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Muscle Mass and Mortality After Cardiac Transplantation.
Transplantation. 2018 12; 102(12):2101-2107.T

Abstract

BACKGROUND

Frailty assessment is recommended to evaluate the candidacy of adults referred for orthotopic heart transplantation (OHT). Psoas muscle area (PMA) is an easily measured biomarker for frailty. There has yet to be a study examining the prognostic impact of PMA in OHT patients.

METHODS

In this retrospective study, preoperative and postoperative computed tomography (CT) scans were retrieved for adults transplanted between 2000 and 2015 at a tertiary care hospital. Psoas muscle area was measured on a single axial image. Outcomes of interest were all-cause mortality over 6 years and a composite of in-hospital mortality or major morbidity (prolonged ventilation, stroke, dialysis, mediastinitis, or reoperation).

RESULTS

Of 161 adult patients transplanted, 82 had at least 1 abdominal CT scan. At baseline, mean PMA was 25.7 ± 5.8 cm in men and 16.0 ± 3.6 cm in women, and decreased by 8% from the first to the last available CT scan. Adjusting for age, sex, body mass index, and cardiomyopathy etiology, every 1-cm increase in PMA was found to be associated with a 9% reduction in long-term mortality (hazard ratio, 0.91; 95% confidence interval [CI], 0.83-0.99; P = 0.031) and a 17% reduction in in-hospital mortality or major morbidity (odds ratio, 0.83; 95% CI, 0.72-0.96; P = 0.014). When PMA was smaller than the sex-specific median, the risk of mortality or major morbidity increased fourfold (odds ratio, 4.29; 95% CI, 1.19-15.46; P = 0.026).

CONCLUSIONS

Muscle mass is an independent predictor of mortality and major morbidity after OHT. Further research is needed to determine whether frail OHT patients with low PMA may benefit from muscle-building interventions to improve outcomes.

Authors+Show Affiliations

Division of Cardiology, McGill University, Montreal, QC, Canada.Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.Division of Cardiology, McGill University, Montreal, QC, Canada.Department of Cell and Molecular Biology, Concordia University, Montreal, QC, Canada.Division of Internal Medicine, McGill University, Montreal, QC, Canada.Division of Nephrology, McGill University Health Center, Montreal, QC, Canada.Division of Cardiac Surgery, McGill University Health Center, Montreal, QC, Canada.Division of Cardiology, McGill University, Montreal, QC, Canada.Division of Cardiology, McGill University, Montreal, QC, Canada. Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29877924

Citation

Bibas, Lior, et al. "Muscle Mass and Mortality After Cardiac Transplantation." Transplantation, vol. 102, no. 12, 2018, pp. 2101-2107.
Bibas L, Saleh E, Al-Kharji S, et al. Muscle Mass and Mortality After Cardiac Transplantation. Transplantation. 2018;102(12):2101-2107.
Bibas, L., Saleh, E., Al-Kharji, S., Chetrit, J., Mullie, L., Cantarovich, M., Cecere, R., Giannetti, N., & Afilalo, J. (2018). Muscle Mass and Mortality After Cardiac Transplantation. Transplantation, 102(12), 2101-2107. https://doi.org/10.1097/TP.0000000000002311
Bibas L, et al. Muscle Mass and Mortality After Cardiac Transplantation. Transplantation. 2018;102(12):2101-2107. PubMed PMID: 29877924.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Muscle Mass and Mortality After Cardiac Transplantation. AU - Bibas,Lior, AU - Saleh,Eli, AU - Al-Kharji,Samah, AU - Chetrit,Jessica, AU - Mullie,Louis, AU - Cantarovich,Marcelo, AU - Cecere,Renzo, AU - Giannetti,Nadia, AU - Afilalo,Jonathan, PY - 2018/6/8/pubmed PY - 2019/5/7/medline PY - 2018/6/8/entrez SP - 2101 EP - 2107 JF - Transplantation JO - Transplantation VL - 102 IS - 12 N2 - BACKGROUND: Frailty assessment is recommended to evaluate the candidacy of adults referred for orthotopic heart transplantation (OHT). Psoas muscle area (PMA) is an easily measured biomarker for frailty. There has yet to be a study examining the prognostic impact of PMA in OHT patients. METHODS: In this retrospective study, preoperative and postoperative computed tomography (CT) scans were retrieved for adults transplanted between 2000 and 2015 at a tertiary care hospital. Psoas muscle area was measured on a single axial image. Outcomes of interest were all-cause mortality over 6 years and a composite of in-hospital mortality or major morbidity (prolonged ventilation, stroke, dialysis, mediastinitis, or reoperation). RESULTS: Of 161 adult patients transplanted, 82 had at least 1 abdominal CT scan. At baseline, mean PMA was 25.7 ± 5.8 cm in men and 16.0 ± 3.6 cm in women, and decreased by 8% from the first to the last available CT scan. Adjusting for age, sex, body mass index, and cardiomyopathy etiology, every 1-cm increase in PMA was found to be associated with a 9% reduction in long-term mortality (hazard ratio, 0.91; 95% confidence interval [CI], 0.83-0.99; P = 0.031) and a 17% reduction in in-hospital mortality or major morbidity (odds ratio, 0.83; 95% CI, 0.72-0.96; P = 0.014). When PMA was smaller than the sex-specific median, the risk of mortality or major morbidity increased fourfold (odds ratio, 4.29; 95% CI, 1.19-15.46; P = 0.026). CONCLUSIONS: Muscle mass is an independent predictor of mortality and major morbidity after OHT. Further research is needed to determine whether frail OHT patients with low PMA may benefit from muscle-building interventions to improve outcomes. SN - 1534-6080 UR - https://www.unboundmedicine.com/medline/citation/29877924/Muscle_Mass_and_Mortality_After_Cardiac_Transplantation_ L2 - https://doi.org/10.1097/TP.0000000000002311 DB - PRIME DP - Unbound Medicine ER -