hospital stay. The secondary outcomes are the postoperative recovery and cost-effectiveness compared between two groups, assessed by various activity tests, mobility and independence measures and questionnaires. ETHICS AND DISSEMINATION Ethical approvals were provided by London-Harrow Research Ethics Committee (REC) and the Health Research Authority (HRA), Ref: 21/PR/0250. Findings will be published in a peer-reviewed journal and presented at national and international conferences. TRIAL REGISTRATION NUMBER NCT04784962.
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Affiliation(s)
- Megumi Nimura
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Tristan Lane
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
- Cambridge Vascular Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Majd Rawashdeh
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sarah Onida
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Azfar Javed
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ganan Sritharan
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - George Reese
- Section of Colorectal Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - David Hrouda
- Section of Urological Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - A H Davies
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
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Selçuk N, Albeyoğlu Ş, Bastopcu M, Selçuk İ, Barutca H, Şahan H. Sarcopenia is a risk factor for major adverse cardiac events after surgical revascularization for critical limb ischemia. Vascular 2023; 31:64-71. [PMID: 34974778 DOI: 10.1177/17085381211059383] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES We examined the effect of sarcopenia on early surgical outcomes in patients with critical limb ischemia (CLI) in terms of major adverse cardiac events (MACE) and major adverse limb events (MALE), as well as the value of inflammatory markers of neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte ratios (PLR) as indicators of sarcopenia in CLI patients. METHODS This was an observational retrospective single-center study. Patients who required surgical revascularization for CLI between October 2015 and December 2020 were identified. Psoas muscle areas were calculated from computed tomography images for psoas muscle index (PMI) calculations. Sarcopenia was defined as PMI < 5.5 cm2/m2 for men and PMI < 4.0 cm2/m2 for women. Risk factors for 30-day major adverse cardiac events (MACE) and major adverse limb events (MALE) were analyzed. NLR and PLR were compared between sarcopenic and non-sarcopenic patients. RESULTS The mean age of 217 study patients was 61.5 ± 10.9, and 16 (7.4%) patients were female. 82 (37.8%) patients were sarcopenic. Patients with sarcopenia were older (65.1 ± 9.3 vs 59.4 ± 11.2, p < .001) and history of myocardial infarction was more frequent (23.2% vs 12.6%, p = 0.042) among sarcopenic patients. Sarcopenic patients more frequently encountered MACE (9.8% vs 0.7%, p = 0.002), but not MALE. Sarcopenia increased early postoperative MACE in our cohort with an odds ratio of 11.925. NLR was not different between the two groups, while PLR was higher (127.16 vs 104.06, p = 0.010) among sarcopenic patients. The platelet-to-lymphocyte ratio of 125.11 had a sensitivity of 53.7% and a specificity of 68.1% for differentiating sarcopenia. CONCLUSIONS Sarcopenia was associated with more frequent 30-day MACE and perioperative mortality after revascularization for CLI. 30-day MALE was not increased in patients with sarcopenia. The use of PLR as a simple marker of sarcopenia is limited by its low sensitivity and specificity.
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Affiliation(s)
- Nehir Selçuk
- Department of Cardiovascular Surgery, 111319Dr Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Center, Uskudar Turkey
| | - Şebnem Albeyoğlu
- Department of Cardiovascular Surgery, 111319Dr Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Center, Uskudar Turkey
| | - Murat Bastopcu
- Department of Cardiovascular Surgery, 111319Dr Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Center, Uskudar Turkey
| | - İsmail Selçuk
- Department of Cardiovascular Surgery, İstanbul Sultan Abdulhamid Han Research and Training Center, Uskudar Turkey
| | - Hakan Barutca
- Department of Radiology, 111319Dr Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Center, Uskudar, Turkey
| | - Hasan Şahan
- Department of Radiology, 111319Dr Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Center, Uskudar, Turkey
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Chen S, Dunn R, Jackson M, Morley N, Sun J. Frailty score and outcomes of patients undergoing vascular surgery and amputation: A systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1065779. [PMID: 36798484 PMCID: PMC9928186 DOI: 10.3389/fcvm.2023.1065779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/09/2023] [Indexed: 01/26/2023] Open
Abstract
Introduction Frailty is associated with adverse postoperative health outcomes, including increased mortality, longer length of stay, higher rehospitalization, and other complications. There are many frailty assessment tools are to assess the level of frailty in vascular surgery patients. The aim of this study was to perform a systematic review and meta-analysis to assess the association between the frailty levels described by different frailty scores and adverse postoperative health outcomes among hospitalized vascular surgery patients and patients undergoing amputation. Methods Studies utilizing frailty scores and similar frailty assessment tools to describe frailty and investigate the association between frailty and health outcomes were searched. The primary outcomes of this study were in-hospital mortality, postdischarge mortality, length of hospital stay, rehospitalization, and discharge location. Additional outcomes included postoperative myocardial infarction, postoperative renal failure, cerebrovascular accident and stroke, comorbidities, and estimated glomerular filtration rate (eGFR) levels. Joanna Briggs Institute (JBI) Critical Appraisal Tools were used for quality assessment. Results In total, 24 studies with 1,886,611 participants were included in the final analysis. The overall results found that higher in-hospital mortality and postdischarge mortality were significantly associated with frailty. Frailty was also found to be significantly associated with a longer length of hospital stay, higher rehospitalization, and higher likelihood of non-home discharge. In addition, the results also showed that frailty was significantly associated with all kinds of comorbidities investigated, except chronic kidney disease. However, lower eGFR levels were significantly associated with frailty. Conclusion Among patients who underwent all types of vascular surgery and those who underwent amputations, assessment of frailty was significantly associated with adverse postoperative outcomes and multiple comorbidities. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=336374, identifier CRD42022336374.
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Affiliation(s)
- Shujie Chen
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia
| | - Riley Dunn
- School of Pharmacy and Medical Sciences, Griffith University, Nathan, QLD, Australia
| | - Mark Jackson
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia,Department of Vascular Surgery, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Nicola Morley
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia,Department of Vascular Surgery, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Jing Sun
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia,Institute for Integrated and Intelligent Systems, Griffith University, Gold Coast, QLD, Australia,*Correspondence: Jing Sun,
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Mezzetto L, D'Oria M, Mani K, Scali S, Bastos Gonçalves F, Trimarchi S, Budtz-Lilly J, DeMartino R, Veraldi G, Mastrorilli D, Calvagna C, Grando B, Bissacco D, Lepidi S. Scoping review of radiologic assessment and prognostic impact of skeletal muscle sarcopenia in patients undergoing endovascular repair for aortic disease. J Vasc Surg 2022; 76:1407-1416. [PMID: 35667604 PMCID: PMC9613481 DOI: 10.1016/j.jvs.2022.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/10/2022] [Accepted: 05/19/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The primary objectives of our scoping review were to evaluate the methods used by research groups to assess the incidence of sarcopenia in patients with aortic disease and the extent of the evidence base that links sarcopenia to the survival of patients undergoing elective endovascular aortic repair and to identify the recurring themes or gaps in the literature to guide future research. METHODS A scoping review in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) protocols extension for scoping reviews was performed. The available studies included those fully reported in English (last query, April 30, 2022). The following PICO question was used to build the search equation: "in patients with aortic disease [population] undergoing endovascular repair [intervention], what was the prevalence and prognosis of radiologically defined sarcopenia [comparison] on the short- and long-term outcomes?" RESULTS A total of 31 studies were considered relevant, and 18 were included in the present scoping review. In brief, 12 studies had focused on standard endovascular aneurysm repair (EVAR), 2 on thoracic EVAR, and 4 on complex EVAR. All but two studies were retrospective in design, and only one study had included patients from a multicenter database. Sarcopenia had generally been defined using the computed tomography angiography (CTA) findings of the cross-sectional area of the psoas muscle at L3 or L4, sometimes with normalization against the height. Overall, despite the heterogeneity in the methods used for its definition, sarcopenia was highly prevalent (range, 12.5%-67.6%). The patients with sarcopenia had had higher rates of mortality (ratio ranged from 2.28 [95% confidence interval, 1.35-3.84] to 6.34 [95% confidence interval, 3.37-10.0]) and adverse events (41% vs 16%; P = .020). CONCLUSIONS Sarcopenia, as identified using computed tomography angiography-based measurements of the skeletal muscle mass, was prevalent among patients undergoing elective EVAR, thoracic EVAR, or complex EVAR. The presence of sarcopenia has been shown to have a negative prognostic impact, increasing the operative risk and has been linked to poorer long-term survival.
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Affiliation(s)
- Luca Mezzetto
- Unit of Vascular Surgery, Integrated University Hospital of Verona, Verona, Italy
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy.
| | - Kevin Mani
- Section of Vascular Surgery, Department of Surgical Sciences, University of Uppsala, Uppsala, Sweden
| | - Salvatore Scali
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL
| | - Frederico Bastos Gonçalves
- Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Santi Trimarchi
- Division of Vascular Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Jacob Budtz-Lilly
- Division of Vascular Surgery, Department of Cardiovascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Randall DeMartino
- Division of Vascular and Endovascular Surgery, Gonda Vascular Center, Mayo Clinic Rochester Campus, Rochester, MN
| | - Gianfranco Veraldi
- Unit of Vascular Surgery, Integrated University Hospital of Verona, Verona, Italy
| | - Davide Mastrorilli
- Unit of Vascular Surgery, Integrated University Hospital of Verona, Verona, Italy
| | - Cristiano Calvagna
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Beatrice Grando
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Daniele Bissacco
- Division of Vascular Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sandro Lepidi
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
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13
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Bradley NA, Roxburgh CSD, McMillan DC, Guthrie GJK. The relationship between pre-operative psoas and skeletal muscle parameters and survival following endovascular aneurysm repair: a systematic review and meta-analysis. Sci Rep 2022; 12:16663. [PMID: 36198699 PMCID: PMC9534993 DOI: 10.1038/s41598-022-20490-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/14/2022] [Indexed: 11/09/2022] Open
Abstract
Sarcopenia is characterised by chronically reduced skeletal muscle volume and function, and is determined radiologically by psoas and skeletal muscle measurement. The present systematic review and meta-analysis aims to examine the relationship between pre-operative CT-derived psoas and skeletal muscle parameters and outcomes in patients undergoing EVAR and F/B-EVAR for aortic aneurysm. The MEDLINE database was interrogated for studies investigating the effect of pre-operative CT-diagnosed sarcopenia on outcomes following EVAR and F/B-EVAR. The systematic review was carried out in accordance with PRISMA guidelines. The primary outcome was overall mortality. RevMan 5.4.1 was used to perform meta-analysis. PROSPERO Database Registration Number: CRD42021273085. Ten relevant studies were identified, one reporting skeletal muscle parameters, and the remaining nine reporting psoas muscle parameters, which were used for meta-analysis. There were a total of 2563 patients included (2062 EVAR, 501 F/B-EVAR), with mean follow-up ranging from 25 to 101 months. 836 patients (33%) were defined as radiologically sarcopenic. In all studies, the combined HR for all-cause mortality in sarcopenic versus non-sarcopenic patients was 2.61 (1.67–4.08), p < .001. Two studies reported outcomes on patients undergoing F/B-EVAR; the combined HR for all-cause mortality in sarcopenic versus non-sarcopenic patients was 3.08 (1.66–5.71), p = .004. Radiological sarcopenia defined by psoas or skeletal muscle parameters was associated with inferior survival in patients undergoing both EVAR and F/B-EVAR. Current evidence is limited by heterogeneity in assessment of body composition and lack of a consensus definition of radiological sarcopenia.
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14
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Jacobs CR, Scali ST, Filiberto A, Anderson E, Fazzone B, Back MR, Cooper M, Upchurch GR, Huber TS. Psoas Muscle Area as a Prognostic Factor for Survival in Patients Undergoing EVAR Conversion. Ann Vasc Surg 2022; 87:1-12. [PMID: 36058454 DOI: 10.1016/j.avsg.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/05/2022] [Accepted: 08/15/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE EVAR conversion(EVAR-c) is increasingly reported and known to be technically complex and physiologically demanding. It has been proposed that pragmatic anthropomorphic measures such as psoas muscle area(PMA) may reliably quantify levels of preoperative frailty and be used to inform point of care clinical decision making and patient discussions for a variety of complex operations. To date, there is mixed data supporting use of PMA as a prognostic factor in fenestrated endovascular and open AAA repairs; however, no literature exists evaluating the impact of preoperative PMA on EVAR-c results. Therefore, the purpose of this study was to review our EVAR-c experience and evaluate the association of PMA with perioperative and long-term mortality outcomes. METHODS A retrospective single-center review of all AAA repairs was performed(2002-2019) and EVAR-c procedures were subsequently analyzed(n=153). Cross-sectional PMA at the mid-body of the L3 vertebrae was measured. The lowest PMA tertile was used as a threshold value to designate patients as having "low" PMA(n=51) and this cohort was subsequently compared to subjects with "normal" PMA(n=102). Cox proportional hazards modeling was used to estimate covariate association with all-cause mortality. RESULTS Patients with low PMA were older(77 vs. 72 years;p=.002), more likely to be female(27% vs. 5%;p<.001), and had reduced BMI(26 vs. 29kg/m2;p=.002). Time to conversion, total number of EVAR reinterventions prior to conversion and elective EVAR-c presentation incidence were similar; however, patients with low PMA had larger aneurysms(8.3 vs. 7.5cm;p=.01) and increased post-EVAR sac growth(2.3 vs. 1cm;p=.005). Unadjusted inpatient mortality was significantly greater for low PMA patients(16% vs. normal PMA, 5%, p=.02). Similarly, the total number of complications was higher among low PMA subjects(1.5±1.9 vs. normal PMA, 0.9±1.5;p=.02). Although frequency of major adverse cardiovascular events and new onset inpatient hemodialysis were similar, low PMA patients had a more than four-fold increased likelihood of having persistent requirement of hemodialysis at discharge(18% vs. 4%,p=.01). The low PMA group had decreased survival at 1 and 5 years, respectively(77±5%, 65±6% vs. normal PMA, 86±3%, 82%±5%;log-rank p=.03). Low PMA was an independent predictor of mortality with every 100mm2 increase in PMA being associated with a 15% reduction in mortality(HR 0.85,95% CI, .74-.97;p=.02). CONCLUSION Among EVAR-c patients, subjects with low preoperative PMA had higher rates of postoperative complications and worse overall survival. PMA assessments may be a useful adjunct to supplement traditional risk-stratification strategies when patients are being considered for EVAR-c.
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Affiliation(s)
- Christopher R Jacobs
- Division of Vascular Surgery and Endovascular Therapy; University of Florida, Gainesville
| | - Salvatore T Scali
- Division of Vascular Surgery and Endovascular Therapy; University of Florida, Gainesville.
| | - Amanda Filiberto
- Division of Vascular Surgery and Endovascular Therapy; University of Florida, Gainesville
| | - Erik Anderson
- Division of Vascular Surgery and Endovascular Therapy; University of Florida, Gainesville
| | - Brian Fazzone
- Division of Vascular Surgery and Endovascular Therapy; University of Florida, Gainesville
| | - Martin R Back
- Division of Vascular Surgery and Endovascular Therapy; University of Florida, Gainesville
| | - Michol Cooper
- Division of Vascular Surgery and Endovascular Therapy; University of Florida, Gainesville
| | - Gilbert R Upchurch
- Division of Vascular Surgery and Endovascular Therapy; University of Florida, Gainesville
| | - Thomas S Huber
- Division of Vascular Surgery and Endovascular Therapy; University of Florida, Gainesville
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15
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Monti CB, Righini P, Bonanno MC, Capra D, Mazzaccaro D, Giannetta M, Nicolino GM, Nano G, Sardanelli F, Marrocco-Trischitta MM, Secchi F. Psoas Cross-Sectional Measurements Using Manual CT Segmentation before and after Endovascular Aortic Repair (EVAR). J Clin Med 2022; 11:jcm11144023. [PMID: 35887786 PMCID: PMC9325160 DOI: 10.3390/jcm11144023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/08/2022] [Indexed: 02/04/2023] Open
Abstract
Sarcopenia has been associated with an increased incidence of adverse outcomes, including higher mortality, after endovascular aortic repair (EVAR). We aim to use computed tomography (CT) to quantify changes in total psoas muscles area (PMA) and psoas muscle density (PMD) after EVAR, and to evaluate the reproducibility of both measurements. PMA and PMD were assessed via manual segmentation of the psoas muscle on pre- and post-operative CT scans belonging to consecutive patients who underwent EVAR. Wilcoxon test was used to compare PMA and PMD before and after EVAR, and inter- and intra-reader agreements of both methods were evaluated through Bland−Altman analysis. A total of 50 patients, 42 of them males (84%), were included in the study. PMA changes from 1243 mm2 (1006−1445 mm2) to 1102 mm2 (IQR 937−1331 mm2), after EVAR (p < 0.001). PMD did not vary between pre-EVAR (33 HU, IQR 26.5−38.7 HU) and post-EVAR (32 HU, IQR 26−37 HU, p = 0.630). At inter-reader Bland−Altman analysis, PMA showed a bias of 64.0 mm2 and a coefficient of repeatability (CoR) of 359.2 mm2, whereas PMD showed a bias of −2.43 HU and a CoR of 6.19 HU. At intra-reader Bland−Altman analysis, PMA showed a bias of −81.1 mm2 and a CoR of 394.6 mm2, whereas PMD showed a bias of 1.41 HU and a CoR of 6.36 HU. In conclusion, PMA decreases after EVAR. A good intra and inter-reader reproducibility was observed for both PMA and PMD. We thus propose to use PMA during the follow-up of patients who underwent EVAR to monitor muscle depletion after surgery.
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Affiliation(s)
- Caterina Beatrice Monti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20100 Milan, Italy; (C.B.M.); (M.C.B.); (D.C.); (G.N.); (F.S.)
| | - Paolo Righini
- Unit of Vascular Surgery, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (P.R.); (D.M.); (M.G.)
| | - Maria Chiara Bonanno
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20100 Milan, Italy; (C.B.M.); (M.C.B.); (D.C.); (G.N.); (F.S.)
| | - Davide Capra
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20100 Milan, Italy; (C.B.M.); (M.C.B.); (D.C.); (G.N.); (F.S.)
| | - Daniela Mazzaccaro
- Unit of Vascular Surgery, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (P.R.); (D.M.); (M.G.)
| | - Matteo Giannetta
- Unit of Vascular Surgery, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (P.R.); (D.M.); (M.G.)
| | - Gabriele Maria Nicolino
- Radiology and Diagnostic Imaging Unit, Clinica San Carlo, Paderno Dugnano, 20100 Milan, Italy;
| | - Giovanni Nano
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20100 Milan, Italy; (C.B.M.); (M.C.B.); (D.C.); (G.N.); (F.S.)
- Unit of Vascular Surgery, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (P.R.); (D.M.); (M.G.)
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20100 Milan, Italy; (C.B.M.); (M.C.B.); (D.C.); (G.N.); (F.S.)
- Unit of Radiology, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy
| | | | - Francesco Secchi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20100 Milan, Italy; (C.B.M.); (M.C.B.); (D.C.); (G.N.); (F.S.)
- Unit of Radiology, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy
- Correspondence:
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16
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Hu G, Ding N, Wang Z, Jin Z. The association of body composition with abdominal aortic aneurysm growth after endovascular aneurysm repair. Insights Imaging 2022; 13:76. [PMID: 35467156 PMCID: PMC9038972 DOI: 10.1186/s13244-022-01187-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 02/19/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Body composition (BC) may be associated with abdominal aortic aneurysm (AAA) growth, but the results of previous research are contradictory. This study aimed to explore the relationship between BC and postoperative aneurysm progression.
Methods
Patients with regular postoperative follow-ups were retrospectively identified. The volume change of the aneurysm was measured to evaluate AAA progression. After segmenting different body components (subcutaneous fat, visceral fat, pure muscle, and intramuscular fat), the shape features and gray features of these tissues were extracted. Uni- and multivariable methods were used to analyze the relationship between imaging features of BC and AAA growth.
Results
A total of 94 patients (68 ± 8 years) were eligible for feature analyses. Patients with expansive aneurysms (29/94; volume change > 2%) were classified into Group(+) and others with stable or shrunken aneurysms (65/94) were classified into Group(−). Compared with Group(+), Group(−) showed a higher volume percent of pure muscle (21.85% vs 19.51%; p = .042) and a lower value of intramuscular fat (1.23% vs 1.65%; p = .025). CT attenuation of muscle tissues of Group(−) got a higher mean value (31.16 HU vs 23.92 HU; p = .019) and a lower standard deviation (36.12 vs 38.82; p = .006) than Group(+). For adipose tissue, we found no evidence of a difference between the two groups. The logistic regression model containing muscle imaging features showed better discriminative accuracy than traditional factors (84% vs 73%).
Conclusions
Muscle imaging features are associated with the volume change of postoperative aneurysms and can make an early prediction. Adipose tissue is not specifically related to AAA growth.
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Paajanen P, Lindström I, Oksala N, Väärämäki S, Saari P, Mäkinen K, Kärkkäinen JM. Radiographically Quantified Sarcopenia and Traditional Cardiovascular Risk Assessment in Predicting Long-term Mortality after EVAR. J Vasc Surg 2022; 76:908-915.e2. [PMID: 35367563 DOI: 10.1016/j.jvs.2022.03.859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/14/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This study evaluated radiographically quantified sarcopenia and patient's comorbidity burden based on traditional cardiovascular risk assessment as potential predictors of long-term mortality after endovascular aortic repair (EVAR). METHODS The study included 480 patients treated with standard EVAR for intact infrarenal abdominal aortic aneurysms. Patient characteristics, comorbidities, aneurysm dimensions and other preoperative risk factors were collected retrospectively. Preoperative computed tomography was used to measure psoas muscle area (PMA) at L3 level. Patients were divided into three groups based on ASA-score and PMA. In high-risk group, patients had sarcopenia (PMA <8.0 cm2 for males and <5.5 cm2 for females) and ASA score 4. In medium-risk group, patients had either sarcopenia or ASA 4. Patients in the low-risk group had no sarcopenia and ASA score was less than 4. Risk factors for long-term mortality were determined using multivariable analysis. Kaplan-Meier survival estimates were calculated for all-cause mortality. RESULTS Patients in the high- and medium risk-groups were older than in the low-risk group (77±7, 76±6 and 74±8 years, respectively, p<0.01). Patients in the high-risk group had higher prevalence of coronary artery disease, pulmonary disease and chronic kidney disease. There were no differences in 30-day or 90-day mortality between the groups. The independent predictors of long-term mortality were age, ASA-score, PMA, chronic kidney disease and maximum aneurysm sac diameter. The estimated one-year mortality rates were 5±2% for the low-risk, 5±2% for the medium-risk and 18±5% for the high-risk group (p<0.01). Five-year mortality estimates were 23±4%, 36±3% and 60±6%, respectively (p<0.01). The mean follow-up time was 5.0±2.8 years. CONCLUSIONS Both ASA and PMA were strong predictors of increased mortality after elective EVAR. The combination of these two can be used as a simple risk stratification tool to identify patients in whom aneurysm repair or the intensive long-term surveillance after EVAR may be unwarranted.
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Affiliation(s)
- Paavo Paajanen
- Heart Center, Kuopio University Hospital, Kuopio, Finland; Department of Surgery, Jyväskylä Central Hospital, Jyväskylä, Finland.
| | - Iisa Lindström
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Surgery, Jyväskylä Central Hospital, Jyväskylä, Finland
| | - Niku Oksala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Vascular Centre, Tampere University Hospital, Tampere, Finland; Finnish Cardiovascular Research Center Tampere, Finland
| | - Suvi Väärämäki
- Vascular Centre, Tampere University Hospital, Tampere, Finland
| | - Petri Saari
- Department of Clinical Radiology, Kuopio University Hospital, Finland
| | - Kimmo Mäkinen
- Heart Center, Kuopio University Hospital, Kuopio, Finland
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Dakis K, Nana P, Brodis A, Kouvelos G, Behrendt CA, Giannoukas A, Kölbel T, Spanos K. Sarcopenia is a prognostic biomarker for long-term survival after endovascular aortic aneurysm repair: A systematic review and meta-analysis. Ann Vasc Surg 2022; 83:358-368. [DOI: 10.1016/j.avsg.2022.02.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/19/2022] [Accepted: 02/25/2022] [Indexed: 12/11/2022]
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19
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Preoperative sarcopenia and malnutrition are correlated with poor long-term survival after endovascular abdominal aortic aneurysm repair. Surg Today 2021; 52:98-105. [PMID: 34477979 DOI: 10.1007/s00595-021-02362-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/19/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Sarcopenia and malnutrition are often used as surrogates for frailty, which is predictive of poor prognosis after surgery. We investigated the effects of sarcopenia and malnutrition on mortality after endovascular aneurysm repair (EVAR). METHODS The subjects of this study were patients who underwent EVAR at our hospital between June 2007 and December 2013, excluding those who underwent reintervention. The psoas muscle area at the L4 level was used as an indicator of sarcopenia. The Geriatric Nutritional Risk Index was used as an indicator of malnutrition. RESULTS There were 324 patients included in the study, with a mean age of 78.1 years and a median follow-up period of 56.7 months. Multivariate analysis revealed that sarcopenia (HR, 1.79; p = .042) and malnutrition (HR, 1.78; p = .043) were independent prognostic factors. Patients with both factors were classified as the high-risk group and others were classified as the low-risk group. The survival rate was significantly lower in the high-risk group than in the low-risk groups (p < .001). Even after propensity score matching, the high-risk group had a significantly lower survival rate (p < .001). CONCLUSION Both sarcopenia and malnutrition were associated with long-term mortality after EVAR. Patients with both indicators had a poor mid-term survival.
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Impact of Sarcopenia on Acute Kidney Injury after Infrarenal Abdominal Aortic Aneurysm Surgery: A Propensity Matching Analysis. Nutrients 2021; 13:nu13072212. [PMID: 34199110 PMCID: PMC8308481 DOI: 10.3390/nu13072212] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 02/07/2023] Open
Abstract
Background: Sarcopenia contributes to increased morbidity and mortality in patients undergoing surgery for abdominal aortic aneurysms (AAA). However, few reports have demonstrated whether sarcopenia would affect the development of postoperative acute kidney injury (AKI) in these patients. This study aimed to examine whether sarcopenia is associated with AKI and morbidity and mortality after infrarenal AAA operation. Methods: We retrospectively analysed 379 patients who underwent infrarenal AAA surgery. The diagnosis of sarcopenia was performed using the skeletal muscle index, which was calculated from axial computed tomography at the level of L3. The patients were separated into those with sarcopenia (n = 104) and those without sarcopenia (n = 275). We applied multivariable and Cox regression analyses to evaluate the risk factors for AKI and overall mortality. A propensity score matching (PSM) evaluation was done to assess the postoperative results. Results: The incidence of AKI was greater in sarcopenia than non-sarcopenia group before (34.6% vs. 15.3%; p < 0.001) and after the PSM analysis (34.6% vs. 15.4%; p = 0.002). Multivariable analysis revealed sarcopenia to be associated with AKI before (p = 0.010) and after PSM (p = 0.016). Sarcopenia was also associated with overall mortality before (p = 0.048) and after PSM (p = 0.032). A Kaplan–Meier analysis revealed that overall mortality was elevated patients with sarcopenia before and after PSM than in those without (log-rank test, p < 0.001, p = 0.022). Conclusions: Sarcopenia was associated with increased postoperative AKI incidence and overall mortality among individuals who underwent infrarenal AAA operation.
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21
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Veronese N, Barbagallo M. Consequences of Sarcopenia in Older People: The Epidemiological Evidence. PRACTICAL ISSUES IN GERIATRICS 2021:27-31. [DOI: 10.1007/978-3-030-80038-3_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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22
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Kärkkäinen JM, Oderich GS, Tenorio ER, Pather K, Oksala N, Macedo TA, Vrtiska T, Mees B, Jacobs MJ. Psoas muscle area and attenuation are highly predictive of complications and mortality after complex endovascular aortic repair. J Vasc Surg 2020; 73:1178-1188.e1. [PMID: 33002587 DOI: 10.1016/j.jvs.2020.08.141] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/17/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The present study evaluated the psoas muscle area and attenuation (radiodensity), quantified by computed tomography, together with clinical risk assessment, as predictors of outcomes after fenestrated and branched endovascular aortic repair (FBEVAR). METHODS The present single-center study included 504 patients who had undergone elective FBEVAR for pararenal or thoracoabdominal aortic aneurysms. The clinical risk assessment included age, sex, comorbidities, body mass index, glomerular filtration rate, aneurysm size and extent, cardiac stress test results, ejection fraction, and American Society of Anesthesiologists (ASA) score. Preoperative computed tomography was used to measure the psoas muscle area and attenuation at the L3 level. The lean psoas muscle area (LPMA; area in cm2 multiplied by attenuation in Hounsfield units [HU]) was calculated by multiplying the area by the attenuation. The risk factors for 90-day mortality, major adverse events (MAEs), and long-term mortality were determined using multivariable analysis. MAEs included 30-day or in-hospital death, acute kidney injury, myocardial infarction, respiratory failure, paraplegia, stroke, and bowel ischemia. A novel risk stratification method was proposed according to the strongest predictors of mortality and MAEs on multivariable analysis. RESULTS The 30-day mortality, 90-day mortality, and MAE rates were 2.0%, 5.6%, and 20%, respectively. The independent predictors of 90-day mortality were chronic obstructive pulmonary disease, chronic kidney disease, ASA score, and LPMA. The independent predictors of MAEs were aneurysm diameter, glomerular filtration rate, and LPMA. For long-term mortality, the independent predictors were chronic kidney disease, congestive heart failure, extent I-III thoracoabdominal aortic aneurysms, ASA score, and LPMA. The patients were stratified into three groups according to the ASA score and LPMA: low risk, ASA score II or LPMA >350 cm2HU (n = 290); medium risk, ASA score III and LPMA ≤350 cm2HU (n = 181); and high risk, ASA score IV and LPMA ≤350 cm2HU (n = 33). The 90-day mortality and MAE rates were 1.7% and 16% in the low-, 7.2% and 24% in the medium-, and 30% and 33% in the high-risk patients, respectively (P < .001 and P = .02, respectively). Patients with ASA score IV and LPMA <200 cm2HU, indicating sarcopenia (n = 14) had a 43% risk of death within 90 days. The 3-year survival estimates were 80% ± 3% for the low-, 70% ± 4% for the medium-, and 35% ± 9% for the high-risk patients (P < .001). The mean follow-up time was 3.1 ± 2.3 years. CONCLUSIONS LPMA was a strong predictor of outcomes and the only independent predictor of both mortality and MAEs after FBEVAR. A high muscle mass was protective against complications, regardless of the ASA score. Risk stratification based on the ASA score and LPMA can be used to identify patients at excessively high operative risk.
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Affiliation(s)
- Jussi M Kärkkäinen
- Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn; Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Gustavo S Oderich
- Division of Vascular and Endovascular Surgery, University of Texas Health Science, Houston, Tex.
| | - Emanuel R Tenorio
- Division of Vascular and Endovascular Surgery, University of Texas Health Science, Houston, Tex
| | - Keouna Pather
- Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Niku Oksala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland
| | - Thanila A Macedo
- Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Terri Vrtiska
- Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Barend Mees
- Maastricht University Medical Center, Maastricht, The Netherlands; European Vascular Center Aachen-Maastricht, University Hospital Aachen, Aachen, Germany
| | - Michael J Jacobs
- Maastricht University Medical Center, Maastricht, The Netherlands; European Vascular Center Aachen-Maastricht, University Hospital Aachen, Aachen, Germany; Maastricht University Medical Center, Maastricht, The Netherlands
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23
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Oliveira VC, Oliveira P, Moreira M, Correia M, Lima P, Silva JC, Pereira RV, Fonseca M. Impact of Total Psoas Area and Lean Muscular Area on Mortality after Endovascular Aortic Aneurysm Repair. Ann Vasc Surg 2020; 72:479-487. [PMID: 32949746 DOI: 10.1016/j.avsg.2020.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/06/2020] [Accepted: 09/09/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Sarcopenia has assumed growing relevance as a morbimortality predictor after major abdominal surgery. The aim of this study is to access total psoas muscle area (TPA) and lean muscle area (LMA) impact in morbimortality after elective endovascular abdominal aortic aneurysm repair (EVAR). METHODS Asymptomatic patients submitted to aortic endoprosthesis implantation between January 1, 2014 and December 31, 2018 at our vascular surgery department were retrospectively evaluated. After exclusion criteria were applied, 105 patients were included in the study; preoperative computed tomography scans were evaluated using OSIRIX software (Bernex, Switzerland). Two observers independently calculated TPA at the most caudal level of the L3 vertebra and respective density, therefore calculating LMA. Patients were separated by tertiles with the lowest being considered sarcopenic and with higher muscle steatosis and compared with the higher tertiles. Patient demographics and intraoperative and postoperative period variables were collected. Charlson comorbidity index was calculated and surgical complications classified according to Clavien-Dindo. The intraclass correlation coefficient and Bland-Altman plot were made to characterize interobserver variability. Survival analysis was performed with the Kaplan-Meier method, and differences between survival curves were tested with the log-rank test. The effect of sarcopenia on patient survival was assessed using Cox proportional hazard models. RESULTS Considering TPA, univariate analyses revealed that patients in the lower tertile had inferior survival (P = 0.03), whereas multivariate analyses showed increased likelihood of mortality (P = 0.039, hazard ratio (HR) 3.829). For LMA, univariate analyses revealed that patients in the lower tertile had inferior survival (P = 0.013), whereas multivariate analyses showed increased likelihood of mortality (P = 0.026, HR 4.153). When analyzing patients in the lowest tertile of both TPA and LMA, both univariate (P = 0.002) and multivariate (P = 0.018, HR 4.166) analyses reveled inferior survival. CONCLUSIONS Our study reveals reduced survival in patients with low TPA and low LMA submitted to elective EVAR; these factors should probably be taken into consideration in the future for preoperative risk evaluation and surgical planning.
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Affiliation(s)
- Vânia Constâncio Oliveira
- Angiology and Vascular Surgery Department, Centro Hospitalar e Universitário de Coimbra, EPE, Praceta Professor Mota Pinto, Coimbra, Portugal.
| | - Pedro Oliveira
- Liver Transplantation Department, Centro Hospitalar e Universitário de Coimbra, EPE, Praceta Professor Mota Pinto, Coimbra, Portugal
| | - Mário Moreira
- Angiology and Vascular Surgery Department, Centro Hospitalar e Universitário de Coimbra, EPE, Praceta Professor Mota Pinto, Coimbra, Portugal
| | - Mafalda Correia
- Angiology and Vascular Surgery Department, Centro Hospitalar e Universitário de Coimbra, EPE, Praceta Professor Mota Pinto, Coimbra, Portugal
| | - Pedro Lima
- Angiology and Vascular Surgery Department, Centro Hospitalar e Universitário de Coimbra, EPE, Praceta Professor Mota Pinto, Coimbra, Portugal
| | - Joana Cruz Silva
- Angiology and Vascular Surgery Department, Centro Hospitalar e Universitário de Coimbra, EPE, Praceta Professor Mota Pinto, Coimbra, Portugal
| | - Ricardo Vale Pereira
- Angiology and Vascular Surgery Department, Centro Hospitalar e Universitário de Coimbra, EPE, Praceta Professor Mota Pinto, Coimbra, Portugal
| | - Manuel Fonseca
- Angiology and Vascular Surgery Department, Centro Hospitalar e Universitário de Coimbra, EPE, Praceta Professor Mota Pinto, Coimbra, Portugal
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24
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Houghton JSM, Nickinson ATO, Morton AJ, Nduwayo S, Pepper CJ, Rayt HS, Gray LJ, Conroy SP, Haunton VJ, Sayers RD. Frailty Factors and Outcomes in Vascular Surgery Patients: A Systematic Review and Meta-analysis. Ann Surg 2020; 272:266-276. [PMID: 32675539 DOI: 10.1097/sla.0000000000003642] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To describe and critique tools used to assess frailty in vascular surgery patients, and investigate its associations with patient factors and outcomes. BACKGROUND Increasing evidence shows negative impacts of frailty on outcomes in surgical patients, but little investigation of its associations with patient factors has been undertaken. METHODS Systematic review and meta-analysis of studies reporting frailty in vascular surgery patients (PROSPERO registration: CRD42018116253) searching Medline, Embase, CINAHL, PsycINFO, and Scopus. Quality of studies was assessed using Newcastle-Ottawa scores (NOS) and quality of evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria. Associations of frailty with patient factors were investigated by difference in means (MD) or expressed as risk ratios (RRs), and associations with outcomes expressed as odds ratios (ORs) or hazard ratios (HRs). Data were pooled using random-effects models. RESULTS Fifty-three studies were included in the review and only 8 (15%) were both good quality (NOS ≥ 7) and used a well-validated frailty measure. Eighteen studies (62,976 patients) provided data for the meta-analysis. Frailty was associated with increased age [MD 4.05 years; 95% confidence interval (CI) 3.35, 4.75], female sex (RR 1.32; 95% CI 1.14, 1.54), and lower body mass index (MD -1.81; 95% CI -2.94, -0.68). Frailty was associated with 30-day mortality [adjusted OR (AOR) 2.77; 95% CI 2.01-3.81), postoperative complications (AOR 2.16; 95% CI 1.55, 3.02), and long-term mortality (HR 1.85; 95% CI 1.31, 2.62). Sarcopenia was not associated with any outcomes. CONCLUSION Frailty, but not sarcopenia, is associated with worse outcomes in vascular surgery patients. Well-validated frailty assessment tools should be preferred clinically, and in future research.
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Affiliation(s)
- John S M Houghton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Leicester, UK
- National Institute for Health Research Leicester Biomedical Research Centre - The Glenfield Hospital, Leicester, UK
| | - Andrew T O Nickinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Leicester, UK
- National Institute for Health Research Leicester Biomedical Research Centre - The Glenfield Hospital, Leicester, UK
| | | | - Sarah Nduwayo
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Leicester, UK
- National Institute for Health Research Leicester Biomedical Research Centre - The Glenfield Hospital, Leicester, UK
| | - Coral J Pepper
- Library Service, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Harjeet S Rayt
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Simon P Conroy
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Victoria J Haunton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Rob D Sayers
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Leicester, UK
- National Institute for Health Research Leicester Biomedical Research Centre - The Glenfield Hospital, Leicester, UK
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25
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Waduud MA, Giannoudi M, Drozd M, Sucharitkul PP, Slater TA, Blackman DJ, Scott DJ. Morphometric and traditional frailty assessment in transcatheter aortic valve implantation. J Cardiovasc Med (Hagerstown) 2020; 21:779-786. [DOI: 10.2459/jcm.0000000000001014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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26
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Pizzimenti M, Charles AL, Riou M, Thaveau F, Chakfé N, Geny B, Lejay A. Usefulness of Platelet-to-Lymphocyte Ratio as a Marker of Sarcopenia for Critical Limb Threatening Ischemia. Ann Vasc Surg 2020; 72:72-78. [PMID: 32479878 DOI: 10.1016/j.avsg.2020.05.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/16/2020] [Accepted: 05/21/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sarcopenia is a factor of poor prognosis for patients with critical limb threatening ischemia (CLTI), but its diagnosis requires imaging measurements and is time consuming. We investigated whether preoperative platelet-to-lymphocyte ratio (PLR) could be an easy and rapid marker of sarcopenia. METHODS Patients treated for CLTI between January 2019 and July 2019 were included in this single-center retrospective study. Sarcopenia was defined by a psoas muscle index (PMI) <5.5 cm2/m2 in men, and <4.0 cm2/m2 in women. PLR was calculated for all patients based on their systematic preoperative blood analysis. The diagnostic power of PLR was analyzed through a receiver operating characteristic (ROC) curve. Early outcomes of sarcopenic patients in terms of 30-day mortality and 30-day morbidity were retrieved. RESULTS Sixty-four patients were included in the study: 48 nonsarcopenic patients (mean PMI 7.34 cm2/m2; interquartile range [IQR] 6.58-8.01) and 16 sarcopenic patients (mean PMI 4.30 cm2/m2; IQR 3.45-5.17). No difference was found between both groups regarding patient demographics, clinical characteristics, cardiovascular risk factors, comorbidities, or revascularization modalities. PLR was significantly higher in the sarcopenic group (mean 332.1; IQR 158.2-320.7) compared with the nonsarcopenic group (mean 204.6; IQR 133.8-265.6) (P = 0.02). A PLR value ≥292.5 was shown to be a diagnostic marker for sarcopenia based on the ROC curve (sensitivity 31.3%, specificity 91.7%). Thirty-day mortality was 12.5% in the sarcopenic group and 2.1% in the nonsarcopenic group (P = 0.15); 30-day morbidity was 56.3% in the sarcopenic group and 10.4% in the nonsarcopenic group (P < 0.001). CONCLUSIONS PLR might help identifying a subgroup of CTLI patients associated with poor prognosis but does not seem appropriate to be used as a marker of sarcopenia given its low sensitivity.
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Affiliation(s)
- Mégane Pizzimenti
- FMTS, Department of Physiology, EA3072 Mitochondria, Oxidative Stress and Muscular Protection, University of Strasbourg, Strasbourg, France; Department of Physiology and Functional Explorations, University Hospital of Strasbourg, Strasbourg, France
| | - Anne L Charles
- Department of Physiology and Functional Explorations, University Hospital of Strasbourg, Strasbourg, France
| | - Marianne Riou
- FMTS, Department of Physiology, EA3072 Mitochondria, Oxidative Stress and Muscular Protection, University of Strasbourg, Strasbourg, France
| | - Fabien Thaveau
- Department of Physiology and Functional Explorations, University Hospital of Strasbourg, Strasbourg, France; Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Nabil Chakfé
- Department of Physiology and Functional Explorations, University Hospital of Strasbourg, Strasbourg, France; Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Bernard Geny
- FMTS, Department of Physiology, EA3072 Mitochondria, Oxidative Stress and Muscular Protection, University of Strasbourg, Strasbourg, France; Department of Physiology and Functional Explorations, University Hospital of Strasbourg, Strasbourg, France
| | - Anne Lejay
- FMTS, Department of Physiology, EA3072 Mitochondria, Oxidative Stress and Muscular Protection, University of Strasbourg, Strasbourg, France; Department of Physiology and Functional Explorations, University Hospital of Strasbourg, Strasbourg, France; Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France.
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27
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Waduud MA, Ul-Hassan A, Naveed T, Adusumilli P, Slater TA, Straw S, Hammond C, Ashbridge Scott DJ. Comparison of quantity and quality of muscle as clinical prognostic markers in patients undergoing carotid endarterectomy. Br J Radiol 2020; 93:20200136. [PMID: 32406752 DOI: 10.1259/bjr.20200136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The measurement of muscle area is routinely utilised in determining sarcopaenia in clinical research. However, this simple measure fails to factor in age-related morphometric changes in muscle quality such as myosteatosis. The aims of this study were to: firstly investigate the relationship between the masseter area (quantity) and density (quality), and secondly compare the prognostic clinical relevance of each parameter. METHODS Cross-sectional CT head scans were reviewed for patients undergoing carotid endarterectomy. The masseter was manually delineated and the total masseter area (TMA) and the total masseter density (TMD) calculated. Measurements of the TMA were standardised against the cranial circumference. Observer variability in measurements were assessed using Bland-Altman plots. The relationship between TMA and TMD were evaluated using Pearson's correlation and linear regression analyses. The prognostic value of TMA and TMD were assessed using receiver operator curves and cox-regression analyses. RESULTS In total, 149 patients who had undergone routine CT scans prior to a carotid endarterectomy were included in this study. No significant observer variations were observed in measuring the TMA, TMD and cranium circumference. There was a significant positive correlation between standardised TMA and TMD (Pearson's correlation 0.426, p < 0.001, adjusted R-squared 17.6%). The area under the curve for standardised TMA in predicting all-cause mortality at 30 days, 1 year and 4 years were higher when compared to TMD. Standardised TMA was only predictive of post-operative overall all-cause mortality (adjusted hazard ratio 0.38, 95% confidence interval 0.15-0.97, p = 0.043). CONCLUSION We demonstrate a strong relationship between muscle size and density. However, the utilisation of muscle area is likely to be limited in routine clinical care. ADVANCES IN KNOWLEDGE Our study supports the utilisation of muscle area in clinical sarcopaenia research. We did not observe any additional prognostic advantage in quantifying muscle density.
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Affiliation(s)
- Mohammed Abdul Waduud
- Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, United Kingdom.,Leeds Institute of Cardiovascular and Metabolic Medicine, The University of Leeds, Clarendon Way, Leeds, LS2 9JT, United Kingdom
| | - Awais Ul-Hassan
- Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, United Kingdom
| | - Talha Naveed
- Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, United Kingdom
| | - Pratik Adusumilli
- Department of Radiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, United Kingdom
| | - Thomas Alexander Slater
- Leeds Institute of Cardiovascular and Metabolic Medicine, The University of Leeds, Clarendon Way, Leeds, LS2 9JT, United Kingdom
| | - Sam Straw
- Leeds Institute of Cardiovascular and Metabolic Medicine, The University of Leeds, Clarendon Way, Leeds, LS2 9JT, United Kingdom
| | - Christopher Hammond
- Department of Radiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, United Kingdom
| | - David Julian Ashbridge Scott
- Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, United Kingdom.,Leeds Institute of Cardiovascular and Metabolic Medicine, The University of Leeds, Clarendon Way, Leeds, LS2 9JT, United Kingdom
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28
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Sarcopenia and myosteatosis at presentation adversely affect survival after esophagectomy for esophageal cancer. Radiol Oncol 2020; 54:237-246. [PMID: 32229679 PMCID: PMC7276641 DOI: 10.2478/raon-2020-0016] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/03/2020] [Indexed: 02/07/2023] Open
Abstract
Background Esophageal cancer remains a disease with poor survival and many complications. Measuring muscle mass and quality can identify patients with diminished muscle mass (sarcopenia) and muscle fat infiltration (myosteatosis). We studied the impact of sarcopenia and myosteatosis in resectable esophageal cancer on overall survival and complications. Patients and methods 139 patients received a radical esophagectomy. Skeletal muscle area (SMA) and muscle attenuation (MA) in CT images at L3 level were recorded and groups with and without sarcopenia and myosteatosis were compared for overall survival (OS), perioperative mortality, conduit complications, pleuropulmonary complications, respiratory failure requiring mechanical ventilation and other significant complications. Results Prevalence of sarcopenia and myosteatosis at presentation was 16.5% and 51.8%, respectively. Both were associated with decreased OS. Median survival was 18.3 months (CI 5.4-31.1) vs 31.0 months (CI 7.4-54.6) for sarcopenia/no sarcopenia (log rank p = 0.042) and 19.0 months (CI 13.3-24.7) vs 57.1 months (CI 15.2-99.0) for myosteatosis (log rank p = 0.044), respectively. A relationship between sarcopenia and myosteatosis and other negative outcomes after esophagectomy could not be established. Conclusions Sarcopenia and myosteatosis before esophagectomy are associated with decreased overall survival but not with more frequent perioperative complications. Identification of patients at risk can guide therapeutic decisions and interventions aimed at replenishing muscle reserves.
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Pre-operative Psoas Muscle Size Combined With Radiodensity Predicts Mid-Term Survival and Quality of Life After Fenestrated-Branched Endovascular Aortic Repair. Eur J Vasc Endovasc Surg 2020; 59:31-39. [DOI: 10.1016/j.ejvs.2019.06.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/11/2019] [Accepted: 06/19/2019] [Indexed: 12/22/2022]
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Waduud MA, Sucharitkul PPJ, Drozd M, Gupta A, Hammond C, Ashbridge Scott DJ. Validation of two-dimensional vertebral body parameters in estimating patient height in elderly patients. Br J Radiol 2019; 92:20190342. [PMID: 31596119 DOI: 10.1259/bjr.20190342] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Standardised comparison of abdominal muscle and adipose tissue is often utilised in morphometric clinical research. Whilst measurements are traditionally standardised against the patient's height, this may not be always practically feasible. The aim of this study was to investigate the relationship between measurements of the vertebral body and patient height. METHODS We analysed cross-sectional CT scans. Measurements of the vertebral body area (VBA), anteroposterior vertebral body diameter (APVBD) and lateral vertebral body diameter (LVBD) were made by two independent investigators by manual tracing. Patients were randomly divided into two groups: Group 1 standardisation and Group 2 validation. We compared height and vertebral body parameters from patients in Group 1 and mathematically modelled this relationship. We then utilised the model to predict the height of patients in Group 2 and compared this with their actual height. Observer variability was assessed using Bland-Altman plots and t-tests of differences. RESULTS CT scans from 382 patients were analysed. No significant intraobserver or interobserver differences were apparent when measuring vertebral body parameters. We describe models which enable the prediction of the patients' height using the measured VBA, APVBD and LVBD. No significant differences were observed between the patients predicted and actual heights in the validation group. CONCLUSIONS We demonstrate an important relationship between measurements of the patient's height and the vertebral body. This can be utilised in future research when the patient's height has not been measured. ADVANCES IN KNOWLEDGE In the absence of the patient's height, we demonstrate that two-dimensional vertebral body parameters may be reliably used to standardise morphometric measurements.
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Affiliation(s)
- Mohammed Abdul Waduud
- The Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospital NHS Trust, Great George St, Leeds LS1 3EX, United Kingdom.,Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LIGHT Laboratories, Level 7, Leeds, LS2 9JT, United Kingdom
| | - Penelope Poppy Janpen Sucharitkul
- The Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospital NHS Trust, Great George St, Leeds LS1 3EX, United Kingdom
| | - Michael Drozd
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LIGHT Laboratories, Level 7, Leeds, LS2 9JT, United Kingdom
| | - Ankit Gupta
- The Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospital NHS Trust, Great George St, Leeds LS1 3EX, United Kingdom
| | - Christopher Hammond
- Department of Radiology, Leeds General Infirmary, Leeds Teaching Hospital NHS Trust, Great George St, Leeds LS1 3EX, United Kingdom
| | - David Julian Ashbridge Scott
- The Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospital NHS Trust, Great George St, Leeds LS1 3EX, United Kingdom.,Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LIGHT Laboratories, Level 7, Leeds, LS2 9JT, United Kingdom
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31
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Jones AD, Waduud MA. Re. "Effect of Low Skeletal Muscle Mass on Post-operative Survival of Patients With Abdominal Aortic Aneurysm: A Prognostic Factor Review and Meta-Analysis of Time to Event Data". Eur J Vasc Endovasc Surg 2019; 58:940. [PMID: 31477518 DOI: 10.1016/j.ejvs.2019.07.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 07/19/2019] [Accepted: 07/23/2019] [Indexed: 10/26/2022]
Affiliation(s)
| | - Mohammed A Waduud
- The Leeds Vascular Institute, Leeds General Infirmary, Leeds, UK; The Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK
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32
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Antoniou GA, Rojoa D, Antoniou SA, Alfahad A, Torella F, Juszczak MT. Effect of Low Skeletal Muscle Mass on Post-operative Survival of Patients With Abdominal Aortic Aneurysm: A Prognostic Factor Review and Meta-Analysis of Time-to-Event Data. Eur J Vasc Endovasc Surg 2019; 58:190-198. [DOI: 10.1016/j.ejvs.2019.03.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/25/2019] [Accepted: 03/01/2019] [Indexed: 01/06/2023]
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33
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Wardle BG, Ambler GK, Twine CP, Coughlin PA. Correspondence. Br J Surg 2019; 106:951. [PMID: 31162665 DOI: 10.1002/bjs.11212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 03/22/2019] [Indexed: 11/05/2022]
Affiliation(s)
- B G Wardle
- Bristol, Bath and Weston Vascular Network, North Bristol Trust, Southmead Hospital, Bristol
| | - G K Ambler
- Bristol, Bath and Weston Vascular Network, North Bristol Trust, Southmead Hospital, Bristol.,Centre for Surgical Research at University of Bristol, Bristol
| | - C P Twine
- Bristol, Bath and Weston Vascular Network, North Bristol Trust, Southmead Hospital, Bristol.,Centre for Surgical Research at University of Bristol, Bristol
| | - P A Coughlin
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Waduud MA, Adusumilli P, Drozd M, Bailey MA, Cuthbert G, Hammond C, Scott JA. Volumetric versus single slice measurements of core abdominal muscle for sarcopenia. Br J Radiol 2019; 92:20180434. [PMID: 30912955 DOI: 10.1259/bjr.20180434] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE We investigated whether total psoas muscle area (TPMA) was representative of the total psoas muscle volume (TPMV). Secondly, we assessed whether there was a relationship between the two commonly used single slice measurements of sarcopenia, TPMA and total abdominal muscle area (TAMA). METHODS Pre-operative CT imaging of 110 patients undergoing elective endovascular aneurysm repair were analyzed by two trained independent observers. TPMA was measured at individual vertebral levels between the second lumbar vertebrae and sacrum. TPMV was also estimated between the second lumbar vertebrae and sacrum. TAMA was measured at the third lumbar vertebrae (L3). Observer differences were assessed using Bland-Altman plots. Associations between the different measures were assessed using linear regression and Pearson's correlation. RESULTS We found single slice measurements of the TPMA to be representative of the TPMV at individual levels between L2 to the sacrum. The strongest association was seen at L3 [adjusted regression coefficient 16.7, 95% confidence interval (12.1 to 21.4), p < 0.001]. There was no association between TPMA and TAMA [adjusted regression coefficient -0.7, 95% confidence interval (-4.1 to 2.8), p = 0.710]. CONCLUSION We demonstrate that measurements of the TPMA between L2 to the sacrum are representative of the TPMV, with the greatest association at the third lumbar vertebrae. There was no association between the TPMA and TAMA. ADVANCES IN KNOWLEDGE We demonstrate that a single slice measurement of TPMA at L3 is representative of the muscle volume, contrary to previous criticism. Future sarcopenia studies can continue to measure TPMA which is representative of the TPMV.
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Affiliation(s)
| | | | - Michael Drozd
- 3 Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds , Leeds , UK
| | - Marc A Bailey
- 3 Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds , Leeds , UK
| | - Gary Cuthbert
- 1 Leeds Vascular Institute, Leeds General Infirmary , Leeds , UK
| | | | - Julian A Scott
- 1 Leeds Vascular Institute, Leeds General Infirmary , Leeds , UK
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