Pectoralis muscle area is associated with bone mineral density and lung function in lung transplant candidates

Pre-operative pectoralis muscle area index is associated with biomarkers of inflammation and endotoxemia and predicts clinical outcomes after left ventricular assist device implantation: A cohort study

BACKGROUND

Pre-left ventricular assist device (LVAD) pectoralis muscle assessment, an estimate of sarcopenia, has been associated with postoperative mortality and gastrointestinal bleeding, though its association with inflammation, endotoxemia, length-of-stay (LOS), and readmissions remains underexplored.

METHODS

This was a single-center cohort study of LVAD patients implanted 1/2015-10/2018. Preoperative pectoralis muscle area was measured on chest computed tomography (CT), adjusted for height squared to derive pectoralis muscle area index (PMI). Those with PMI in the lowest quintile were defined as low-PMI cohort; all others constituted the reference cohort. Biomarkers of inflammation (interleukin-6, adiponectin, tumor necrosis factor-α [TNFα]) and endotoxemia (soluble (s)CD14) were measured in a subset of patients.

RESULTS

Of the 254 LVAD patients, 95 had a preoperative chest CT (median days pre-LVAD: 7 [IQR 3-13]), of whom 19 (20.0%) were in the low-PMI cohort and the remainder were in the reference cohort. Compared with the reference cohort, the low-PMI cohort had higher levels of sCD14 (2594 vs. 1850 ng/mL; p = 0.04) and TNFα (2.9 vs. 1.9 pg/mL; p = 0.03). In adjusted analyses, the low-PMI cohort had longer LOS (incidence rate ratio 1.56 [95% confidence interval 1.16-2.10], p = 0.004) and higher risk of 90-day and 1-year readmissions (subhazard ratio 5.48 [1.88-16.0], p = 0.002; hazard ratio 1.73 [1.02-2.94]; p = 0.04, respectively).

CONCLUSIONS

Pre-LVAD PMI is associated with inflammation, endotoxemia, and increased LOS and readmissions.

Vertebral HU value and the pectoral muscle index based on chest CT can be used to opportunistically screen for osteoporosis

BACKGROUND

Existing studies have shown that computed tomography (CT) attenuation and skeletal muscle tissue are strongly associated with osteoporosis; however, few studies have examined whether vertebral HU values and the pectoral muscle index (PMI) measured at the level of the 4th thoracic vertebra (T4) are strongly associated with bone mineral density (BMD). In this study, we demonstrate that vertebral HU values and the PMI based on chest CT can be used to opportunistically screen for osteoporosis and reduce fracture risk through prompt treatment.

METHODS

We retrospectively evaluated 1000 patients who underwent chest CT and DXA scans from August 2020-2022. The T4 HU value and PMI were obtained using manual chest CT measurements. The participants were classified into normal, osteopenia, and osteoporosis groups based on the results of dual-energy X-ray (DXA) absorptiometry. We compared the clinical baseline data, T4 HU value, and PMI between the three groups of patients and analyzed the correlation between the T4 HU value, PMI, and BMD to further evaluate the diagnostic efficacy of the T4 HU value and PMI for patients with low BMD and osteoporosis.

RESULTS

The study ultimately enrolled 469 participants. The T4 HU value and PMI had a high screening capacity for both low BMD and osteoporosis. The combined diagnostic model-incorporating sex, age, BMI, T4 HU value, and PMI-demonstrated the best diagnostic efficacy, with areas under the receiver operating characteristic curve (AUC) of 0.887 and 0.892 for identifying low BMD and osteoporosis, respectively.

CONCLUSIONS

The measurement of T4 HU value and PMI on chest CT can be used as an opportunistic screening tool for osteoporosis with excellent diagnostic efficacy. This approach allows the early prevention of osteoporotic fractures via the timely screening of individuals at high risk of osteoporosis without requiring additional radiation.

Predictive Value of CT Biomarkers in Lung Transplantation Survival: Preliminary Investigation in a Diverse, Underserved, Urban Population

INTRODUCTION

Survival following lung transplant is low. With limited donor lung availability, predicting post-transplant survival is key. We investigated the predictive value of pre-transplant CT biomarkers on survival.

METHODS

In this single-center retrospective cohort study of adults in a diverse, underserved, urban lung transplant program (11/8/2017-5/20/2022), chest CTs were analyzed using TeraRecon to assess musculature, fat, and bone. Erector spinae and pectoralis muscle area and attenuation were analyzed. Sarcopenia thresholds were 34.3 (women) and 38.5 (men) Hounsfield Units (HU). Visceral and subcutaneous fat area and HU, and vertebral body HU were measured. Demographics and pre-transplant metrics were recorded. Survival analyses included Kaplan-Meier and Cox proportional hazard.

RESULTS

The study cohort comprised 131 patients, 50 women, mean age 60.82 (SD 10.15) years, and mean follow-up 1.78 (SD 1.23) years. Twenty-nine percent were White. Mortality was 32.1%. Kaplan-Meier curves did not follow the proportional hazard assumption for sex, so analysis was stratified. Pre-transplant EMR metrics did not predict survival. Women without sarcopenia at erector spinae or pectoralis had 100% survival (p = 0.007). Sarcopenia did not predict survival in men and muscle area did not predict survival in either sex. Men with higher visceral fat area and HU had decreased survival (p = 0.02). Higher vertebral body density predicted improved survival in men (p = 0.026) and women (p = 0.045).

CONCLUSION

Pre-transplantation CT biomarkers had predictive value in lung transplant survival and varied by sex. The absence of sarcopenia in women, lower visceral fat attenuation and area in men, and higher vertebral body density in both sexes predicted survival in our diverse, urban population.

Muscle mass cross-sectional area is associated with survival outcomes in malignant pleural disease related to lung cancer

INTRODUCTION

Malignant pleural effusions are common in advanced malignancy and associated with overall poor survival. The presence of sarcopenia (decreased muscle mass) is associated with poor outcomes in numerous disease states, however, its relationship to malignant pleural disease has not been defined. We sought to understand if there was an association between decreased survival and decreased muscle mass in patients with malignant pleural effusion.

METHODS

Patients with malignant pleural disease undergoing indwelling tunneled pleural catheter placement were retrospectively reviewed. Computed tomography was reviewed and cross-sectional area of pectoralis and paraspinous muscle areas were calculated. Overall survival and associations with muscle mass were calculated.

RESULTS

A total of 309 patients were available for analysis, with a median age of 67 years and the majority female (58%). The median survival was 129 days from initial pleural drainage to death. Regression analysis and Kaplan-Meier survival analysis did not reveal an association with survival and muscle mass for the entire population. However, Kaplan-Meier survival analysis of the lung cancer subgroup revealed the presence of decreased muscle mass and decreased survival time.

CONCLUSION

The presence of decreased muscle mass within a lung cancer population that has malignant pleural effusions are associated with decreased survival. However, the presence of decreased muscle mass within a heterogenous population of malignant pleural disease was not associated with decreased overall survival time. Further study of the role that sarcopenia may play in malignant pleural disease is warranted.

Pectoralis muscle index might be a factor associated with frailty in older women with breast cancer

BACKGROUND

To investigate the possible relationship between pectoralis muscle (PM) measurement and frailty in older women with breast cancer (BC) (preoperatively defined as stage 1, 2, and 3 diseases).

METHODS

This retrospective, observational study was conducted at Konya Training and Research Hospital between June and December 2020. A total of 102 patients [median age 62.5 years, median follow-up period two years] were included in the study. PM measurements were obtained from thorax computerized tomography (CT). Pectoralis muscle index (PMI) was calculated by dividing the PM area by the height square of the patients (cm2/m2). Pectoralis muscle density (PMD) was evaluated using CT findings, including their Hounsfield Units (HU). Frailty status and sarcopenia-risk assessments were done by a telephone interview in September 2020 using the FRAIL index (categorized as robust or nonrobust) and SARC-F questionnaire (classified as no sarcopenia-risk or risk of sarcopenia), respectively. PM measurements were compared between robust and nonrobust patients and between patients with a risk of sarcopenia and no sarcopenia risk.

RESULTS

The nonrobust patients had lower pectoralis major muscle index (PMaMI) (p = 0.041) and pectoralis major muscle density(PMaD) (p = 0.020) levels than robust patients in the whole study sample. PMI (p = 0.017) and PMaMI (p = 0.010) levels were significantly lower in the nonrobust patients than in robust patients with early-stage BC. Frailty status was positively correlated with age (rho: 0.621; p < 0.001), BC stage (rho: 0.220; p = 0.026), and SARC-F score (rho: 0.747; p < 0.001), and negatively correlated with PMaMI (rho: -0.197; p = 0.047) and PMaD (rho: -0.237; p = 0.016). There were significant associations between PMaMI (OR: 0.467, 95% Confidence Interval (CI): 0.226-0.962 p = 0.039) and PMI (OR: 0.543, 95% CI: 0.299-0.986 p = 0.045) levels with frailty status (being nonrobust) in regression models.

DISCUSSION

In the study, it has been shown that pectoralis muscle assessment might be a related parameter to frailty in older women with breast cancer.

Retrospective analysis of the relationship between bone mineral density and body composition in a health check-up Chinese population

PURPOSE

This study was designed to explore the relationship between bone mineral density (BMD) and body composition indicators in Chinese adults (≥50 years) in order to provide a scientific basis for optimal bone health management.

METHOD

Individuals ≥50 years old who received physical examinations and routine check-ups at the Health Management Research Institute of PLA General Hospital from September 2014 through March 2022 were included as research subjects in this study. Basic clinical and demographic information were recorded for all subjects, along with smoking and drinking status, height and body weight. A panel of routine blood chemistry and metabolite markers were measured, along with lean muscle mass and body fat mass using body composition bioelectrical impedance analysis (BIA). Body mass index (BMI), body fat percentage (BFP), skeletal muscle mass index (SMI), and bone mineral density (BMD) were calculated for all individuals. For comparative analysis, individuals were grouped based on their BMI, BFP, SMI and BMD T-score. Follow-up examinations were performed in a cohort of 1,608 individuals matched for age, sex, smoking and drinking history for ≥5 years.

RESULTS

In this large cross-sectional study, age, smoking, homocysteine (Hcy) and blood glucose levels were established as independent risk factors for osteoporosis. Multi-factor logistic regression analysis showed that age, sex, BMI, intact parathyroid hormone (iPTH), SMI, BFP, smoking, blood levels of inorganic phosphate (P) and K+ were all significantly associated with osteoporosis risk (P<0.05). A subset of these factors- BMI, SMI, BFP and K+, were determined to be protective. In the cohort followed for ≥5 years, SMI and BMD decreased while BFP and BMI increased significantly (P<0.001) over time.

CONCLUSION

Risk of osteoporosis may be reduced by increasing body weight, particularly lean muscle mass, while simultaneously controlling BFP.