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Muscle Mass and Mortality After Cardiac Transplantation

Bibas, Lior, MD1; Saleh, Eli, MD2; Al-Kharji, Samah, MD1; Chetrit, Jessica, BSc3; Mullie, Louis, MD4; Cantarovich, Marcelo, MD5; Cecere, Renzo, MD6; Giannetti, Nadia, MD1; Afilalo, Jonathan, MSc1,7

doi: 10.1097/TP.0000000000002311
Original Clinical Science—General

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 cm2 in men and 16.0 ± 3.6 cm2 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-cm2 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.

In 161 heart transplant recipients, psoas muscle area, a marker of frailty measured with CT scan, is an independent predictor of mortality and major morbidity.

1 Division of Cardiology, McGill University, Montreal, QC, Canada.

2 Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.

3 Department of Cell and Molecular Biology, Concordia University, Montreal, QC, Canada.

4 Division of Internal Medicine, McGill University, Montreal, QC, Canada.

5 Division of Nephrology, McGill University Health Center, Montreal, QC, Canada.

6 Division of Cardiac Surgery, McGill University Health Center, Montreal, QC, Canada.

7 Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada.

Received 5 March 2018. Revision received 5 May 2018.

Accepted 18 May 2018.

The costs related to data retrieval and extraction were funded by N.G.'s Heart Failure Research Fund.

J.A. and L.M. developed the CoreSlicer.com software but do not hold any patents or financial incentives relating to its use. All other authors have reported that they have no relationships relevant to the contents of this article to disclose.

N.G. and J.A. are cosenior authors.

L.B. participated in the conception and design of study, collection of data, interpretation of data, primary authorship of the article. E.S., S.Al-K., and J.C. participated in the collection of data, interpretation of data, coauthorship, and revision of the article. L.M. participated in the software development for collection of data, coauthorship, and revision of the article. M.C. and R.C. interpretation of data, coauthorship, and revision of the article. N.G. participated in the conception and design of study, collection of data, interpretation of data, share the cosenior authorship of the article. J.A. participated in the conception and design of study, software development for collection of data, statistical analysis, interpretation of data, and share cosenior authorship of the article.

Correspondence: Jonathan Afilalo, MD, Jewish General Hospital 3755 Cote Ste Catherine Rd, E-222 Montreal, QC, Canada H3T 1E2. (jonathan.afilalo@mcgill.ca).

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