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Sridhar M, Bodduluri S, O'Hare L, Blumhoff S, Acosta Lara MDP, de Andrade JA, Kim YI, Luckhardt T, McDonald M, Kulkarni T. Association of musculoskeletal involvement with lung function and mortality in patients with idiopathic pulmonary fibrosis. Respir Res 2024; 25:81. [PMID: 38326848 PMCID: PMC10851557 DOI: 10.1186/s12931-024-02705-5] [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: 11/07/2023] [Accepted: 01/25/2024] [Indexed: 02/09/2024] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressive disease associated with high mortality. Low muscle mass, frailty and sarcopenia lead to functional impairment that negatively impact quality of life and survival but are not used in clinical practice. We aimed to determine the association of Fat-free mass index (FFMI) and frailty with lung function, exercise tolerance and survival in patients with IPF. In this study, 70 patients with IPF underwent assessment of body composition, lung function, 6-min walk distance (6MWD) testing, hand grip strength, quality of life (QoL) assessment by St. George's Respiratory questionnaire (SGRQ) and frailty assessment using the SHARE-FI tool. FFMI was calculated using pectoralis muscle cross-sectional area (PM-CSA) on CT chest images and the lowest quartile defined reduced muscle mass. Sarcopenia was defined as low FFMI and handgrip strength. Regression analyses were conducted to determine predictive value of frailty, low FFMI and sarcopenia on clinical outcomes. The Cox proportional hazards model was used to analyze the impact of FFMI and frailty score on survival. The mean age was 70 years with moderate impairment in lung function (mean ppFVC 68.5%, ppDLCO 45.6%). Baseline forced vital capacity (p < 0.001), diffusion capacity of lung for carbon monoxide (p = < 0.01), 6WMD (p < 0.05) were significantly lower in frail patients compared to non-frail patients. BMI was found to closely correlate with FFMI (r = 0.79, p < 0.001), but not with frailty score (r = - 0.2, p = 0.07). Frailty was a significant predictor of FVC, DLCO, 6MWD, SGRQ scores when adjusted for age and gender. Muscle mass and sarcopenia were significant predictors of FVC, DLCO, but not 6MWD or QoL scores. Multivariate cox-proportional hazards ratio model adjusting for age and gender showed that frailty was significantly associated with increased mortality (HR = 2.6, 95% CI 1.1-6.1). Low FFMI (HR = 1.3, 95% CI 0.6-2.8), and sarcopenia (HR = 2.1, 95% CI 0.8-5.3), though associated with a trend to increased mortality, were not statistically significant. Frailty is associated with lower lung function and higher mortality in patients with IPF. Longitudinal evaluations are necessary to further determine the associations between low FFMI, sarcopenia and frailty with outcomes in IPF.
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Affiliation(s)
- Meenakshi Sridhar
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sandeep Bodduluri
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lanier O'Hare
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Maria Del Pilar Acosta Lara
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joao A de Andrade
- Division of Pulmonary, Allergy and Critical Care Medicine, Vanderbilt University, Nashville, TN, USA
| | - Young-Il Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tracy Luckhardt
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - MerryLynn McDonald
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Genetics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tejaswini Kulkarni
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
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Genkin D, Jenkins AR, van Noord N, Makimoto K, Collins S, Stickland MK, Tan WC, Bourbeau J, Jensen D, Kirby M. A fully automated pipeline for the extraction of pectoralis muscle area from chest computed tomography scans. ERJ Open Res 2024; 10:00485-2023. [PMID: 38259805 PMCID: PMC10801752 DOI: 10.1183/23120541.00485-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/09/2023] [Indexed: 01/24/2024] Open
Abstract
Background Computed tomography (CT)-derived pectoralis muscle area (PMA) measurements are prognostic in people with or at-risk of COPD, but fully automated PMA extraction has yet to be developed. Our objective was to develop and validate a PMA extraction pipeline that can automatically: 1) identify the aortic arch slice; and 2) perform pectoralis segmentation at that slice. Methods CT images from the Canadian Cohort of Obstructive Lung Disease (CanCOLD) study were used for pipeline development. Aorta atlases were used to automatically identify the slice containing the aortic arch by group-based registration. A deep learning model was trained to segment the PMA. The pipeline was evaluated in comparison to manual segmentation. An external dataset was used to evaluate generalisability. Model performance was assessed using the Dice-Sorensen coefficient (DSC) and PMA error. Results In total 90 participants were used for training (age 67.0±9.9 years; forced expiratory volume in 1 s (FEV1) 93±21% predicted; FEV1/forced vital capacity (FVC) 0.69±0.10; 47 men), and 32 for external testing (age 68.6±7.4 years; FEV1 65±17% predicted; FEV1/FVC 0.50±0.09; 16 men). Compared with manual segmentation, the deep learning model achieved a DSC of 0.94±0.02, 0.94±0.01 and 0.90±0.04 on the true aortic arch slice in the train, validation and external test sets, respectively. Automated aortic arch slice detection obtained distance errors of 1.2±1.3 mm and 1.6±1.5 mm on the train and test data, respectively. Fully automated PMA measurements were not different from manual segmentation (p>0.05). PMA measurements were different between people with and without COPD (p=0.01) and correlated with FEV1 % predicted (p<0.05). Conclusion A fully automated CT PMA extraction pipeline was developed and validated for use in research and clinical practice.
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Affiliation(s)
- Daniel Genkin
- Department of Electrical, Computer, and Biomedical Engineering, Toronto Metropolitan University, Toronto, Canada
| | - Alex R. Jenkins
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, Canada
| | - Nikki van Noord
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, Canada
| | - Kalysta Makimoto
- Department of Physics, Toronto Metropolitan University, Toronto, Canada
| | - Sophie Collins
- Department of Medicine, University of Alberta, Edmonton, Canada
| | | | - Wan C. Tan
- Center for Heart, Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Jean Bourbeau
- Montreal Chest Institute of the Royal Victoria Hospital, McGill University Health Centre, Montreal, Canada
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of McGill University Health Centre, Montreal, Canada
| | - Dennis Jensen
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, Canada
- Montreal Chest Institute of the Royal Victoria Hospital, McGill University Health Centre, Montreal, Canada
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of McGill University Health Centre, Montreal, Canada
- Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Miranda Kirby
- Department of Physics, Toronto Metropolitan University, Toronto, Canada
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Çinkooğlu A, Bayraktaroğlu S, Ufuk F, Unat ÖS, Köse T, Savaş R, Bishop NM. Reduced CT-derived erector spinae muscle area: a poor prognostic factor for short- and long-term outcomes in idiopathic pulmonary fibrosis patients. Clin Radiol 2023; 78:904-911. [PMID: 37690976 DOI: 10.1016/j.crad.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/25/2023] [Accepted: 08/15/2023] [Indexed: 09/12/2023]
Abstract
AIM To assess the relationship between idiopathic pulmonary fibrosis (IPF) prognosis, baseline skeletal muscle mass, and attenuation on computed tomography (CT) and clinical parameters. MATERIAL AND METHODS This retrospective cohort study enrolled 195 patients. The mean follow-up duration was 42.52 months. Erector spinae muscle area (ESMA), pectoralis muscle area (PMA), and the attenuation of the erector spinae muscle at the level of T12 vertebrae were measured. Muscle indexes were obtained by adjusting the measured muscle areas to the patients' heights. The relationship between baseline CT-derived muscle metrics and clinical parameters including short- and long-term mortality were evaluated. RESULTS There was a moderate correlation between ESMA and PMA and pectoralis muscle index (PMI; r=0.536, p<0001 and r=0.403, p<0.001 respectively). ESMA correlated significantly with forced expiratory volume in 1 second (FEV1; hazard ratio [HR] = 0.488 p<0.001) and forced vital capacity (FVC; HR=0.501, p<0.001). Compared with PMA, ESMA was more strongly associated with 1- and 2-year mortality in patients with IPF (HR=0.957, p=0.022). The survival rate in male patients with sarcopenia was significantly worse (p=0.040). CONCLUSION ESMA measurements obtained from CT correlated with clinical parameters in IPF patients and were also predictors of short- and long-term survival.
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Affiliation(s)
- A Çinkooğlu
- Department of Radiology, Ege University Faculty of Medicine, Bornova, Izmir, Turkey.
| | - S Bayraktaroğlu
- Department of Radiology, Ege University Faculty of Medicine, Bornova, Izmir, Turkey
| | - F Ufuk
- Department of Radiology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Ö S Unat
- Department of Respiratory Medicine, Ege University Faculty of Medicine, Bornova, Izmir, Turkey
| | - T Köse
- Department of Biostatistics, Ege University Faculty of Medicine, Bornova, Izmir, Turkey
| | - R Savaş
- Department of Radiology, Ege University Faculty of Medicine, Bornova, Izmir, Turkey
| | - N Moğulkoç Bishop
- Department of Respiratory Medicine, Ege University Faculty of Medicine, Bornova, Izmir, Turkey
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Erlandson KM, Umbleja T, Lu MT, Taron J, Ribaudo HJ, Overton ET, Presti RM, Haas DW, Sax PE, Yin MT, Zhai BK, Louis R, Upadhyay N, Eslami P, Douglas PS, Zanni MV, Fitch KV, Fulda ES, Fichtenbaum CJ, Malvestutto CD, Grinspoon SK, Brown TT. Associations of Muscle Density and Area With Coronary Artery Plaque and Physical Function. J Acquir Immune Defic Syndr 2023; 94:174-184. [PMID: 37368931 PMCID: PMC10527277 DOI: 10.1097/qai.0000000000003244] [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: 11/29/2022] [Accepted: 06/01/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVE Skeletal muscle quality and mass are important for maintaining physical function during advancing age. We leveraged baseline data from Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) to evaluate whether paraspinal muscle density and muscle area are associated with cardiac or physical function outcomes in people with HIV (PWH). METHODS REPRIEVE is a double-blind randomized trial evaluating the effect of pitavastatin for primary prevention of major adverse cardiovascular events in PWH. This cross-sectional analysis focuses on participants who underwent coronary computed tomography at baseline. Lower thoracic paraspinal muscle density (Hounsfield units [HU]) and area (cm 2 ) were assessed on noncontrast computed tomography. RESULTS Of 805 PWH, 708 had paraspinal muscle measurements. The median age was 51 years and 17% were natal female patients. The median muscle density was 41 HU (male) and 30 HU (female); area 13.2 cm 2 /m (male) and 9.9 cm 2 /m (female). In adjusted analyses, greater density (less fat) was associated with a lower prevalence of any coronary artery plaque, coronary artery calcium score >0, and high plaque burden ( P = 0.06); area was not associated with plaque measures. Among 139 patients with physical function measures, greater area (but not density) was associated with better performance on a short physical performance battery and grip strength. CONCLUSIONS Among PWH, greater paraspinal muscle density was associated with a lower prevalence of coronary artery disease while greater area was associated with better physical performance. Whether changes in density or area are associated with changes in CAD or physical performance will be evaluated through longitudinal analyses in REPRIEVE.
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Affiliation(s)
- Kristine M Erlandson
- Division of Infectious Diseases, Department of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, CO
| | - Triin Umbleja
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Michael T Lu
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Jana Taron
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
- Faculty of Medicine, Department of Radiology, University of Freiburg Medical Center, University of Freiburg, Freiburg, Germany
| | - Heather J Ribaudo
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Edgar T Overton
- Division of Infectious Diseases, University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | - Rachel M Presti
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - David W Haas
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
- Department of Internal Medicine, Meharry Medical College, Nashville, TN
| | - Paul E Sax
- Division of Infectious Disease, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Michael T Yin
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY
| | - Bingxue Kris Zhai
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Rochelle Louis
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Namrata Upadhyay
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Parastou Eslami
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Markella V Zanni
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Kathleen V Fitch
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Evelynne S Fulda
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Carl J Fichtenbaum
- Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Carlos D Malvestutto
- Division of Infectious Diseases, Ohio State University Medical Center, Columbus, OH; and
| | - Steven K Grinspoon
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Todd T Brown
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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5
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O'Mahony AT, Henry PJ, Coghlan P, Waldron M, Crowley C, Ryan D, Moore N, Bennett DM, O'Connor OJ, Maher MM, Henry MT. Analytic Morphomics in Myositis-Related Interstitial Lung Disease. Lung 2023; 201:345-353. [PMID: 37458801 PMCID: PMC10444650 DOI: 10.1007/s00408-023-00637-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/04/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE Interstitial lung disease (ILD) is the most common non-musculoskeletal manifestation of idiopathic inflammatory myopathies (IIM). Identification of body composition change may enable early intervention to improve prognosis. We investigated muscle quantity and quality derived from cross-sectional imaging in IIM, and its relationship to ILD severity. METHODS A retrospective cohort study assessing IIM of ILD patients (n = 31) was conducted. Two datasets separated in time were collected, containing demographics, biochemical data, pulmonary function testing and thoracic CT data. Morphomic analysis of muscle quantity (cross-sectional area) and quality (density in Hounsfield Units) on thoracic CT were analysed utilising a web-based tool allowing segmentation of muscle and fat. Bilateral erector spinae and pectoralis muscle (ESM&PM) were measured at defined vertebral levels. RESULTS FVC and DLCO decreased but within acceptable limits of treatment response (FVC: 83.7-78.7%, p < 0.05, DLCO 63.4-60.6%, p < 0.05). The cross-sectional area of the PM and ESM increased (PM: 39.8 to 40.7 cm2, p = 0.491; ESM: 35.2 to 39.5 cm2, p = 0.098). Density significantly fell for both the PM and ESM (PM: 35.3-31 HU, p < 0.05; ESM: 38-33.7, p < 0.05). Subcutaneous fat area increased from 103.9 to 136.1 cm2 (p < 0.05), while the visceral fat area increased but not reaching statistical significance. The change in PM density between time points demonstrated an inverse correlation with DLCO (p < 0.05, R = - 0.49). CONCLUSION Patients with IIM ILD demonstrated significant body composition changes on CT imaging unlikely to be detected by traditional measurement tools. An increase in muscle area with an inverse decrease in density suggests poor muscle quality.
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Affiliation(s)
| | | | - Patrick Coghlan
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - Michael Waldron
- Department of Radiology, Cork University Hospital, Cork, Ireland.
- Department of Radiology, University College Cork, Cork, Ireland.
| | - Claire Crowley
- Department of Radiology, Mercy University Hospital, Cork, Ireland
| | - David Ryan
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Niamh Moore
- Department of Radiography, School of Medicine, University College Cork, Cork, Ireland
| | | | - Owen J O'Connor
- Department of Radiology, University College Cork, Cork, Ireland
| | - Michael M Maher
- Department of Radiology, Cork University Hospital, Cork, Ireland
- Department of Radiology, University College Cork, Cork, Ireland
- Department of Radiology, Mercy University Hospital, Cork, Ireland
| | - Michael T Henry
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
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6
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Hanada M, Ishimatsu Y, Sakamoto N, Akiyama Y, Kido T, Ishimoto H, Oikawa M, Nagura H, Takeuchi R, Sato S, Takahata H, Mukae H, Kozu R. Urinary titin N-fragment as a predictor of decreased skeletal muscle mass in patients with interstitial lung diseases. Sci Rep 2023; 13:9723. [PMID: 37322176 PMCID: PMC10272142 DOI: 10.1038/s41598-023-36827-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 06/10/2023] [Indexed: 06/17/2023] Open
Abstract
This study aimed to examine the validity of urinary N-terminal titin fragment/creatinine (urinary N-titin/Cr) reflecting muscle damage biomarker in patients with interstitial lung disease. This retrospective study enrolled patients with interstitial lung disease. We measured urinary N-titin/Cr. Furthermore, we measured the cross-sectional areas of the pectoralis muscles above the aortic arch (PMCSA) and erector spinae muscles of the 12th thoracic vertebra muscles (ESMCSA) to assess muscle mass until 1 year. We examined the correlation between urinary N-titin/Cr and the change in muscle mass. We plotted receiver operating characteristic curves to estimate the cut-off points for urinary N-titin/Cr for distinguishing the greater-than-median and smaller-than-median reduction of muscle mass after 1 year. We enrolled 68 patients with interstitial lung disease. The median urinary N-titin/Cr value was 7.0 pmol/mg/dL. We observed significant negative correlations between urinary N-titin/Cr and changes in the PMCSA after 1 year (p < 0.001) and changes in the ESMCSA after 6 months (p < 0.001) and 1 year (p < 0.001). The cut-off points for urinary N-titin/Cr were 5.2 pmol/mg/dL and 10.4 pmol/mg/dL in the PMCSA and ESMCSA, respectively. In summary, urinary N-titin/Cr may predict muscle loss in the long-term and act as a clinically useful biomarker reflecting muscle damage.
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Affiliation(s)
- Masatoshi Hanada
- Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yuji Ishimatsu
- Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8520, Japan.
| | - Noriho Sakamoto
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yoshiko Akiyama
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takashi Kido
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroshi Ishimoto
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masato Oikawa
- Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroki Nagura
- Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Rina Takeuchi
- Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Shuntaro Sato
- Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Hideaki Takahata
- Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ryo Kozu
- Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Ito Y, Anan K, Awano N, Kataoka Y, Johkoh T, Fujimoto K, Ichikado K, Tobino K, Tachikawa R, Ito H, Nakamura T, Kishaba T, Yamamoto Y, Inomata M, Izumo T. Skeletal muscle atrophy and short-term mortality in patients with acute exacerbation of idiopathic pulmonary fibrosis: an observational cohort study. Respir Investig 2023; 61:371-378. [PMID: 37079942 DOI: 10.1016/j.resinv.2023.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/10/2023] [Accepted: 02/26/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Skeletal muscle atrophy, a common complication of idiopathic pulmonary fibrosis (IPF), and its presence upon diagnosis can indicate a poor prognosis. Patients with IPF frequently experience acute exacerbations (AE), which is associated with a high mortality rate. However, the association between skeletal muscle atrophy and short-term mortality remains unknown. METHODS We performed a retrospective, multicenter cohort study of patients admitted for AE-IPF in Japan. The cross-sectional areas of the erector spinae muscle (ESMCSA) and the pectoralis muscle (PMCSA) were analyzed via single-slice computed tomography (CT). The primary outcome was 90-day mortality. Survival probability was estimated using the Kaplan-Meier method, and the log-rank test was used between the low and high groups of ESMCSA and PMCSA. We used multivariable Cox proportional-hazards models to evaluate the association between ESMCSA and PMCSA and prognosis. RESULTS Of the 212 patients included, 94 (44%) died during the observation period. The low ESMCSA group (<25.6 cm2) had a significantly worse prognosis than that of the high ESMCSA group (≥25.6 cm2) (hazard ratio (HR) [95% confidence interval (CI)]: 1.52 [1.00-2.33], P = 0.049). Multivariable analyses showed that all-cause mortality was associated with low ESMCSA (model 1, adjusted HR [95% CI]: 1.59 [0.98-2.60]; model 2, 1.55 [0.95-2.56], and model 3, 1.67 [1.00-2.78], respectively). The adjusted HR of low PMCSA (<20.4 cm2) vs. high PMCSA (≥20.4 cm2) was 1.39 (95% CI: 0.88-2.20). CONCLUSIONS Low ESMCSA on CT images is associated with a high 90-day mortality rate in patients with AE-IPF.
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Affiliation(s)
- Yu Ito
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Japan
| | - Keisuke Anan
- Department of Healthcare Epidemiology, Kyoto University, Graduate School of Medicine, Kyoto, Japan; Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan; Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan
| | - Nobuyasu Awano
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Japan.
| | - Yuki Kataoka
- Department of Healthcare Epidemiology, Kyoto University, Graduate School of Medicine, Kyoto, Japan; Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan; Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Kyoto, Japan; Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Takeshi Johkoh
- Department of Radiology, Kansai Rosai Hospital, Hyogo, Japan
| | - Kiminori Fujimoto
- Department of Radiology, Kurume University School of Medicine, Fukuoka, Japan
| | - Kazuya Ichikado
- Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, Fukuoka, Japan
| | - Ryo Tachikawa
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Hiroyuki Ito
- Department of Pulmonology, Kameda Medical Center, Chiba, Japan
| | - Takahito Nakamura
- Department of General Internal Medicine, Nara Prefecture Seiwa Medical Center, Nara, Japan
| | - Tomoo Kishaba
- Department of Respiratory Medicine, Okinawa Chubu Hospital, Okinawa, Japan
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Minoru Inomata
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Japan
| | - Takehiro Izumo
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Japan
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8
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Comes A, Ryerson CJ. Response. Chest 2022; 162:e204-e205. [PMID: 36210118 DOI: 10.1016/j.chest.2022.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 06/29/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Alessia Comes
- Università Cattolica del Sacro Cuore, Facoltà di Medicina e Chirurgia, Rome, Italy.
| | - Christopher J Ryerson
- The University of British Columbia, Medicine; The University of British Columbia, Centre for Heart Lung Innovation, Vancouver, BC, Canada
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9
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Rinaldi S, Balsillie C, Truchon C, AL‐Mubarak A, Mura M, Madill J. Nutrition implications of intrinsic restrictive lung disease. Nutr Clin Pract 2022; 37:239-255. [DOI: 10.1002/ncp.10849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Sylvia Rinaldi
- School of Food and Nutritional Science, Brescia University College Western University London Ontario Canada
| | - Christine Balsillie
- School of Food and Nutritional Science, Brescia University College Western University London Ontario Canada
| | - Cassandra Truchon
- School of Food and Nutritional Science, Brescia University College Western University London Ontario Canada
| | - Awatif AL‐Mubarak
- School of Food and Nutritional Science, Brescia University College Western University London Ontario Canada
| | - Marco Mura
- Division of Respirology, Schulich School of Medicine and Dentistry Western University London Ontario Canada
| | - Janet Madill
- School of Food and Nutritional Science, Brescia University College Western University London Ontario Canada
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10
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Núñez-Cortés R, Cruz-Montecinos C, Martinez-Arnau F, Torres-Castro R, Zamora-Risco E, Pérez-Alenda S, Andersen LL, Calatayud J, Arana E. 30 s sit-to-stand power is positively associated with chest muscle thickness in COVID-19 survivors. Chron Respir Dis 2022; 19:14799731221114263. [PMID: 35957593 PMCID: PMC9379968 DOI: 10.1177/14799731221114263] [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] [Indexed: 12/03/2022] Open
Abstract
Introduction After hospitalization, early detection of musculoskeletal sequelae might help
healthcare professionals to improve and individualize treatment,
accelerating recovery after COVID-19. The objective was to determine the
association between the 30s sit-to-stand muscle power (30s-STS) and
cross-sectional area of the chest muscles (pectoralis) in COVID-19
survivors. Method This cross-sectional study collected routine data from COVID-19 survivors
one month after hospitalization: 1) a chest computed tomography (CT) scan
and 2) a functional capacity test (30s-STS). The pectoralis muscle area
(PMA) was measured from axial CT images. For each gender, patients were
categorized into tertiles based on PMA. The 30s-STS was performed to
determine the leg extension power. The allometric and relative STS power
were calculated as absolute 30s-STS power normalized to height squared and
body mass. The two-way ANOVA was used to compare the gender-stratified
tertiles of 30s-STS power variants. Results Fifty-eight COVID-19 survivors were included (mean age 61.2 ± 12.9 years,
30/28 (51.7%/48.3%) men/women). The two-way ANOVA showed significant
differences between the PMA tertiles in absolute STS power
(p = .002) and allometric STS power (p
= .001). There were no significant gender x PMA tertile interactions (all
variables p > .05). The high tertile of PMA showed a
higher allometric STS power compared to the low and middle tertile,
p = .002 and p = .004, respectively.
Absolute STS power and allometric STS power had a moderate correlation with
the PMA, r = 0.519 (p < .001) and r = 0.458
(p < .001) respectively. Conclusion The 30s-STS power is associated with pectoralis muscle thickness in both male
and female COVID-19 survivors. Thus, this test may indicate global
muscle-wasting and may be used as a screening tool for lower extremity
functional capacity in the early stages of rehabilitation planning in
COVID-19 survivors.
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Affiliation(s)
- Rodrigo Núñez-Cortés
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), 16781University of Valencia, Valencia, Spain.,Department of Physical Therapy, Faculty of Medicine, 14655University of Chile, Santiago, Chile.,Day Hospital Unit, Hospital Clínico Florida, Santiago, Chile
| | - Carlos Cruz-Montecinos
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), 16781University of Valencia, Valencia, Spain.,Department of Physical Therapy, Faculty of Medicine, 14655University of Chile, Santiago, Chile.,Section of Research, Innovation and Development in Kinesiology, Kinesiology Unit, San José Hospital, Santiago, Chile
| | - Francisco Martinez-Arnau
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), 16781University of Valencia, Valencia, Spain
| | - Rodrigo Torres-Castro
- Department of Physical Therapy, Faculty of Medicine, 14655University of Chile, Santiago, Chile.,International Physiotherapy Research Network (PhysioEvidence), Barcelona, Spain
| | | | - Sofía Pérez-Alenda
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), 16781University of Valencia, Valencia, Spain
| | - Lars L Andersen
- 2686National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Joaquín Calatayud
- 2686National Research Centre for the Working Environment, Copenhagen, Denmark.,Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, 16781University of Valencia, Valencia, Spain
| | - Estanislao Arana
- Department of Radiology, 16829Fundación Instituto Valenciano de Oncología, Valencia, Spain
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11
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OKURA K, TAKAHASHI Y, HASEGAWA K, HATAKEYAMA K, SAITO K, IMAIZUMI C, KAGA H, TAKAHASHI N. Early Pulmonary Rehabilitation with Neuromuscular Electrical Stimulation in a Patient with Acute Exacerbation of Rheumatoid Arthritis-associated Interstitial Lung Disease: A Case Report. Phys Ther Res 2022; 25:156-161. [PMID: 36819914 PMCID: PMC9910346 DOI: 10.1298/ptr.e10188] [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: 04/07/2022] [Accepted: 10/07/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Early implementation of neuromuscular electrical stimulation (NMES) has been reported to prevent muscle atrophy and physical functional decline in patients requiring mechanical ventilation. However, its effect in patients with acute exacerbation of interstitial lung disease (ILD) remains unclear. We herein report our experience using the NMES combined with mobilization in a patient with an acute exacerbation of rheumatoid arthritis-associated ILD (RA-ILD) requiring mechanical ventilation. CASE PRESENTATION A 74-year-old man was admitted to the intensive care unit (ICU) and put on mechanical ventilation due to severe acute exacerbation of RA-ILD. Early mobilization and the NMES using a belt electrode skeletal muscle electrical stimulation system were started on day 7 of hospitalization (day 2 of ICU admission). The NMES duration was 20 min, performed once daily. The patient could perform mobility exercises on day 8 and could walk on day 16. We assessed his rectus femoris and quadriceps muscle thicknesses using ultrasound imaging, and found decreases of 4.5% and 8.4%, respectively, by day 14. On day 27, he could independently visit the lavatory, and the NMES was discontinued. He was instructed to start long-term oxygen therapy on day 49 and was discharged on day 63. His 6-minute walk distance was 308 m and his muscle thickness recovered to levels comparable to those at the initial evaluation at the time of discharge. CONCLUSION Combining the NMES and mobilization started in the early phase and continued after ICU discharge was safe and effective in a patient with a severe acute exacerbation of RA-ILD.
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Affiliation(s)
- Kazuki OKURA
- Division of Rehabilitation, Akita University Hospital, Japan
| | | | - Kakeru HASEGAWA
- Division of Rehabilitation, Akita University Hospital, Japan
| | | | - Kimio SAITO
- Division of Rehabilitation, Akita University Hospital, Japan
| | - Chihiro IMAIZUMI
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Japan
| | - Hajime KAGA
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Japan
| | - Naoto TAKAHASHI
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Japan
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12
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Mendes RG, Castello-Simões V, Trimer R, Garcia-Araújo AS, Gonçalves Da Silva AL, Dixit S, Di Lorenzo VAP, Archiza B, Borghi-Silva A. Exercise-Based Pulmonary Rehabilitation for Interstitial Lung Diseases: A Review of Components, Prescription, Efficacy, and Safety. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:744102. [PMID: 36188788 PMCID: PMC9397914 DOI: 10.3389/fresc.2021.744102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/21/2021] [Indexed: 11/13/2022]
Abstract
Interstitial lung diseases (ILDs) comprise a heterogeneous group of disorders (such as idiopathic pulmonary fibrosis, sarcoidosis, asbestosis, and pneumonitis) characterized by lung parenchymal impairment, inflammation, and fibrosis. The shortness of breath (i.e., dyspnea) is a hallmark and disabling symptom of ILDs. Patients with ILDs may also exhibit skeletal muscle dysfunction, oxygen desaturation, abnormal respiratory patterns, pulmonary hypertension, and decreased cardiac function, contributing to exercise intolerance and limitation of day-to-day activities. Pulmonary rehabilitation (PR) including physical exercise is an evidence-based approach to benefit functional capacity, dyspnea, and quality of life in ILD patients. However, despite recent advances and similarities with other lung diseases, the field of PR for patients with ILD requires further evidence. This mini-review aims to explore the exercise-based PR delivered around the world and evidence supporting prescription modes, considering type, intensity, and frequency components, as well as efficacy and safety of exercise training in ILDs. This review will be able to strengthen the rationale for exercise training recommendations as a core component of the PR for ILD patients.
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Affiliation(s)
- Renata G. Mendes
- Cardiopulmonary Physiotherapy Laboratory, Department of Physiotherapy, Federal University of Sao Carlos (UFSCar), Sao Carlos, Brazil
- *Correspondence: Renata G. Mendes
| | - Viviane Castello-Simões
- Cardiopulmonary Physiotherapy Laboratory, Department of Physiotherapy, Federal University of Sao Carlos (UFSCar), Sao Carlos, Brazil
| | - Renata Trimer
- Cardiorespiratory Rehabilitation Laboratory, Health Sciences Department, University of Santa Cruz do Sul, Santa Cruz do Sul, Brazil
| | - Adriana S. Garcia-Araújo
- Cardiopulmonary Physiotherapy Laboratory, Department of Physiotherapy, Federal University of Sao Carlos (UFSCar), Sao Carlos, Brazil
| | - Andrea Lucia Gonçalves Da Silva
- Cardiorespiratory Rehabilitation Laboratory, Health Sciences Department, University of Santa Cruz do Sul, Santa Cruz do Sul, Brazil
| | - Snehil Dixit
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Valéria Amorim Pires Di Lorenzo
- Laboratory of Spirometry and Respiratory Physiotherapy, Department of Physiotherapy, Federal University of Sao Carlos (UFSCar), Sao Carlos, Brazil
| | - Bruno Archiza
- Cardiopulmonary Physiotherapy Laboratory, Department of Physiotherapy, Federal University of Sao Carlos (UFSCar), Sao Carlos, Brazil
| | - Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Department of Physiotherapy, Federal University of Sao Carlos (UFSCar), Sao Carlos, Brazil
- Audrey Borghi-Silva
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