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Koh JH, Tan LTP, Lim CYJ, Yuen LZH, Ho JSY, Tan JA, Sia CH, Yeo LLL, Koh FHX, Hallinan JTPD, Makmur A, Tan BYQ, Tan LF. Association of head and neck CT-derived sarcopenia with mortality and adverse outcomes: A systematic review. Arch Gerontol Geriatr 2024; 126:105549. [PMID: 38944005 DOI: 10.1016/j.archger.2024.105549] [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: 03/28/2024] [Revised: 06/11/2024] [Accepted: 06/24/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND There is growing interest in the association of CT-assessed sarcopenia with adverse outcomes in non-oncological settings. PURPOSE The aim of this systematic review is to summarize existing literature on the prognostic implications of CT-assessed sarcopenia in non-oncological patients. MATERIALS AND METHODS Three independent authors searched Medline/PubMed, Embase and Cochrane Library up to 30 December 2023 for observational studies that reported the presence of sarcopenia defined on CT head and neck in association with mortality estimates and other adverse outcomes, in non-oncological patients. The quality of included studies were assessed using the Quality of Prognostic Studies tool. RESULTS Overall, 15 studies (3829 participants) were included. Nine studies were at low risk of bias, and six were at moderate risk of bias. Patient populations included those admitted for trauma or treatment of intracranial aneurysms, ischemic stroke, transient ischemic attack, and intracranial stenosis. Sarcopenia was associated with increased 30-day to 2-year mortality in inpatients and patients undergoing carotid endarterectomy or mechanical thrombectomy for acute ischemic stroke. Sarcopenia was also associated with poorer neurological and functional outcomes, increased likelihood of admission to long-term care facilities, and longer duration of hospital stays. The observed associations of sarcopenia with adverse outcomes remained similar across different imaging modalities and methods for quantifying sarcopenia. CONCLUSION CT-assessed sarcopenia was associated with increased mortality and poorer outcomes across diverse patient populations. Measurement and early identification of sarcopenia in vulnerable patients allows for enhanced prognostication, and focused allocation of resources to mitigate adverse outcomes.
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Affiliation(s)
- Jin Hean Koh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lucas Tze Peng Tan
- Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Claire Yi Jia Lim
- Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Linus Zhen Han Yuen
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Justina Angel Tan
- Division of Geriatric Medicine, Department of Medicine, Alexandra Hospital, Singapore
| | - Ching Hui Sia
- Department of Cardiology, National University Heart Centre, Singapore
| | | | | | | | - Andrew Makmur
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Benjamin Y Q Tan
- Division of Neurology, Department of Medicine, National University Hospital, Singapore
| | - Li Feng Tan
- Department of Medicine, Alexandra Hospital, Singapore.
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Borda MG, Duque G, Pérez-Zepeda MU, Baldera JP, Westman E, Zettergren A, Samuelsson J, Kern S, Rydén L, Skoog I, Aarsland D. Using magnetic resonance imaging to measure head muscles: An innovative method to opportunistically determine muscle mass and detect sarcopenia. J Cachexia Sarcopenia Muscle 2024; 15:189-197. [PMID: 38050325 PMCID: PMC10834349 DOI: 10.1002/jcsm.13362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/04/2023] [Accepted: 09/20/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Sarcopenia is associated with multiple adverse outcomes. Traditional methods to determine low muscle mass for the diagnosis of sarcopenia are mainly based on dual-energy X-ray absorptiometry (DXA), whole-body magnetic resonance imaging (MRI) and bioelectrical impedance analysis. These tests are not always available and are rather time consuming and expensive. However, many brain and head diseases require a head MRI. In this study, we aim to provide a more accessible way to detect sarcopenia by comparing the traditional method of DXA lean mass estimation versus the tongue and masseter muscle mass assessed in a standard brain MRI. METHODS The H70 study is a longitudinal study of older people living in Gothenburg, Sweden. In this cross-sectional analysis, from 1203 participants aged 70 years at baseline, we included 495 with clinical data and MRI images available. We used the appendicular lean soft tissue index (ALSTI) in DXA images as our reference measure of lean mass. Images from the masseter and tongue were analysed and segmented using 3D Slicer. For the statistical analysis, the Spearman correlation coefficient was used, and concordance was estimated with the Kappa coefficient. RESULTS The final sample consisted of 495 participants, of which 52.3% were females. We found a significant correlation coefficient between both tongue (0.26) and masseter (0.33) with ALSTI (P < 0.001). The sarcopenia prevalence confirmed using the alternative muscle measure in MRI was calculated using the ALSTI (tongue = 2.0%, masseter = 2.2%, ALSTI = 2.4%). Concordance between sarcopenia with masseter and tongue versus sarcopenia with ALSTI as reference has a Kappa of 0.989 (P < 0.001) for masseter and a Kappa of 1 for the tongue muscle (P < 0.001). Comorbidities evaluated with the Cumulative Illness Rating Scale were significantly associated with all the muscle measurements: ALSTI (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.07-1.26, P < 0.001), masseter (OR 1.16, 95% CI 1.07-1.26, P < 0.001) and tongue (OR 1.13, 95% CI 1.04-1.22, P = 0.002); the higher the comorbidities, the higher the probability of having abnormal muscle mass. CONCLUSIONS ALSTI was significantly correlated with tongue and masseter muscle mass. When performing the sarcopenia diagnostic algorithm, the prevalence of sarcopenia calculated with head muscles did not differ from sarcopenia calculated using DXA, and almost all participants were correctly classified using both methods.
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Affiliation(s)
- Miguel German Borda
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway
- Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá, Colombia
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Gustavo Duque
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Dr. Joseph Kaufmann Chair in Geriatric Medicine, Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Mario Ulises Pérez-Zepeda
- Instituto Nacional de Geriatría, Dirección de Investigación, Ciudad de México, México
- Centro de Investigación en Ciencias de la Salud (CICSA), FCS, Universidad Anáhuac México Campus Norte, Huixquilucan, México
| | - Jonathan Patricio Baldera
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway
- Escuela de Estadística de la Universidad Autónoma de Santo Domingo, Santo Domingo, República Dominicana
| | - Eric Westman
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Anna Zettergren
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jessica Samuelsson
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Silke Kern
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Psychiatry, Cognition and Old Age Psychiatry, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Lina Rydén
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ingmar Skoog
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Psychiatry, Cognition and Old Age Psychiatry, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Dag Aarsland
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
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Janović A, Miličić B, Antić S, Bracanović Đ, Marković-Vasiljković B. Feasibility of using cross-sectional area of masticatory muscles to predict sarcopenia in healthy aging subjects. Sci Rep 2024; 14:2079. [PMID: 38267441 PMCID: PMC10808244 DOI: 10.1038/s41598-024-51589-4] [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: 11/01/2023] [Accepted: 01/07/2024] [Indexed: 01/26/2024] Open
Abstract
Determination of sarcopenia is crucial in identifying patients at high risk of adverse health outcomes. Recent studies reported a significant decline in masticatory muscle (MM) function in patients with sarcopenia. This study aimed to analyze the cross-sectional area (CSA) of MMs on computed tomography (CT) images and to explore their potential to predict sarcopenia. The study included 149 adult subjects retrospectively (59 males, 90 females, mean age 57.4 ± 14.8 years) who underwent head and neck CT examination for diagnostic purposes. Sarcopenia was diagnosed on CT by measuring CSA of neck muscles at the C3 vertebral level and estimating skeletal muscle index. CSA of MMs (temporal, masseter, medial pterygoid, and lateral pterygoid) were measured bilaterally on reference CT slices. Sarcopenia was diagnosed in 67 (45%) patients. Univariate logistic regression analysis demonstrated a significant association between CSA of all MMs and sarcopenia. In the multivariate logistic regression model, only masseter CSA, lateral pterygoid CSA, age, and gender were marked as predictors of sarcopenia. These parameters were combined in a regression equation, which showed excellent sensitivity and specificity in predicting sarcopenia. The masseter and lateral pterygoid CSA can be used to predict sarcopenia in healthy aging subjects with a high accuracy.
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Affiliation(s)
- Aleksa Janović
- School of Dental Medicine, Center for Diagnostic Imaging, University of Belgrade, 6 Rankeova, 11000, Belgrade, Republic of Serbia.
| | - Biljana Miličić
- School of Dental Medicine, Department of Statistics, University of Belgrade, 2 dr Subotića, 11000, Belgrade, Republic of Serbia
| | - Svetlana Antić
- School of Dental Medicine, Center for Diagnostic Imaging, University of Belgrade, 6 Rankeova, 11000, Belgrade, Republic of Serbia
| | - Đurđa Bracanović
- School of Dental Medicine, Center for Diagnostic Imaging, University of Belgrade, 6 Rankeova, 11000, Belgrade, Republic of Serbia
| | - Biljana Marković-Vasiljković
- School of Dental Medicine, Center for Diagnostic Imaging, University of Belgrade, 6 Rankeova, 11000, Belgrade, Republic of Serbia
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Lauksio I, Wallenius L, Lindström I, Kärkkäinen JM, Khan N, Hernesniemi J, Protto S, Oksala NKJ. Multivariable Analysis of Pre-operative Brain Atrophy as a Predictor of Long Term Mortality After Carotid Endarterectomy. Eur J Vasc Endovasc Surg 2023; 65:339-345. [PMID: 36209966 DOI: 10.1016/j.ejvs.2022.10.001] [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: 10/13/2021] [Revised: 09/04/2022] [Accepted: 10/02/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Brain atrophy is associated with an increased mortality rate in elderly trauma patients and in patients treated with mechanical thrombectomy for acute ischaemic stroke. In the setting of ischaemic stroke, the association between brain atrophy and death is stronger than that of sarcopenia. It has previously been shown that lower masseter area, as a marker of sarcopenia, is linked to lower survival after carotid endarterectomy (CEA). The aim of this study was to investigate whether brain atrophy is also associated with long term mortality in patients undergoing CEA. METHODS A cohort of patients treated with CEA between 2004 and 2010 was retrieved from the Tampere University Hospital vascular registry and those with available pre-operative computed tomography (CT) imaging were analysed retrospectively. CT images were evaluated for brain atrophy index (BAI) and masseter muscle surface area and density. The association between BAI and mortality was investigated with Cox regression. RESULTS Two hundred and thirty-three patients with a median (interquartile range [IQR]) age of 71 years (64.0, 77.0) were included. Most patients were operated on for symptomatic stenosis (n = 203; 87.1%). The median (IQR) duration of follow up was 115.0 months (66.0, 153.0), and 155 patients (66.5%) died during follow up. BAI was statistically significantly correlated with age (r = .489), average masseter density (r = -.202), and smoking (r = -.186; all p <.005). Increased BAI was statistically significantly associated with overall mortality (hazard ratio [HR] 1.45, 95% confidence interval [CI] 1.25 - 1.68, per one standard deviation [SD] increase) in the univariable analysis, and the association remained (HR 1.23, 95% CI 1.04 - 1.46, per one SD increase) in the multivariable models. Age, peripheral artery disease, and chronic obstructive pulmonary disease were also independently associated with mortality. The optimal cutoff value for BAI was 0.133. CONCLUSION Brain atrophy independently predicts the long term post-operative mortality rate after CEA in a cohort containing mainly symptomatic patients. Future studies are needed to validate the results in prospective settings and in asymptomatic patients.
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Affiliation(s)
- Iisa Lauksio
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Linda Wallenius
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Iisa Lindström
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Niina Khan
- Vascular Centre, Tampere University Hospital, Tampere, Finland
| | - Jussi Hernesniemi
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Cardiology, Tampere University Hospital, Heart Hospital, Tampere, Finland; Finnish Cardiovascular Research Center, Tampere, Finland
| | - Sara Protto
- Vascular Centre, Tampere University Hospital, Tampere, Finland
| | - Niku K J Oksala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Vascular Centre, Tampere University Hospital, Tampere, Finland; Finnish Cardiovascular Research Center, Tampere, Finland
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Takashima M, Arai Y, Matsuzaki N, Yamazaki Y, Nishiyama H, Nohno K. Masseter muscle cross-sectional area and late implant failure: A case-control study. Clin Implant Dent Relat Res 2023; 25:313-320. [PMID: 36726209 DOI: 10.1111/cid.13189] [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: 10/18/2022] [Revised: 01/22/2023] [Accepted: 01/23/2023] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Occlusal overload is considered to be one of the causes of late implant failure. However, it is unclear whether the magnitude of the patient's occlusal force is a risk factor for late implant failure. PURPOSE This case-control study aimed to clarify the association between the cross-sectional area (CSA) of the masseter muscle and late implant failure. METHODS This case-control study was limited to implant-supported fixed prostheses. We compared cases with at least one late implant failure (n = 25 patients) to controls (n = 82 patients) without implant failure. Patients were matched by age, sex, year of surgery, jaw and tooth type, and bone graft. Log-rank and Cox proportional hazard regression analyses were used to identify possible risk factors for late implant failure. RESULTS The incidence of late implant failure was significantly associated with masseter muscle CSA ≥504.5 mm2 (hazard ratio: 4.43; 95% CI: 1.82-10.79; p < 0.01). CONCLUSION Higher masseter muscle CSA increases the risk of late implant failure.
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Affiliation(s)
- Makiko Takashima
- Oral Implant and Temporomandibular Joint Clinic, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Yoshiaki Arai
- Oral Implant and Temporomandibular Joint Clinic, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Nanaka Matsuzaki
- Oral Implant and Temporomandibular Joint Clinic, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Yuta Yamazaki
- Oral Implant and Temporomandibular Joint Clinic, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Hideyoshi Nishiyama
- Division of Oral and Maxillofacial Radiology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kaname Nohno
- Department of Oral Health and Welfare, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Kamada T, Ohdaira H, Ito E, Takahashi J, Nakashima K, Nakaseko Y, Suzuki N, Yoshida M, Eto K, Suzuki Y. Association between masseter muscle sarcopenia and postoperative pneumonia in patients with esophageal cancer. Sci Rep 2022; 12:16374. [PMID: 36180776 PMCID: PMC9525668 DOI: 10.1038/s41598-022-20967-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/21/2022] [Indexed: 11/10/2022] Open
Abstract
Sarcopenia affects the swallowing and chewing muscles, such as the masseter muscle. However, the significance of masseter muscle loss in pneumonia remains unclear. We investigated the effects of masseter muscle sarcopenia (MMS) on postoperative pneumonia in patients with esophageal cancer. In this retrospective cohort study, we analyzed the data of 86 patients who underwent esophagectomy for stage I-III esophageal cancer at our hospital between March 2013 and October 2021. The primary endpoint was postoperative pneumonia within 3 months of surgery. MMS was defined as a (1) masseter muscle index (MMI) that was less than the sex-specific MMI cutoff values, and (2) sarcopenia diagnosed using the L3-psoas muscle index (L3-PMI). Postoperative pneumonia was noted in 27 (31.3%) patients. In multivariate analysis, FEV1.0 < 1.5 L (odds ratio, OR: 10.3; 95% confidence interval, CI 1.56-67.4; p = 0.015), RLNP (OR: 5.14; 95%CI 1.47-17.9; p = 0.010), and MMS (OR: 4.83; 95%CI 1.48-15.8; p = 0.009) were independent risk factors for postoperative pneumonia. The overall survival was significantly worse in patients with pneumonia (log-rank: p = 0.01) than in those without pneumonia. Preoperative MMS may serve as a predictor of postoperative pneumonia in patients with esophageal cancer.
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Affiliation(s)
- Teppei Kamada
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara, Tochigi, 329-2763, Japan.
| | - Hironori Ohdaira
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara, Tochigi, 329-2763, Japan
| | - Eisaku Ito
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara, Tochigi, 329-2763, Japan
| | - Junji Takahashi
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara, Tochigi, 329-2763, Japan
| | - Keigo Nakashima
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara, Tochigi, 329-2763, Japan
| | - Yuichi Nakaseko
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara, Tochigi, 329-2763, Japan
| | - Norihiko Suzuki
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara, Tochigi, 329-2763, Japan
| | - Masashi Yoshida
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara, Tochigi, 329-2763, Japan
| | - Ken Eto
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Yutaka Suzuki
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara, Tochigi, 329-2763, Japan
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Association between Masseter Muscle Area and Thickness and Outcome after Carotid Endarterectomy: A Retrospective Cohort Study. J Clin Med 2022; 11:jcm11113087. [PMID: 35683474 PMCID: PMC9181694 DOI: 10.3390/jcm11113087] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/23/2022] [Accepted: 05/27/2022] [Indexed: 02/01/2023] Open
Abstract
Low muscle mass is associated with adverse outcomes after surgery. This study examined whether facial muscles, such as the masseter muscle, could be used as a proxy for generalized low muscle mass and could be associated with deviant outcomes after carotid endarterectomy (CEA). As a part of the Vascular Ageing study, patients with an available preoperative CT-scan, who underwent an elective CEA between December 2009 and May 2018, were included. Bilateral masseter muscle area and thickness were measured on preoperative CT scans. A masseter muscle area or thickness of one standard deviation below the sex-based mean was considered low masseter muscle area (LMA) or low masseter muscle thickness (LMT). Of the 123 included patients (73.3% men; mean age 68 (9.7) years), 22 (17.9%) patients had LMA, and 18 (14.6%) patients had LMT. A total of 41 (33.3%) patients had a complicated postoperative course and median length of hospital stay was four (4–5) days. Recurrent stroke within 5 years occurred in eight (6.6%) patients. Univariable analysis showed an association between LMA, complications and prolonged hospital stay. LMT was associated with a prolonged hospital stay (OR 8.78 [1.15–66.85]; p = 0.036) and recurrent stroke within 5 years (HR 12.40 [1.83–84.09]; p = 0.010) in multivariable logistic regression analysis. Masseter muscle might be useful in preoperative risk assessment for adverse short- and long-term postoperative outcomes.
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Ito E, Ohki T, Nakagawa H, Toya N. The masseter muscle thickness is a predictive marker for postoperative pneumonia after endovascular aneurysm repair. Surg Today 2022; 52:1591-1598. [PMID: 35511358 DOI: 10.1007/s00595-022-02506-7] [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: 01/19/2022] [Accepted: 02/22/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Oral frailty is characterized by a decrease in the oral and swallowing function and is a risk factor for pneumonia. In the current study, we analyzed the association between the masseter muscle thickness (MMT) and postoperative pneumonia and mortality after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm. METHODS Overall, 247 patients were retrospectively evaluated. The primary end point was postoperative pneumonia. The MMT was measured as the maximum thickness of the masseter muscle 2 cm caudal to the zygomatic arch using computed tomography images obtained within 3 months before EVAR. Pneumonia was defined as the presence of progressive infiltrates, consolidation, or cavitation on imaging and a fever or leukocytosis. RESULTS Twenty (8.1%) cases of postoperative pneumonia occurred within 1 year after EVAR. We found that patients with a low MMT (≤ 30th percentile: males, 10.4 mm; females: 8.8 mm) had a significantly higher risk of developing postoperative pneumonia within 1 year after elective EVAR than those with a high value. A comparison of the utility of the MMT and psoas muscle index (PMI) for predicting the 1-, 3-, and 5-year all-cause mortality revealed that the MMT had superior predictive performance. CONCLUSION The MMT before elective EVAR predicted postoperative pneumonia and life expectancy, and its predictive performance was superior to that of the PMI.
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Affiliation(s)
- Eisaku Ito
- Division of Vascular Surgery, Department of Surgery, The Jikei University Kashiwa Hospital, Tokyo, Japan
| | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, 3-19-18, Nishi-shimbashi, Minato-city, Tokyo, 105-8471, Japan.
| | - Hikaru Nakagawa
- Division of Vascular Surgery, Department of Surgery, The Jikei University Kashiwa Hospital, Tokyo, Japan
| | - Naoki Toya
- Division of Vascular Surgery, Department of Surgery, The Jikei University Kashiwa Hospital, Tokyo, Japan
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9
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Varma S, Wilson MSJ, Naik M, Sandhu A, Ota HCU, Aylwin C, Fertleman M, Peck G. The associations of psoas and masseter muscles with sarcopenia and related adverse outcomes in older trauma patients: a retrospective study. Aging Clin Exp Res 2022; 34:1901-1908. [PMID: 35357685 PMCID: PMC9283168 DOI: 10.1007/s40520-022-02119-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 03/14/2022] [Indexed: 11/25/2022]
Abstract
Background There is an emerging role for radiological evaluation of psoas muscle as a marker of sarcopenia in trauma patients. Older trauma patients are more likely to undergo cranial than abdomino-pelvic imaging. Identifying sarcopenia using masseter cross-sectional area (M-CSA) has shown correlation with mortality. We sought to determine the correlation between psoas: lumbar vertebral index (PLVI) and the M-CSA, and their association with health outcomes. Methods Patients aged 65 or above, who presented as a trauma call over a 1-year period were included if they underwent cranial or abdominal CT imaging. Images were retrospectively analysed to obtain PLVI and mean M-CSA measurements. Electronic records were abstracted for outcomes. Logistic regression methods, log scale analyses, Cox regression model and Kaplan–Meier plots were used to determine association of sarcopenia with outcomes. Results There were 155 eligible patients in the M-CSA group and 204 patients in the PLVI group. Sarcopenia was defined as the lowest quartile in each group. Pearson’s correlation indicated a weakly positive linear relationship (r = 0.35, p < 0.001) between these. There was no statistical association between M-CSA sarcopenia status and any measured outcomes. Those with PLVI sarcopenia were more likely to die in hospital (adjusted OR 3.38, 95% CI 1.47–9.73, p = 0.006) and at 2 years (adjusted HR 1.90, 95% CI 1.11–3.25, p = 0.02). Only 29% patients with PLVI sarcopenia were discharged home, compared with 58% without sarcopenia (p = 0.001). Conclusion Sarcopenia, defined by PLVI, is predictive of increased in-patient and 2-year mortality. Our study did not support prognostic relevance of M-CSA.
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10
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McGoldrick DM, Yassin Alsabbagh A, Shaikh M, Pettit L, Bhatia SK. Masseter muscle defined sarcopenia and survival in head and neck cancer patients. Br J Oral Maxillofac Surg 2022; 60:454-458. [PMID: 35339299 DOI: 10.1016/j.bjoms.2021.07.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 07/28/2021] [Indexed: 11/18/2022]
Abstract
Sarcopenia is increasingly recognised as a poor prognostic factor in older patients undergoing cancer treatment. Recently, masseter muscle cross sectional area (MMCSA) has been shown to accurately identify sarcopenic patients. We aimed to apply this novel technique to a head and neck cohort to identify any potential relationship with survival. A retrospective review was undertaken of patients over 65 years, diagnosed with squamous cell carcinoma of the head and neck and treated with curative intent in our unit between October 2009 and October 2017. MMCSA was measured on staging CT scans using a validated technique. Patients were categorised into tertiles and also high and low MMCSA groups based on gender based tertile and mean MMCSA values. Survival analysis was performed using the Kaplan-Meier and Cox regression methods. A total of 111 patients were included in the study. The average age was 74 years (range 65-92 years) and 69% were male. The majority of patients had malignancies of the oral cavity (41%) or larynx (37%). The overall survival was 46% with a follow-up between 24 and 60 months. MMCSA was significantly associated with worse overall survival when defined using a gender based mean cut-off point (p=0.038) or tertile groupings (p=0.026), but did not maintain significance in multivariable analysis. Masseter muscle defined sarcopenia was associated with worse survival in our cohort in univariate analysis.Opportunistic measurement of this new factor on staging scans may aid prognostication and management in older patients.
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Affiliation(s)
- David M McGoldrick
- Department of Oral and Maxillofacial Surgery, Shrewsbury and Telford Hospital NHS Trust, Telford, UK.
| | - Aghiad Yassin Alsabbagh
- Department of Oral and Maxillofacial Surgery, Shrewsbury and Telford Hospital NHS Trust, Telford, UK
| | - Moinuddin Shaikh
- Department of Radiology, Shrewsbury and Telford Hospital NHS Trust, Telford, UK
| | - Laura Pettit
- Department of Clinical Oncology, Shrewsbury and Telford Hospital NHS Trust, Telford, UK
| | - Sunil K Bhatia
- Department of Clinical Oncology, Shrewsbury and Telford Hospital NHS Trust, Telford, UK
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van Heusden HC, Chargi N, Dankbaar JW, Smid EJ, de Bree R. Masseter muscle parameters can function as an alternative for skeletal muscle mass assessments on cross-sectional imaging at lumbar or cervical vertebral levels. Quant Imaging Med Surg 2022; 12:15-27. [PMID: 34993057 PMCID: PMC8666780 DOI: 10.21037/qims-21-43] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/25/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients with head and neck cancer are at increased risk of developing low skeletal muscle mass (SMM), which is associated with adverse treatment outcomes and prognosis. Low SMM is most commonly assessed by the skeletal muscle cross sectional area (CSA) at the third lumbar vertebra (L3) or more recently the third cervical vertebra (C3). L3 is not routinely imaged and C3 may be impacted by disease or treatment. As an alternative we analyzed masseter muscle characteristics and their relationship with L3 and C3 skeletal muscle CSA and overall survival (OS). METHODS In this single-center retrospective study, 99 patients with head and neck cancer who underwent whole body FDG-PET/CT-scans were reviewed. Of these patients, L3 CSA, C3 CSA, masseter CSA, masseter thickness, masseter volume, masseter Hounsfield Unit values, lumbar skeletal muscle index (LSMI), cervical skeletal muscle index (CSMI), and masseter skeletal muscle index (MSMI) were recorded and correlated with each other and with OS. RESULTS We included 72 male and 27 female patients. The masseter muscle parameters differed significantly between sexes. The Spearman correlation coefficients for C3 CSA-Masseter volume and L3 CSA-Masseter volume were 0.639 and 0.531 (P<0.001) respectively. In multivariate analysis low MSMI was a predictor of OS (HR 2.227, P=0.009). CONCLUSIONS There is a moderate to strong association between the masseter muscle volume (MV) and C3 CSA and L3 CSA. MSMI predicts OS. Further research should investigate the relationship between muscle function and masseter muscle parameters and impacting factors on masseter muscle dimensions.
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Affiliation(s)
- Hugo C. van Heusden
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Najiba Chargi
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Jan Willem Dankbaar
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Ernst J. Smid
- Department of Radiation Oncology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
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12
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Poorthuis MH, Herings RA, Dansey K, Damen JA, Greving JP, Schermerhorn ML, de Borst GJ. External Validation of Risk Prediction Models to Improve Selection of Patients for Carotid Endarterectomy. Stroke 2022; 53:87-99. [PMID: 34634926 PMCID: PMC8712365 DOI: 10.1161/strokeaha.120.032527] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE The net benefit of carotid endarterectomy (CEA) is determined partly by the risk of procedural stroke or death. Current guidelines recommend CEA if 30-day risks are <6% for symptomatic stenosis and <3% for asymptomatic stenosis. We aimed to identify prediction models for procedural stroke or death after CEA and to externally validate these models in a large registry of patients from the United States. METHODS We conducted a systematic search in MEDLINE and EMBASE for prediction models of procedural outcomes after CEA. We validated these models with data from patients who underwent CEA in the American College of Surgeons National Surgical Quality Improvement Program (2011-2017). We assessed discrimination using C statistics and calibration graphically. We determined the number of patients with predicted risks that exceeded recommended thresholds of procedural risks to perform CEA. RESULTS After screening 788 reports, 15 studies describing 17 prediction models were included. Nine were developed in populations including both asymptomatic and symptomatic patients, 2 in symptomatic and 5 in asymptomatic populations. In the external validation cohort of 26 293 patients who underwent CEA, 702 (2.7%) developed a stroke or died within 30-days. C statistics varied between 0.52 and 0.64 using all patients, between 0.51 and 0.59 using symptomatic patients, and between 0.49 to 0.58 using asymptomatic patients. The Ontario Carotid Endarterectomy Registry model that included symptomatic status, diabetes, heart failure, and contralateral occlusion as predictors, had C statistic of 0.64 and the best concordance between predicted and observed risks. This model identified 4.5% of symptomatic and 2.1% of asymptomatic patients with procedural risks that exceeded recommended thresholds. CONCLUSIONS Of the 17 externally validated prediction models, the Ontario Carotid Endarterectomy Registry risk model had most reliable predictions of procedural stroke or death after CEA and can inform patients about procedural hazards and help focus CEA toward patients who would benefit most from it.
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Affiliation(s)
| | - Reinier A.R. Herings
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kirsten Dansey
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, US
| | - Johanna A.A. Damen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jacoba P. Greving
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marc L. Schermerhorn
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, US
| | - Gert J. de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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13
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Cho HJ, Hwang Y, Yang S, Kim M. A Comprehensive Analysis of the Association of Psoas and Masseter Muscles with Traumatic Brain Injury Using Computed Tomography Anthropometry. J Korean Neurosurg Soc 2021; 64:950-956. [PMID: 34689478 PMCID: PMC8590921 DOI: 10.3340/jkns.2021.0004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/10/2021] [Indexed: 12/25/2022] Open
Abstract
Objective Psoas and masseter muscles are known markers of sarcopenia. However, the relative superiority of either muscle as a marker is unclear. Therefore, this study analyzed the two muscles in patients with a prognosis of traumatic brain injury (TBI).
Methods Patients with TBI visiting a regional trauma center between January 2017 and December 2018 were selected, and their medical records were reviewed. TBI patients with an abbreviated injury score (AIS) of 4 or 5 were selected. Patients with an AIS of 4 or 5 at the chest, abdomen, and extremity were excluded. Patients with a hospital stay of 1 to 2 days were excluded. Both muscle areas were measured based on the initial computed tomography. The psoas muscle index (PMI) and the masseter muscle index (MMI) were calculated by dividing both muscle areas by height in meters squared (cm2/m2). These muscle parameters along with other medical information were used to analyze mortality and the Glasgow outcome scale (GOS).
Results A total of 179 patients, including 147 males (82.1%), were analyzed statistically. The mean patient age was 58.0 years. The mortality rate was 16.8% (30 patients). The mean GOS score was 3.7. Analysis was performed to identify the parameters associated with mortality, which was a qualitative study outcome. The psoas muscle area (16.9 vs. 14.4 cm2, p=0.028) and PMI (5.9 vs. 5.1 cm2/m2, p=0.004) showed statistical differences between the groups. The PMI was also statistically significant as a risk factor for mortality in logistic regression analysis (p=0.023; odds ratio, 0.715; 95% confidence interval, 0.535–0.954). Quantitative analyses were performed with the GOS scores. Bivariate correlation analysis showed a statistically significant correlation between PMI and GOS scores (correlation coefficient, 0.168; p=0.003). PMI (p=0.004, variation inflation factor 1.001) was significant in multiple regression analysis. The masseter muscle area and MMI did not show significance in the study.
Conclusion Larger PMI was associated with statistically significant improved survival and GOS scores, indicating its performance as a superior prognostic marker. Further analyses involving a larger number of patients, additional parameters, and more precise settings would yield a better understanding of sarcopenia and TBI.
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Affiliation(s)
- Hang Joo Cho
- Department of Trauma Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yunsup Hwang
- Department of Radiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seiyun Yang
- Department of Neurourgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Maru Kim
- Department of Trauma Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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14
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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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15
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Lauksio I, Lindström I, Khan N, Sillanpää N, Hernesniemi J, Oksala N, Protto S. Brain atrophy predicts mortality after mechanical thrombectomy of proximal anterior circulation occlusion. J Neurointerv Surg 2020; 13:415-420. [PMID: 32620574 DOI: 10.1136/neurintsurg-2020-016168] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/31/2020] [Accepted: 06/06/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Brain atrophy is associated with an inferior functional outcome in patients undergoing mechanical thrombectomy (MT) for acute ischemic stroke. We hypothesized that brain atrophy determined from pre-interventional non-contrast-enhanced CT scans would also be linked to increased mortality in this cohort. METHODS A total of 204 patients treated with MT for acute occlusions of the internal carotid artery (ICA) or the M1 segment of the middle cerebral artery (M1) at Tampere University Hospital, Finland between 2013 and 2017 were retrospectively studied. Brain atrophy index (BAI), masseter muscle surface area and density, chronic ischemic lesions, and white matter lesions were evaluated from pre-interventional CT studies. Logistic regression was applied in analyzing the association of BAI with 3-month mortality. RESULTS Median age at baseline was 69.9 years (IQR 15.6) and mortality at 3 months was 13.2% (n=27). BAI, measured with excellent reproducibility (intraclass correlation coefficient ≥0.894, p<0.001), was significantly associated with age (r=0.54), white matter lesions (r=0.43), dental status (r=-0.31), masseter area (r=-0.24), masseter density (r=-0.28), and chronic ischemic lesions (r=0.24) (p≤0.001 for all). In univariable analysis, BAI demonstrated a strong association with mortality (OR 2.02, 95% CI 1.34 to 3.05, per 1 SD increase), and none of the other factors associated with mortality remained as significant when included in the same multivariable model. The results remained similar when extending the follow-up up to 2.5 years. CONCLUSIONS Brain atrophy predicts 3-month mortality after MT of the ICA or the M1 independent of age, masseter sarcopenia, chronic ischemic lesions, or white matter lesions.
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Affiliation(s)
- Iisa Lauksio
- Surgery, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Iisa Lindström
- Surgery, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Niina Khan
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland
| | - Niko Sillanpää
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland
| | - Jussi Hernesniemi
- Internal Medicine, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Tays Heart Hospital, Tampere University Hospital, Tampere, Finland.,Finnish Cardiovascular Research Center, Tampere University Hospital, Tampere, Finland
| | - Niku Oksala
- Surgery, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland.,Finnish Cardiovascular Research Center, Tampere University Hospital, Tampere, Finland
| | - Sara Protto
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland
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16
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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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17
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Lindström I, Protto S, Khan N, Hernesniemi J, Sillanpää N, Oksala N. Association of masseter area and radiodensity with three-month survival after proximal anterior circulation occlusion. J Neurointerv Surg 2020; 13:25-29. [PMID: 32303585 DOI: 10.1136/neurintsurg-2020-015837] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/19/2020] [Accepted: 03/24/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Masseter area (MA), a surrogate for sarcopenia, appears to be useful when estimating postoperative survival, but there is lack of consensus regarding the potential predictive value of sarcopenia in acute ischemic stroke (AIS) patients. We hypothesized that MA and density (MD) evaluated from pre-interventional CT angiography scans predict postinterventional survival in patients undergoing mechanical thrombectomy (MT). MATERIALS AND METHODS 312 patients treated with MT for acute occlusions of the internal carotid artery (ICA) or the M1 segment of the middle cerebral artery (M1-MCA) between 2013 and 2018. Median follow-up was 27.4 months (range 0-70.4). Binary logistic (alive at 3 months, OR <1) and Cox regression analyses were used to study the effect of MA and MD averages (MAavg and MDavg) on survival. RESULTS In Kaplan-Meier analysis, there was a significant inverse relationship with both MDavg and MAavg and mortality (MDavg P<0.001, MAavg P=0.002). Long-term mortality was 19.6% (n=61) and 3-month mortality 12.2% (n=38). In multivariable logistic regression analysis at 3 months, per 1-SD increase MDavg (OR 0.61, 95% CI 0.41 to 0.92, P=0.018:) and MAavg (OR 0.57, 95% CI 0.35 to 0.91, P=0.019) were the independent predictors associated with lower mortality. In Cox regression analysis, MDavg and MAavg were not associated with long-term survival. CONCLUSIONS In acute ischemic stroke patients, MDavg and MAavg are independent predictors of 3-month survival after MT of the ICA or M1-MCA. A 1-SD increase in MDavg and MAavg was associated with a 39%-43% decrease in the probability of death during the first 3 months after MT.
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Affiliation(s)
- Iisa Lindström
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sara Protto
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland
| | - Niina Khan
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland
| | - Jussi Hernesniemi
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Cardiology, Tampere University Hospital, Heart Hospital, Tampere, Finland.,Finnish Cardiovascular Research Center, Tampere University Hospital, Tampere, Finland
| | - Niko Sillanpää
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland
| | - Niku Oksala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland.,Finnish Cardiovascular Research Center, Tampere University Hospital, Tampere, Finland
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18
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Choke E, Tan JSJ. Chewing the Rag: Masseters, Sarcopenia, and Late Survival After Carotid Surgery. Eur J Vasc Endovasc Surg 2019; 57:339. [PMID: 30686674 DOI: 10.1016/j.ejvs.2018.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 12/12/2018] [Indexed: 11/16/2022]
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