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Pfeiffer P, Wittemann K, Mattern L, Buchholz V, El Beyrouti H, Ghazy A, Oezkur M, Duerr GD, Probst C, Treede H, Dohle DS. The Effect of Obesity on Short- and Long-Term Outcome after Surgical Treatment for Acute Type A Aortic Dissection. Life (Basel) 2024; 14:955. [PMID: 39202697 PMCID: PMC11355667 DOI: 10.3390/life14080955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/24/2024] [Accepted: 07/28/2024] [Indexed: 09/03/2024] Open
Abstract
BACKGROUND A paradox of lower morbidity and mortality in overweight or obese patients undergoing cardiac surgery has been described; however, knowledge about the influence of obesity in patients with acute Type A aortic dissection (AAD) is limited. This study aimed to evaluate the effect of obesity on short- and long-term outcomes after surgical treatment for AAD. METHODS Between 01/2004 and 12/2022, 912 patients with a BMI of 18.5 or greater were operated on for AAD. Patients were grouped according to their BMI (normal weight: BMI 18.5-24.9, n = 332; overweight: BMI 25-29.9, n = 367; obesity class I: BMI 30-34.9, n = 133; obesity class II+: BMI ≥ 35, n = 67), and the obtained clinical and surgical data were compared. RESULTS Obese patients were younger at the time of AAD (p = 0.001) and demonstrated higher rates of typical cardiovascular comorbidities (arterial hypertension, p = 0.005; diabetes mellitus, p < 0.001). The most important preoperative parameters, as well as the surgical approach, were similar between all four groups. The occurrence of renal failure requiring dialysis was higher in patients with BMI ≥ 35 (p = 0.010), but the in-hospital (p = 0.461) and long-term survival (p = 0.894) showed no significant differences. CONCLUSIONS There are no indications that the obesity paradox is applicable in the setting of AAD. Since obese patients are affected by AAD at a younger age, obesity might constitute a risk factor for AAD. However, obesity does not influence short- or long-term survival. Regardless of body weight, immediate surgical therapy remains the treatment of choice for AAD.
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Affiliation(s)
- Philipp Pfeiffer
- Department of Cardiovascular Surgery, University Medical Center Mainz, 55131 Mainz, Germany; (K.W.); (L.M.); (V.B.); (H.E.B.); (A.G.); (M.O.); (G.D.D.); (C.P.); (H.T.); (D.-S.D.)
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Navas-Moreno V, Sebastian-Valles F, Rodríguez-Laval V, Knott-Torcal C, Marazuela M, de la Blanca NS, Arranz Martín JA, Girón RM, Sampedro-Núñez MA. Impact of CFTR modulator therapy on body composition as assessed by thoracic computed tomography: A follow-up study. Nutrition 2024; 123:112425. [PMID: 38621324 DOI: 10.1016/j.nut.2024.112425] [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: 12/06/2023] [Revised: 01/30/2024] [Accepted: 03/09/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVE Treatment with cystic fibrosis transmembrane conductance regulator (CFTR) modulators in individuals with cystic fibrosis (CF) has brought a significant change in forced expiratory volume in 1 second (FEV1) and clinical parameters. However, it also results in weight gain. The aim of our study is to evaluate the effect of CFTR modulator treatment on body composition, measured by computed tomography (CT). METHODS Adult subjects with CF under follow-up at La Princesa University Hospital were recruited. All of them were on elexacaftor-tezacaftor-ivacaftor (ELX/TEZ/IVA) treatment. Body composition analysis was conducted using CT scans and an open-source software. The results were then compared with bioimpedance estimations, as well as other clinical and spirometry data. RESULTS Our sample consisted of 26 adult subjects. The fat mass compartments on CT scans correlated with similar compartments on bioimpedance, and normal-density muscle mass exhibited a strong correlation with phase angle. Higher levels of very low-density muscle prior to treatment were associated with lower final FEV1 and less improvement in FEV1 after therapy. We observed an increase in total body area (P < 0.001), driven by increases in total fat mass (P < 0.001), subcutaneous fat (P < 0.001), visceral fat (P = 0.002), and intermuscular fat (P = 0.022). The only muscle compartment that showed an increase after treatment was very low-density muscle (P = 0.032). CONCLUSIONS CT scans represent an opportunity to assess body composition on CF. Combination treatment with CFTR modulators, leads to an improvement in FEV1 and to an increase in body mass in all compartments primarily at the expense of fat mass.
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Affiliation(s)
- Víctor Navas-Moreno
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain
| | - Fernando Sebastian-Valles
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain.
| | | | - Carolina Knott-Torcal
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain
| | - Mónica Marazuela
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain
| | - Nuria Sánchez de la Blanca
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain
| | - Jose Alfonso Arranz Martín
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain
| | - Rosa María Girón
- Department of Pneumology, Hospital Universitario la Princesa, IIS-Princesa, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Miguel Antonio Sampedro-Núñez
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain
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Westhölter D, Haubold J, Welsner M, Salhöfer L, Wienker J, Sutharsan S, Straßburg S, Taube C, Umutlu L, Schaarschmidt BM, Koitka S, Zensen S, Forsting M, Nensa F, Hosch R, Opitz M. Elexacaftor/tezacaftor/ivacaftor influences body composition in adults with cystic fibrosis: a fully automated CT-based analysis. Sci Rep 2024; 14:9465. [PMID: 38658613 PMCID: PMC11043331 DOI: 10.1038/s41598-024-59622-2] [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: 01/30/2024] [Accepted: 04/11/2024] [Indexed: 04/26/2024] Open
Abstract
A poor nutritional status is associated with worse pulmonary function and survival in people with cystic fibrosis (pwCF). CF transmembrane conductance regulator modulators can improve pulmonary function and body weight, but more data is needed to evaluate its effects on body composition. In this retrospective study, a pre-trained deep-learning network was used to perform a fully automated body composition analysis on chest CTs from 66 adult pwCF before and after receiving elexacaftor/tezacaftor/ivacaftor (ETI) therapy. Muscle and adipose tissues were quantified and divided by bone volume to obtain body size-adjusted ratios. After receiving ETI therapy, marked increases were observed in all adipose tissue ratios among pwCF, including the total adipose tissue ratio (+ 46.21%, p < 0.001). In contrast, only small, but statistically significant increases of the muscle ratio were measured in the overall study population (+ 1.63%, p = 0.008). Study participants who were initially categorized as underweight experienced more pronounced effects on total adipose tissue ratio (p = 0.002), while gains in muscle ratio were equally distributed across BMI categories (p = 0.832). Our findings suggest that ETI therapy primarily affects adipose tissues, not muscle tissue, in adults with CF. These effects are primarily observed among pwCF who were initially underweight. Our findings may have implications for the future nutritional management of pwCF.
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Affiliation(s)
- Dirk Westhölter
- Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Essen, Germany
| | - Johannes Haubold
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Matthias Welsner
- Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Essen, Germany
- Adult Cystic Fibrosis Center, Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Essen, Germany
| | - Luca Salhöfer
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Johannes Wienker
- Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Essen, Germany
| | - Sivagurunathan Sutharsan
- Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Essen, Germany
- Adult Cystic Fibrosis Center, Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Essen, Germany
| | - Svenja Straßburg
- Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Essen, Germany
- Adult Cystic Fibrosis Center, Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Essen, Germany
| | - Christian Taube
- Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Essen, Germany
| | - Lale Umutlu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Benedikt M Schaarschmidt
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Sven Koitka
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Sebastian Zensen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Felix Nensa
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - René Hosch
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Marcel Opitz
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany.
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
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Abidi MZ, Umbleja T, Overton ET, Burdo T, Flynn JM, Lu MT, Taron J, Schnittman SR, Fitch KV, Zanni MV, Fichtenbaum CJ, Malvestutto C, Aberg JA, Fulda ES, Eckard AR, Manne-Goehler J, Tuan JJ, Ribaudo HJ, Douglas PS, Grinspoon SK, Brown TT, Erlandson KM. Cytomegalovirus IgG is Associated With Physical Function But Not Muscle Density in People With HIV. J Acquir Immune Defic Syndr 2024; 95:470-478. [PMID: 38180893 PMCID: PMC10947880 DOI: 10.1097/qai.0000000000003377] [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: 07/03/2023] [Accepted: 12/07/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Cytomegalovirus (CMV) seropositivity is associated with poor outcomes, including physical function impairment, in people without HIV. We examined associations between CMV IgG titer and physical function in virologically suppressed people with HIV (PWH). METHODS REPRIEVE is a double-blind randomized trial evaluating pitavastatin for primary prevention of atherosclerotic cardiovascular disease in PWH. This analysis focused on participants enrolled in a substudy with additional biomarker testing, imaging [coronary CT angiography], and physical function measures at entry. CMV IgG was measured using quantitative enzyme immunoassay, physical function by Short Physical Performance Battery, and muscle density and area by CT. Associations between CMV IgG (risk factor) and outcomes were evaluated using the partial Spearman correlation and linear and log-binomial regression. RESULTS Among 717 participants, 82% male, the median CMV IgG was 2716 (Q1, Q3: 807, 6672) IU/mL, all above the limit of quantification. Among 631 participants with imaging, there was no association between CMV IgG and CT-based muscle density or area, controlling for age (r = -0.03 and r = -0.01, respectively; P ≥ 0.38). Among 161 participants with physical function data, higher CMV IgG was associated with poorer overall modified Short Physical Performance Battery score ( P = 0.02), adjusted for age, nadir CD4, and high-sensitivity C-reactive protein. CONCLUSIONS Higher CMV IgG titer was associated with poorer physical function, not explained by previous immune compromise, inflammation, or muscle density or area. Further mechanistic studies are needed to understand this association and whether CMV-specific therapy can affect physical function in PWH.
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Affiliation(s)
- Maheen Z. Abidi
- Division of Infectious Diseases, Department of Medicine, University of Colorado, Denver, CO, USA
| | - Triin Umbleja
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Edgar T. Overton
- Division of Infectious Diseases, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Tricia Burdo
- Department of Microbiology, Immunology, and Inflammation and Center for Neurovirology and Gene Editing, Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Jacqueline M. Flynn
- Department of Microbiology, Immunology, and Inflammation and Center for Neurovirology and Gene Editing, Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Michael T. Lu
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jana Taron
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Medical Center – University of Freiburg, Germany
| | - Samuel R. Schnittman
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Kathleen V. Fitch
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Markella V. Zanni
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Carl J. Fichtenbaum
- Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Carlos Malvestutto
- Division of Infectious Diseases, Ohio State University Medical Center, Columbus, OH, USA
| | - Judith A. Aberg
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Evelynne S. Fulda
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Allison Ross Eckard
- Departments of Pediatrics and Medicine, Divisions of Infectious Diseases, Medical University of South Carolina, Charleston, SC, USA
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Jessica J. Tuan
- Division of Infectious Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Heather J. Ribaudo
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Pamela S. Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, U.S.A
| | - Steven K. Grinspoon
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Todd T. Brown
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kristine M. Erlandson
- Division of Infectious Diseases, Department of Medicine, University of Colorado, Denver, CO, USA
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Bunk SA, Ipema J, Sidorenkov G, Bennink E, Vliegenthart R, de Jong PA, Pompe E, Charbonnier JP, Luijk BH, Aerts J, Groen HJ, Mohamed Hoesein FA. The relationship of fat and muscle measurements with emphysema and bronchial wall thickening in smokers. ERJ Open Res 2024; 10:00749-2023. [PMID: 38444665 PMCID: PMC10910310 DOI: 10.1183/23120541.00749-2023] [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: 10/06/2023] [Accepted: 12/17/2023] [Indexed: 03/07/2024] Open
Abstract
Introduction Differences in body composition in patients with COPD may have important prognostic value and may provide opportunities for patient-specific management. We investigated the relation of thoracic fat and muscle with computed tomography (CT)-measured emphysema and bronchial wall thickening. Methods Low-dose baseline chest CT scans from 1031 male lung cancer screening participants from one site were quantified for emphysema, bronchial wall thickening, subcutaneous fat, visceral fat and skeletal muscle. Body composition measurements were performed by segmenting the first slice above the aortic arch using Hounsfield unit thresholds with region growing and manual corrections. COPD presence and severity were evaluated with pre-bronchodilator spirometry testing. Results Participants had a median age of 61.5 years (58.6-65.6, 25th-75th percentile) and median number of 38.0 pack-years (28.0-49.5); 549 (53.2%) were current smokers. Overall, 396 (38.4%) had COPD (256 Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1, 140 GOLD 2-3). Participants with COPD had less subcutaneous fat, visceral fat and skeletal muscle (p<0.001 for all). With increasing GOLD stages, subcutaneous (p=0.005) and visceral fat values (p=0.004) were higher, and skeletal muscle was lower (p=0.004). With increasing severity of CT-derived emphysema, subcutaneous fat, visceral fat and skeletal muscle values were lower (p<0.001 for all). With increasing CT-derived bronchial wall thickness, subcutaneous and visceral fat values were higher (p<0.001 for both), without difference in skeletal muscle. All statistical relationships remained when adjusted for age, pack-years and smoking status. Conclusion COPD presence and emphysema severity are associated with smaller amounts of thoracic fat and muscle, whereas bronchial wall thickening is associated with fat accumulation.
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Affiliation(s)
- Stijn A.O. Bunk
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jetty Ipema
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Grigory Sidorenkov
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands
| | - Edwin Bennink
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rozemarijn Vliegenthart
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging-North East Netherlands, Groningen, The Netherlands
| | - Pim A. de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Esther Pompe
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Bart H.D. Luijk
- Department of Pulmonology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joachim Aerts
- Department of Respiratory Medicine, ErasmusMC, Rotterdam, The Netherlands
| | - Harry J.M. Groen
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Xu K, Li T, Khan MS, Gao R, Antic SL, Huo Y, Sandler KL, Maldonado F, Landman BA. Body composition assessment with limited field-of-view computed tomography: A semantic image extension perspective. Med Image Anal 2023; 88:102852. [PMID: 37276799 PMCID: PMC10527087 DOI: 10.1016/j.media.2023.102852] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 01/30/2023] [Accepted: 05/23/2023] [Indexed: 06/07/2023]
Abstract
Field-of-view (FOV) tissue truncation beyond the lungs is common in routine lung screening computed tomography (CT). This poses limitations for opportunistic CT-based body composition (BC) assessment as key anatomical structures are missing. Traditionally, extending the FOV of CT is considered as a CT reconstruction problem using limited data. However, this approach relies on the projection domain data which might not be available in application. In this work, we formulate the problem from the semantic image extension perspective which only requires image data as inputs. The proposed two-stage method identifies a new FOV border based on the estimated extent of the complete body and imputes missing tissues in the truncated region. The training samples are simulated using CT slices with complete body in FOV, making the model development self-supervised. We evaluate the validity of the proposed method in automatic BC assessment using lung screening CT with limited FOV. The proposed method effectively restores the missing tissues and reduces BC assessment error introduced by FOV tissue truncation. In the BC assessment for large-scale lung screening CT datasets, this correction improves both the intra-subject consistency and the correlation with anthropometric approximations. The developed method is available at https://github.com/MASILab/S-EFOV.
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Affiliation(s)
- Kaiwen Xu
- Vanderbilt University, 2301 Vanderbilt Place, Nashville, 37235, United States.
| | - Thomas Li
- Vanderbilt University, 2301 Vanderbilt Place, Nashville, 37235, United States
| | - Mirza S Khan
- Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, 37232, United States
| | - Riqiang Gao
- Vanderbilt University, 2301 Vanderbilt Place, Nashville, 37235, United States
| | - Sanja L Antic
- Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, 37232, United States
| | - Yuankai Huo
- Vanderbilt University, 2301 Vanderbilt Place, Nashville, 37235, United States
| | - Kim L Sandler
- Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, 37232, United States
| | - Fabien Maldonado
- Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, 37232, United States
| | - Bennett A Landman
- Vanderbilt University, 2301 Vanderbilt Place, Nashville, 37235, United States; Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, 37232, United States
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Xu K, Gao R, Tang Y, Deppen SA, Sandler KL, Kammer MN, Antic SL, Maldonado F, Huo Y, Khan MS, Landman BA. Extending the value of routine lung screening CT with quantitative body composition assessment. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2022; 12032:120321L. [PMID: 36303578 PMCID: PMC9604426 DOI: 10.1117/12.2611784] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Certain body composition phenotypes, like sarcopenia, are well established as predictive markers for post-surgery complications and overall survival of lung cancer patients. However, their association with incidental lung cancer risk in the screening population is still unclear. We study the feasibility of body composition analysis using chest low dose computed tomography (LDCT). A two-stage fully automatic pipeline is developed to assess the cross-sectional area of body composition components including subcutaneous adipose tissue (SAT), muscle, visceral adipose tissue (VAT), and bone on T5, T8 and T10 vertebral levels. The pipeline is developed using 61 cases of the VerSe'20 dataset, 40 annotated cases of NLST, and 851 inhouse screening cases. On a test cohort consisting of 30 cases from the inhouse screening cohort (age 55 - 73, 50% female) and 42 cases of NLST (age 55 - 75, 59.5% female), the pipeline achieves a root mean square error (RMSE) of 7.25 mm (95% CI: [6.61, 7.85]) for the vertebral level identification and mean Dice similarity score (DSC) 0.99 ± 0.02, 0.96 ± 0.03, and 0.95 ± 0.04 for SAT, muscle, and VAT, respectively for body composition segmentation. The pipeline is generalized to the CT arm of the NLST dataset (25,205 subjects, 40.8% female, 1,056 lung cancer incidences). Time-to-event analysis for lung cancer incidence indicates inverse association between measured muscle cross-sectional area and incidental lung cancer risks (p < 0.001 female, p < 0.001 male). In conclusion, automatic body composition analysis using routine lung screening LDCT is feasible.
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Affiliation(s)
- Kaiwen Xu
- Department of Computer Science, Vanderbilt University, Nashville TN, USA 37235
| | - Riqiang Gao
- Department of Computer Science, Vanderbilt University, Nashville TN, USA 37235
| | - Yucheng Tang
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville TN, USA 37235
| | - Steve A. Deppen
- Vanderbilt University Medical Center, Nashville TN, USA 37235
| | - Kim L. Sandler
- Vanderbilt University Medical Center, Nashville TN, USA 37235
| | | | - Sanja L. Antic
- Vanderbilt University Medical Center, Nashville TN, USA 37235
| | | | - Yuankai Huo
- Department of Computer Science, Vanderbilt University, Nashville TN, USA 37235
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville TN, USA 37235
| | - Mirza S. Khan
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville TN, USA 37235
- Vanderbilt University Medical Center, Nashville TN, USA 37235
- Department of Biomedical Informatics, Vanderbilt University, Nashville TN, USA 37235
- U.S. Department of Veterans Affairs, Nashville TN, USA 37212
| | - Bennett A. Landman
- Department of Computer Science, Vanderbilt University, Nashville TN, USA 37235
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville TN, USA 37235
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8
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Yang G, Yang Q, Li Y, Zhang Y, Chen S, He D, Zhang M, Ban B, Liu F. Association Between the Growth Hormone/Insulin-Like Growth Factor-1 Axis and Muscle Density in Children and Adolescents of Short Stature. Front Endocrinol (Lausanne) 2022; 13:920200. [PMID: 35774144 PMCID: PMC9238351 DOI: 10.3389/fendo.2022.920200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/16/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To evaluate the association between the growth hormone (GH)/insulin-like growth factor-1 (IGF-1) axis and muscle density in children and adolescents of short stature. METHODS Participants were children and adolescents of short stature hospitalized in the Affiliated Hospital of Jining Medical University between January 2020 and June 2021. All participants had CT scan images available. We performed an analysis of the images to calculate the muscle density or skeletal muscle attenuation (SMA), skeletal muscle index (SMI), and fat mass index (FMI). Bioelectrical impedance analysis (BIA) was used to ensure that chest CT is a credible way of evaluating body composition. RESULTS A total of 297 subjects were included with the mean age of 10.00 ± 3.42 years, mean height standard deviation score (SDS) of -2.51 ± 0.53, and mean IGF-1 SDS of -0.60 ± 1.07. The areas of muscle and fat tissues at the fourth thoracic vertebra level in the CT images showed strong correlation with the total weights of the participants (R2 = 0.884 and 0.897, respectively). The peak of GH was negatively associated with FMI (r = - 0.323, P <.01) and IGF-1 SDS was positively associated with SMI (r = 0.303, P <.01). Both the peak GH and IGF-1 SDS were positively associated with SMA (r = 0.244, P <.01 and r = 0.165, P <.05, respectively). Multiple stepwise linear regression analysis demonstrated that the GH peak was the predictor of FMI (β = - 0.210, P < .01), the IGF-1 SDS was the predictor of SMI (β = 0.224, P < .01), and both the peak GH and IGF-1 SDS were predictors of SMA (β = 0.180, P < .01 and β = 0.222, P < .01). CONCLUSIONS A chest CT scan is a credible method of evaluating body composition in children and adolescents of short stature. In these patients, peak GH and IGF-1 SDS are independent predictors of muscle density and the GF/IGF-1 axis may regulate body composition through complex mechanisms.
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Affiliation(s)
- Guangzhi Yang
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Qing Yang
- Department of Nutrition, Affiliated Hospital of Jining Medical University, Jining, China
| | - Yanying Li
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Yanhong Zhang
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Shuxiong Chen
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Dongye He
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Mei Zhang
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Bo Ban
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining, China
- *Correspondence: Fupeng Liu, ; Bo Ban,
| | - Fupeng Liu
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining, China
- *Correspondence: Fupeng Liu, ; Bo Ban,
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Association of Thoracic Computed Tomographic Measurements and Outcomes in Patients with Hematologic Malignancies Requiring Mechanical Ventilation. Ann Am Thorac Soc 2021; 18:1219-1226. [PMID: 33433272 DOI: 10.1513/annalsats.202008-914oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Rationale: Patients with hematologic malignancies requiring mechanical ventilation have historically experienced poor outcomes.Objectives: We aimed to determine whether body composition characteristics derived from thoracic computed tomographic (CT) imaging were associated with time to liberation from mechanical ventilation.Methods: We evaluated mechanically ventilated patients with hematological malignancies admitted between 2014 and 2018. We included patients with thoracic CT imaging completed between 1 month before and 48 hours after intensive care unit (ICU) admission. We assessed the association of carinal skeletal muscle cross-sectional area (CSA), subcutaneous fat CSA, and fat index (fat/skeletal muscle ratio) with time to liberation from mechanical ventilation within 28 days. We accounted for the competing event of death within 28 days of mechanical ventilation.Results: One hundred fifty-six patients were included; the mean age was 57 years (standard deviation 14) and 39% were female. Thirty-seven percent had received a hematopoietic stem cell transplant, and the median ratio of arterial oxygen tension/pressure to fraction of inspired oxygen was 134 mm Hg (interquartile range [IQR], 92-205). Median skeletal muscle CSA was 68 cm2 (IQR, 54-88) and subcutaneous fat CSA was 38 cm2 (IQR, 27-52). Forty-two percent of patients were liberated from mechanical ventilation within 28 days and 56% died in the ICU. Subcutaneous fat CSA (subdistribution hazard ratio [sHR], 0.81; 95% confidence interval [95% CI], -0.68 to 0.97) and fat index (sHR, 0.81; 95% CI, -0.68 to 0.97) were significantly associated with longer time to liberation from mechanical ventilation. Skeletal muscle CSA was not associated with time to liberation from ventilation (sHR, 1.08; 95% CI, -0.94 to 1.23).Conclusions: Body composition measurements based on thoracic CT scans were associated with time to liberation from ventilation. These could represent novel surrogate markers of physical frailty in patients with hematologic malignancies receiving mechanical ventilation.
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Reply: Subcutaneous Fat Tissue: Which Region Is More Appropriate for the Measurement? Ann Am Thorac Soc 2021; 18:1431-1432. [PMID: 33625953 PMCID: PMC8513650 DOI: 10.1513/annalsats.202102-149le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Pishgar F, Shabani M, Quinaglia A. C. Silva T, Bluemke DA, Budoff M, Barr RG, Allison MA, Bertoni AG, Post WS, Lima JAC, Demehri S. Adipose tissue biomarkers and type 2 diabetes incidence in normoglycemic participants in the MESArthritis Ancillary Study: A cohort study. PLoS Med 2021; 18:e1003700. [PMID: 34242221 PMCID: PMC8337053 DOI: 10.1371/journal.pmed.1003700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 08/04/2021] [Accepted: 06/16/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Given the central role of skeletal muscles in glucose homeostasis, deposition of adipose depots beneath the fascia of muscles (versus subcutaneous adipose tissue [SAT]) may precede insulin resistance and type 2 diabetes (T2D) incidence. This study was aimed to investigate the associations between computed tomography (CT)-derived biomarkers for adipose tissue and T2D incidence in normoglycemic adults. METHODS AND FINDINGS This study was a population-based multiethnic retrospective cohort of 1,744 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) with normoglycemia (baseline fasting plasma glucose [FPG] less than 100 mg/dL) from 6 United States of America communities. Participants were followed from April 2010 and January 2012 to December 2017, for a median of 7 years. The intermuscular adipose tissue (IMAT) and SAT areas were measured in baseline chest CT exams and were corrected by height squared (SAT and IMAT indices) using a predefined measurement protocol. T2D incidence, as the main outcome, was based on follow-up FPG, review of hospital records, or self-reported physician diagnoses. Participants' mean age was 69 ± 9 years at baseline, and 977 (56.0%) were women. Over a median of 7 years, 103 (5.9%) participants were diagnosed with T2D, and 147 (8.4%) participants died. The IMAT index (hazard ratio [HR]: 1.27 [95% confidence interval [CI]: 1.15-1.41] per 1-standard deviation [SD] increment) and the SAT index (HR: 1.43 [95% CI: 1.16-1.77] per 1-SD increment) at baseline were associated with T2D incidence over the follow-up. The associations of the IMAT and SAT indices with T2D incidence were attenuated after adjustment for body mass index (BMI) and waist circumference, with HRs of 1.23 (95% CI: 1.09-1.38) and 1.29 (95% CI: 0.96-1.74) per 1-SD increment, respectively. The limitations of this study include unmeasured residual confounders and one-time measurement of adipose tissue biomarkers. CONCLUSIONS In this study, we observed an association between IMAT at baseline and T2D incidence over the follow-up. This study suggests the potential role of intermuscular adipose depots in the pathophysiology of T2D. TRIAL REGISTRATION ClinicalTrials.gov NCT00005487.
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Affiliation(s)
- Farhad Pishgar
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Mahsima Shabani
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Thiago Quinaglia A. C. Silva
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - David A. Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Matthew Budoff
- Lundquist Institute at Harbor-University of California Los Angeles School of Medicine, Torrance, California, United States of America
| | - R Graham Barr
- Department of Medicine, Columbia University Medical Center, New York, New York, United States of America
- Department of Epidemiology, Columbia University Medical Center, New York, New York, United States of America
| | - Matthew A. Allison
- Division of Preventive Medicine, Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, United States of America
| | - Alain G. Bertoni
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Wendy S. Post
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - João A. C. Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Shadpour Demehri
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
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Balki HBSc I, de Perrot M, Bavaghar-Zaeimi F, Nourouzpour S, Granton JT, Thenganatt J, McInnis M, McRae K, Donahoe L, Rozenberg D. CLINICAL IMPLICATIONS OF BODY COMPOSITION AND EXERCISE CAPACITY FOLLOWING PULMONARY ENDARTERECTOMY. Ann Thorac Surg 2021; 113:444-451. [PMID: 33667463 DOI: 10.1016/j.athoracsur.2021.01.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 12/15/2020] [Accepted: 01/27/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pulmonary endarterectomy (PEA) is a curative procedure for patients with chronic thromboembolic pulmonary hypertension. Body composition and exercise capacity have been associated with adverse outcomes in patients undergoing cardiothoracic surgeries, but their significance with PEA is unclear. We evaluated the association of body composition and 6-minute walk distance (6MWD) with disease severity, hospital length of stay, discharge disposition and post-operative functional recovery. METHODS Retrospective, single-center cohort study of patients who underwent PEA (Jan/2014-Dec/2017). Body composition (skeletal muscle mass and adiposity cross sectional area, body mass index) was quantified using thoracic computed tomography with Slice-O-Matic software. Association of body composition measures and 6MWD with clinical outcomes was evaluated using multivariable regression models. RESULTS 127 patients (58±14 years; 42% males, Body Mass Index: 31±7 kg/m2, 6MWD: 361±165 m) were included. Muscle and 6MWD were associated with disease severity measures. Of those surviving hospitalization (n=125), a greater 6MWD was associated with a shorter hospital stay (1.9 median days per 100m, p<0.001) and higher likelihood of being discharged directly home from hospital (OR: 2.1 per 100m, p= 0.004), independent of age, sex and body mass index. Those with a lower pre-operative 6MWD (per 100m) had a greater increase in their post-operative 6MWD (52m, p< 0.0001), independent of age, sex, and body mass index. Body composition measures were not associated with hospital outcomes or exercise capacity in the first-year post-operatively. CONCLUSIONS Exercise capacity was a more prognositc marker of PEA outcomes compared to body composition. Future research is needed to explore pre-PEA rehabilitation strategies.
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Affiliation(s)
| | - Marc de Perrot
- Dept of Medicine, University of Toronto; Thoracic Surgery, Chronic Thromboembolic Pulmonary Hypertension Program, University Health Network (UHN)
| | - Fatemeh Bavaghar-Zaeimi
- Thoracic Surgery, Chronic Thromboembolic Pulmonary Hypertension Program, University Health Network (UHN)
| | | | - John T Granton
- Dept of Medicine, University of Toronto; Respirology, Pulmonary Hypertension Program, UHN
| | - John Thenganatt
- Dept of Medicine, University of Toronto; Respirology, Pulmonary Hypertension Program, UHN
| | | | | | - Laura Donahoe
- Dept of Medicine, University of Toronto; Thoracic Surgery, Chronic Thromboembolic Pulmonary Hypertension Program, University Health Network (UHN)
| | - Dmitry Rozenberg
- Dept of Medicine, University of Toronto; Respirology, Lung Transplant Program, Toronto General Research Institute, UHN.
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Rozenberg D, Orsso CE, Chohan K, Orchanian‐Cheff A, Nourouzpour S, Nicholson JM, Elangeswaran B, Vagaon A, Fidler L, Singer LG, Mathur S. Clinical outcomes associated with computed tomography‐based body composition measures in lung transplantation: a systematic review. Transpl Int 2020; 33:1610-1625. [DOI: 10.1111/tri.13749] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/24/2020] [Accepted: 09/13/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Dmitry Rozenberg
- Department of Medicine University of Toronto Toronto ON Canada
- Lung Transplant Program Respirology Toronto General Hospital Research InstituteUniversity Health Network Toronto ON Canada
| | - Camila E. Orsso
- Department of Agricultural, Food and Nutritional Science University of Alberta Edmonton AB Canada
| | - Karan Chohan
- Department of Medicine University of Toronto Toronto ON Canada
| | - Ani Orchanian‐Cheff
- Library and Information Services University Health Network Toronto ON Canada
| | - Sahar Nourouzpour
- Lung Transplant Program Respirology Toronto General Hospital Research InstituteUniversity Health Network Toronto ON Canada
| | | | - Brenawen Elangeswaran
- Lung Transplant Program Respirology Toronto General Hospital Research InstituteUniversity Health Network Toronto ON Canada
| | - Andrei Vagaon
- Department of Medicine University of Toronto Toronto ON Canada
| | - Lee Fidler
- Department of Medicine University of Toronto Toronto ON Canada
- Respirology Sunnybrook Health Sciences Centre Toronto ON Canada
| | - Lianne G. Singer
- Department of Medicine University of Toronto Toronto ON Canada
- Lung Transplant Program Respirology Toronto General Hospital Research InstituteUniversity Health Network Toronto ON Canada
| | - Sunita Mathur
- Department of Physical Therapy University of Toronto Toronto ON Canada
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Body composition on low dose chest CT is a significant predictor of poor clinical outcome in COVID-19 disease - A multicenter feasibility study. Eur J Radiol 2020; 132:109274. [PMID: 32961451 PMCID: PMC7480673 DOI: 10.1016/j.ejrad.2020.109274] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/02/2020] [Accepted: 09/05/2020] [Indexed: 02/06/2023]
Abstract
Obesity and body composition determined in initial LDCT is a risk factor for SARS‐CoV‐2 infected patients. An initial LDCT can be used to screen opportunistically for obese COVID-19 patients. Unfavorable body composition is associated with increased risk for the need of intensive care treatment.
Purpose Low-dose computed tomography (LDCT) of the chest is a recommended diagnostic tool in early stage of COVID-19 pneumonia. High age, several comorbidities as well as poor physical fitness can negatively influence the outcome within COVID-19 infection. We investigated whether the ratio of fat to muscle area, measured in initial LDCT, can predict severe progression of COVID-19 in the follow-up period. Method We analyzed 58 individuals with confirmed COVID-19 infection that underwent an initial LDCT in one of two included centers due to COVID-19 infection. Using the ratio of waist circumference per paravertebral muscle circumference (FMR), the body composition was estimated. Patient outcomes were rated on an ordinal scale with higher numbers representing more severe progression or disease associated complications (hospitalization/ intensive care unit (ICU)/ tracheal intubation/ death) within a follow-up period of 22 days after initial LDCT. Results In the initial LDCT a significantly higher FMR was found in patients requiring intensive care treatment within the follow-up period. In multivariate logistic regression analysis, FMR (p < .001) in addition to age (p < .01), was found to be a significant predictor of the necessity for ICU treatment of COVID-19 patients. Conclusion FMR as potential surrogate of body composition and obesity can be easily determined in initial LDCT of COVID-19 patients. Within the multivariate analysis, in addition to patient age, low muscle area in proportion to high fat area represents an additional prognostic information for the patient outcome and the need of an ICU treatment during the follow-up period within the next 22 days. This multicentric pilot study presents a method using an initial LDCT to screen opportunistically for obese patients who have an increased risk for the need of ICU treatment. While clinical capacities, such as ICU beds and ventilators, are more crucial than ever to help manage the current global corona pandemic, this work introduces an approach that can be used for a cost-effective way to help determine the amount of these rare clinical resources required in the near future.
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