Psoas Muscle Area Predicts Mortality after Left Ventricular Assist Device Implantation.

Franziska Wittmann,Günther Laufer,Dietrich Beitzke,Edda Tschernko,Thomas Schlöglhofer,Dominik Wiedemann,Daniel Zimpfer,Anne-Kristin Schaefer,Christian Loewe,Julia Riebandt

doi:10.3390/life11090922

Franziska Wittmann, Günther Laufer + Show 8 more

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https://doi.org/10.3390/life11090922

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Abstract

Several risk scores and classifications are available to predict peri- and post-operative mortality of patients with end stage heart failure receiving Left Ventricular Assist Device (LVAD) therapy. Sarcopenia has been suggested as a sensitive predictor for post-operative mortality. We evaluated whether the psoas muscle area can predict mortality in patients undergoing LVAD implantation. The indexed psoas mean area (PMAi) was obtained by measuring the psoas muscle area at the superior endplate of the third lumbar vertebra correlated to body surface area of 106 adult patients undergoing LVAD implantation (Medtronic HVAD n = 41, Abbott HeartMate II n = 4, Abbott HeartMate 3 n = 61; mean age 65, IQR 12, 90.6% male; INTERMACS Level 1 24.5%; ischemic CMP 64.2%). Patients were divided in two groups: high/moderate and low muscle mass. The primary endpoint was 30-day mortality, assessed using a multivariate Cox proportional hazards model. Baseline characteristics did not differ between patients with high or moderate and low PMAi. Estimated survival calculated a significant higher 30-day mortality in patients with low PMAi (p = 0.04). Multivariable Cox proportional hazards regression analysis indicated low PMAi, history of previous cardiac surgery and levels of bilirubin as independent predictors of mortality in the first 30 days. In conclusion, indexed psoas muscle area predicts mortality after LVAD implantation and can be used as an additional tool for risk stratification.

Highlights

Cardiovascular diseases (CVDs) are the number one cause of morbidity and mortality in today’s society [1]
The aim of this study was to sarcopenia be used a risk factor in patients destined for transcatheter aortic valve imevaluate if can muscle massascan serve as an independent predictor for mortality after plantation showed that reduced muscle mass increased post-interventional mortality [8,9]
Mean patient age was 65 (IQR 12) years, the majority of patients (90.6%) were male and 41.5% were in INTERMACS Levels 1 and 2

Summary

Introduction

Cardiovascular diseases (CVDs) are the number one cause of morbidity and mortality in today’s society [1]. Terminal heart failure (HF) is often the ultimate fate of patients suffering from CVDs. Available treatment options include conservative medical therapy, heart transplantation and implantation of a left ventricular assist device (LVAD) [2]. Survival after LVAD implantation has improved significantly over recent decades [3]. This progress has been achieved through technical improvements in the implantable devices as well as improved peri- and post-operative patient management. Patient selection has proven to be crucial for outcomes and careful risk stratification is needed to evaluate the benefit for each individual patient. The INTERMACS classification was introduced to evaluate post-operative outcomes for patients with terminal HF undergoing LVAD implantation. The classification categorizes patients from level 1, representing patients in

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