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Yamashita M1, Kamiya K2, Matsunaga A1,2, Kitamura T3, Hamazaki N4, Matsuzawa R4, Nozaki K4, Nakamura T1, Ako J5, Miyaji K3
1Kitasato University Graduate School of Medical Sciences, Department of Rehabilitation Sciences, Sagamihara, Japan, 2Kitasato University School of Allied Health Sciences, Department of Rehabilitation, Sagamihara, Japan, 3Kitasato University School of Medicine, Department of Cardiovascular Surgery, Sagamihara, Japan, 4Kitasato University Hospital, Department of Rehabilitation, Sagamihara, Japan, 5Kitasato University Graduate School of Medical Sciences, Department of Cardiovascular Medicine, Sagamihara, Japan
Background: Sarcopenia is recognized as an age-related loss of muscle mass. Its incidence has increased with the aging of the world's population. Sarcopenia is particularly prevalent among patients with cardiovascular disease. Sarcopenic obesity, described as sarcopenia with concomitant excess of adipose tissue, has attracted considerable attention because it is associated with a poorer outcome than sarcopenia alone. However, there are currently limited data regarding sarcopenic obesity in patients with cardiovascular disease.
Purpose: The present study aimed to investigate whether sarcopenic obesity, determined by various body composition parameters, is a useful predictor of postoperative mortality in patients undergoing cardiovascular surgery.
Methods: Overall, 773 consecutive patients undergoing cardiovascular surgery and preoperative computed tomography at the level of the third lumbar vertebra were included. Psoas muscle attenuation (MA) determined using computed tomography (in Hounsfield units) was used as a muscle mass parameter. The areas of visceral and subcutaneous adipose tissue (VAT and SAT, respectively) were measured from the same computed tomography images. Moreover, obesity diagnosis was based on waist circumference and body mass index. Sarcopenia was defined as low MA (i.e., below overall median), and severe obesity was defined as high VAT area (103.0 cm2 for males and 69.0 cm2 for females), SAT area (sex-specific median), total adipose tissue area (VAT + SAT, sex-specific median), waist circumference (85 cm2 for males and 90 cm2 for females), and body mass index (23.0 kg/m2). The preoperative risk was quantified using the EuroSCORE, and the endpoint was all-cause mortality. Cox regression analysis was performed to estimate the hazard ratio (HR) and 95% confidence interval (CI) of sarcopenic obesity prognostic value by constructing univariate and multivariate models adjusted for EuroSCORE.
Results: The patient mean age was 65.0 ± 13.1 years, and 64.7% of the study population was male. Regarding the type of surgery, 35.6% of the patients underwent coronary artery bypass grafting, 29.9% underwent cardiac valve surgery, and 10.6% had aortic surgery. The median follow-up was 1.82 years (6.5%, interquartile range 0.82-3.99), during which 50 patients died. The multivariate Cox regression analysis following adjustment for EuroSCORE revealed that sarcopenic obesity defined by MA and VAT areas was associated with an increased mortality risk (HR: 2.62, 95% CI: 1.18-5.86). Other definitions of sarcopenic obesity were not related to all-cause mortality.
Conclusion(s): Sarcopenic obesity is associated with all-cause mortality in patients undergoing cardiovascular surgery only when defined in terms of MA and VAT areas.
Implications: This study highlights the need for quantitative measurements to diagnose sarcopenic obesity, which could further aid in elucidating the clinical roles of preoperative computed tomography and cardiac rehabilitation in patients undergoing cardiovascular surgery.
Keywords: sarcopenic obesity, mortality, cardiovascular surgery
Funding acknowledgements: None.
Purpose: The present study aimed to investigate whether sarcopenic obesity, determined by various body composition parameters, is a useful predictor of postoperative mortality in patients undergoing cardiovascular surgery.
Methods: Overall, 773 consecutive patients undergoing cardiovascular surgery and preoperative computed tomography at the level of the third lumbar vertebra were included. Psoas muscle attenuation (MA) determined using computed tomography (in Hounsfield units) was used as a muscle mass parameter. The areas of visceral and subcutaneous adipose tissue (VAT and SAT, respectively) were measured from the same computed tomography images. Moreover, obesity diagnosis was based on waist circumference and body mass index. Sarcopenia was defined as low MA (i.e., below overall median), and severe obesity was defined as high VAT area (103.0 cm2 for males and 69.0 cm2 for females), SAT area (sex-specific median), total adipose tissue area (VAT + SAT, sex-specific median), waist circumference (85 cm2 for males and 90 cm2 for females), and body mass index (23.0 kg/m2). The preoperative risk was quantified using the EuroSCORE, and the endpoint was all-cause mortality. Cox regression analysis was performed to estimate the hazard ratio (HR) and 95% confidence interval (CI) of sarcopenic obesity prognostic value by constructing univariate and multivariate models adjusted for EuroSCORE.
Results: The patient mean age was 65.0 ± 13.1 years, and 64.7% of the study population was male. Regarding the type of surgery, 35.6% of the patients underwent coronary artery bypass grafting, 29.9% underwent cardiac valve surgery, and 10.6% had aortic surgery. The median follow-up was 1.82 years (6.5%, interquartile range 0.82-3.99), during which 50 patients died. The multivariate Cox regression analysis following adjustment for EuroSCORE revealed that sarcopenic obesity defined by MA and VAT areas was associated with an increased mortality risk (HR: 2.62, 95% CI: 1.18-5.86). Other definitions of sarcopenic obesity were not related to all-cause mortality.
Conclusion(s): Sarcopenic obesity is associated with all-cause mortality in patients undergoing cardiovascular surgery only when defined in terms of MA and VAT areas.
Implications: This study highlights the need for quantitative measurements to diagnose sarcopenic obesity, which could further aid in elucidating the clinical roles of preoperative computed tomography and cardiac rehabilitation in patients undergoing cardiovascular surgery.
Keywords: sarcopenic obesity, mortality, cardiovascular surgery
Funding acknowledgements: None.
Topic: Cardiorespiratory; Cardiorespiratory; Disability & rehabilitation
Ethics approval required: Yes
Institution: Kitasato university
Ethics committee: Ethics Committee of Kitasato university, School of Medicine
Ethics number: B16-108
All authors, affiliations and abstracts have been published as submitted.
