1
|
Yamashita M, Kamiya K, Kitamura T, Hamazaki N, Ichikawa T, Shibuya M, Kobayashi S, Suzuki Y, Ueno K, Uchida S, Noda T, Hotta K, Maekawa E, Matsunaga A, Yamaoka-Tojo M, Ako J, Miyaji K. Trajectory of Abdominal Skeletal Muscle Changes During Cardiac Rehabilitation in Patients With Aortic Disease. Am J Phys Med Rehabil 2024; 103:158-165. [PMID: 37535584 DOI: 10.1097/phm.0000000000002322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
OBJECTIVE This study focused on routine computed tomography imaging for aortic disease management and evaluated the trajectory of skeletal muscle changes through inpatient and outpatient cardiac rehabilitation. DESIGN Prospective observational study included patients who underwent abdominal computed tomography three times (baseline, postacute care, and follow-up). The area and density of the all-abdominal and erector spine muscles and intramuscular adipose tissue were measured. A generalized linear model with patients as random effects was used to investigate skeletal muscle changes. RESULTS Thirty-nine patients completed outpatient cardiac rehabilitation, and 60 were incomplete. Skeletal muscle area significantly decreased from baseline to the follow-up period only in the incomplete rehabilitation group. Skeletal muscle density significantly decreased from baseline to postacute care and increased at the follow-up period, but only patients who completed rehabilitation showed recovery up to baseline at the follow-up period. These trajectories were more pronounced in the erector spine muscle. Intramuscular adipose tissue showed a trend of gradual increase, but only the incomplete rehabilitation group showed a significant difference from baseline to the follow-up period. CONCLUSIONS The density of skeletal muscle may reflect the most common clinical course; skeletal muscle area and intramuscular adipose tissue are unlikely to improve positively, and their maintenance seemed optimal.
Collapse
Affiliation(s)
- Masashi Yamashita
- From the Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan (MY, KK, YS, KU, SU, TN, KH, AM, MY-T); Division of Research, ARCE Inc, Sagamihara, Japan (MY); Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan (KK, KH, AM, MY-T); Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan (TK, KM); Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan (NH, TI, MS, SK); and Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan (EM, JA)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Zhang Y, Zhang T, Yin W, Zhang L, Xiang J. Diagnostic Value of Sarcopenia Computed Tomography Metrics for Older Patients with or without Cancers with Gastrointestinal Disorders. J Am Med Dir Assoc 2023; 24:220-227.e4. [PMID: 36463968 DOI: 10.1016/j.jamda.2022.10.019] [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: 06/22/2022] [Revised: 10/11/2022] [Accepted: 10/28/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVES The diagnostic utility of poor body composition measures in sarcopenia remains unclear. We hypothesize that the skeletal muscle gauge [combination of skeletal muscle index (SMI) and skeletal muscle density (SMD); SMG = SMI × SMD] would have significant diagnostic and predictive value in certain muscle regions and populations. DESIGN Prospective cross-sectional study. SETTING AND PARTICIPANTS We examined inpatients age ≥60 years with or without cancer and with gastrointestinal disorders. METHODS We used computed tomography (CT) image metrics in the 12th thoracic (T12), third lumbar (L3), erector spinae muscle (ESM), and psoas muscle (PM) regions to establish correlations with the 2019 Asian Working Group for Sarcopenia Consensus and used receiver operating characteristic area under the curve (AUC) to compare differences between metrics. Associations between CT metrics and mortality were reported as relative risk after adjustments. RESULTS We evaluated 385 patients (median age, 69.0 years; 60.8% men) and found consistent trends in cancer (49.6%) and noncancer (50.4%) cohorts. SMG had a stronger correlation with muscle mass than SMD [mean rho: 0.68 (range, 0.59‒0.73) vs 0.39 (range, 0.28‒0.48); all P < .01] in T12, L3, and PM regions and a stronger correlation with muscle function than SMI [mean rho: 0.60 (range, 0.50‒0.77) vs 0.36 (range, 0.22‒0.58); all P < .05] in T12, ESM, and L3 regions. SMG outperformed SMI in diagnostic accuracy in all regions, particularly for L3 (AUC: 0.87‒0.88 vs 0.80‒0.82; both P < .05). PMG (PM gauge) and L3SMG did not differ, whereas EMG (ESM gauge) or T12SMG and L3SMG did (AUC: 0.80‒0.82 vs 0.87‒0.88; all P < .05). L3SMI, L3SMD, T12SMG, EMG, and PMG showed no association with 1-year cancer-related mortality after adjusting for confounders; however, L3SMG [relative risk = 0.92 (0.85‒0.99); P = .023) was. CONCLUSIONS AND IMPLICATIONS L3SMG covers all features of sarcopenia with more diagnostic value than other metrics, allowing a complete sarcopenia assessment with CT alone and not just in populations with cancer.
Collapse
Affiliation(s)
- Yunyun Zhang
- The Second School of Clinical Medicine, Xuzhou Medical University, Xuzhou, Jiangsu, China; Department of Rehabilitation, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Ting Zhang
- Department of Rehabilitation, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China; Medical Technology School, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Wenjing Yin
- The Second School of Clinical Medicine, Xuzhou Medical University, Xuzhou, Jiangsu, China; Department of Rehabilitation, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Lei Zhang
- Department of Medical Imaging, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Jie Xiang
- The Second School of Clinical Medicine, Xuzhou Medical University, Xuzhou, Jiangsu, China; Department of Rehabilitation, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China; Medical Technology School, Xuzhou Medical University, Xuzhou, Jiangsu, China.
| |
Collapse
|
3
|
Smith ACJ, Tse JJ, Waungana TH, Bott KN, Kuczynski MT, Michalski AS, Boyd SK, Manske SL. Internal calibration for opportunistic computed tomography muscle density analysis. PLoS One 2022; 17:e0273203. [PMID: 36251648 PMCID: PMC9576101 DOI: 10.1371/journal.pone.0273203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/02/2022] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Muscle weakness can lead to reduced physical function and quality of life. Computed tomography (CT) can be used to assess muscle health through measures of muscle cross-sectional area and density loss associated with fat infiltration. However, there are limited opportunities to measure muscle density in clinically acquired CT scans because a density calibration phantom, allowing for the conversion of CT Hounsfield units into density, is typically not included within the field-of-view. For bone density analysis, internal density calibration methods use regions of interest within the scan field-of-view to derive the relationship between Hounsfield units and bone density, but these methods have yet to be adapted for muscle density analysis. The objective of this study was to design and validate a CT internal calibration method for muscle density analysis. METHODOLOGY We CT scanned 10 bovine muscle samples using two scan protocols and five scan positions within the scanner bore. The scans were calibrated using internal calibration and a reference phantom. We tested combinations of internal calibration regions of interest (e.g., air, blood, bone, muscle, adipose). RESULTS We found that the internal calibration method using two regions of interest, air and adipose or blood, yielded accurate muscle density values (< 1% error) when compared with the reference phantom. The muscle density values derived from the internal and reference phantom calibration methods were highly correlated (R2 > 0.99). The coefficient of variation for muscle density across two scan protocols and five scan positions was significantly lower for internal calibration (mean = 0.33%) than for Hounsfield units (mean = 6.52%). There was no difference between coefficient of variation for the internal calibration and reference phantom methods. CONCLUSIONS We have developed an internal calibration method to produce accurate and reliable muscle density measures from opportunistic computed tomography images without the need for calibration phantoms.
Collapse
Affiliation(s)
- Ainsley C. J. Smith
- Biomedical Engineering Graduate Program, University of Calgary, Alberta, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Alberta, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Alberta, Canada
| | - Justin J. Tse
- Department of Radiology, Cumming School of Medicine, University of Calgary, Alberta, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Alberta, Canada
| | - Tadiwa H. Waungana
- Biomedical Engineering Graduate Program, University of Calgary, Alberta, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Alberta, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Alberta, Canada
| | - Kirsten N. Bott
- Department of Radiology, Cumming School of Medicine, University of Calgary, Alberta, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Alberta, Canada
| | - Michael T. Kuczynski
- Biomedical Engineering Graduate Program, University of Calgary, Alberta, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Alberta, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Alberta, Canada
| | - Andrew S. Michalski
- Biomedical Engineering Graduate Program, University of Calgary, Alberta, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Alberta, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Alberta, Canada
| | - Steven K. Boyd
- Biomedical Engineering Graduate Program, University of Calgary, Alberta, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Alberta, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Alberta, Canada
| | - Sarah L. Manske
- Biomedical Engineering Graduate Program, University of Calgary, Alberta, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Alberta, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Alberta, Canada
- * E-mail:
| |
Collapse
|
4
|
Ueno K, Kaneko H, Itoh H, Takeda N, Morita H, Fujiu K, Kamiya K, Komuro I. Effectiveness and Approach of Rehabilitation in Patients With Acute Heart Failure: A Review. Korean Circ J 2022; 52:576-592. [PMID: 35929052 PMCID: PMC9353252 DOI: 10.4070/kcj.2022.0181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 06/30/2022] [Indexed: 11/11/2022] Open
Abstract
Acute heart failure is associated with high mortality and frequent rehospitalization, resulting in enormous healthcare costs and declining physical function, activities of daily living, and quality of life. Cardiac rehabilitation has been recommended as one of the non-pharmacologic treatments for patients with heart failure. However, much of the evidence for cardiac rehabilitation interventions reported to date has been limited to chronic heart failure. In recent years, the effectiveness of rehabilitation intervention in patients with acute heart failure has been reported, led by the Rehabilitation Therapy in Older Acute Heart Failure Patients (REHAB-HF) trial. This review overviews the recent evidence of rehabilitation in patients with acute heart failure.
Collapse
Affiliation(s)
- Kensuke Ueno
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan
| | - Hidehiro Kaneko
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan.
| | - Hidetaka Itoh
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Norifumi Takeda
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
5
|
Yamashita M, Kamiya K, Matsunaga A, Kitamura T, Hamazaki N, Ichikawa T, Uchida S, Noda T, Yanagi N, Maekawa E, Yamaoka-Tojo M, Ako J, Miyaji K. Features of trunk muscle wasting during acute care and physical function recovery with aortic disease. J Cachexia Sarcopenia Muscle 2022; 13:1054-1063. [PMID: 35178890 PMCID: PMC8978005 DOI: 10.1002/jcsm.12935] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 01/02/2022] [Accepted: 01/17/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Low skeletal muscle area or density, such as myosteatosis, identified on computed tomography (CT) is associated with poor prognosis in patients with cardiovascular diseases. However, there is a lack of evidence regarding the clinical process of skeletal muscle decline as a short-term change during acute care settings. This study focused on the use of routine CT imaging for aortic disease management and investigated the changes in skeletal muscle before and after acute care. METHODS This prospective study included 123 patients who underwent abdominal CT before and after acute care. The all-abdominal and each abdominal muscle areas were divided into eight parts (e.g. rectus abdominis, psoas, and erector spine), and their areas and densities were measured at the third lumbar vertebra level after the patients were discharged and de-identified with blinding to avoid measurement bias. Short physical performance battery (SPPB) was measured at the start and end of in-hospital cardiac rehabilitation. A generalized linear model with patients as random effects was made to investigate skeletal muscle loss during acute care. Multivariate linear regression analysis was also used to assess the relationship between the change in skeletal muscle during acute care and SPPB during in-hospital cardiac rehabilitation. RESULTS The median age of the patients was 70 (interquartile: 58-77) years, and 69.9% (86/123) were men. The median day between acute care from the day of surgery or hospital admission and follow-up CT was 7 (interquartile: 3-8) days. Overall muscle density declined after acute care (estimate value: -3.640, 95% confidence interval [CI]: -4.538 to -2.741), and each abdominal muscle density consistently declined (interaction: F value = 0.099, P = 0.998). In contrast, there was no significant change in the overall muscle area (estimate value: -0.863, 95% CI: -2.925 to 1.200). Changes in the muscle area were different for each skeletal muscle (interaction: F value = 2.142, P = 0.037), and only the erector spine muscle significantly declined (estimate value: -1.836, 95% CI: -2.507 to -1.165). After adjusting for confounding factors, a greater decline in muscle density was associated with lower recovery score on SPPB (β = 0.296, 95% CI: 0.066 to 0.400). CONCLUSIONS Muscle density consistently declined after acute care, especially the erector spine muscles, which also significantly decreased in size. A higher decline in muscle density was associated with a slower recovery of physical function during in-hospital cardiac rehabilitation in patients with aortic diseases.
Collapse
Affiliation(s)
- Masashi Yamashita
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan.,Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan.,Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan.,Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan
| | - Tadashi Kitamura
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Takafumi Ichikawa
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Shota Uchida
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan
| | - Takumi Noda
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan
| | - Naoya Yanagi
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan.,Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kagami Miyaji
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| |
Collapse
|
6
|
Cross-sectional area of erector spinae muscles is associated with activities of daily living at discharge in middle- to older-aged patients with coronavirus disease 2019. Exp Gerontol 2022; 163:111774. [PMID: 35341940 PMCID: PMC8949841 DOI: 10.1016/j.exger.2022.111774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/05/2022] [Accepted: 03/19/2022] [Indexed: 11/23/2022]
Abstract
Objectives Measurement of skeletal muscle wasting using computed tomography (CT) is widely known to be useful in predicting prognosis. Although some reports have been found in patients with coronavirus disease 2019 (COVID-19), few reports have focused on the ability to perform activities of daily living (ADLs). This study retrospectively investigated the relationship between the erector spinae muscle area measured from CT images and ADL at the time of hospital discharge in patients with COVID-19. Methods Among patients aged 40 years or older, 271 patients (median age, 65 years; 180/271 male patients) who had CT cross-sectional images of the 12th thoracic vertebral level on admission were included. The Katz index was used to assess ADLs, and patients who were not completely independent were defined as dependent. Multivariable logistic and Poisson regression analyses were applied to examine the relationship between the cross-sectional area of the erector spinae muscles and the onset of ADL dependence at discharge. Results A total of 75 (27.7%) patients became dependent on ADL at the time of hospital discharge. Decreased erector spinae muscle area was significantly related to dependent ADL at discharge (adjusted odds ratio: 0.886, 95% confidence interval: 0.805–0.975). In addition, the erector spinae muscle area was significantly related to the number of ADL items for which independence was not achieved (adjusted incidence rate ratio: 0.959, P < 0.001). Conclusions The cross-sectional area of the erector spinae muscles from the thoracic CT image was associated with the ability to perform basic ADL at hospital discharge.
Collapse
|