Pectoralis Muscle Area Research Articles

Histomorfologi Dan Histomorfometri Otot Ayam Hutan Hijau (Gallus Varius) Asal Pulau Alor

Green jungle fowl is one of the endemic animals in Indonesia. One of the distribution areas of green jungle fowl in East Nusa Tenggara is the island of Alor. Until now there has been no research conducted to determine the histological structure of the green jungle fowl so that this study was conducted with the aim of knowing the histological structure and muscle histomorphometry of the green jungle fowl. The research samples were pectoralis and bicep femoris muscles taken from three green jungle fowl in Kalabahi, Alor Regency. Muscle tissue was fixed using 10% formalin, histological preparations were made and stained with hematoxylin and eosin (HE). The results showed that the muscle histomorphology in the transverse section showed that the skeletal muscle of the green jungle fowl was composed of muscle fibers in a polygonal shape with many nuclei at the edges and connective tissue. No intramuscular fat cells were found. In the longitudinal section, it consists of muscle fibers with a light dark line pattern, the cell nucleus is elongated at the edges and connective tissue. The results of muscle histomorphometry, namely the diameter of the muscle fibers, the diameter of the fasciculus and the thickness of the connective tissue in the bicep femoris muscle area were higher than the pectoralis muscle area. The number of muscle fibers in each fasciculus in the bicep pectoralis muscle area is more than in the bicep femoris muscle area. Muscle histomorphometry is influenced by species, breed/race, age, diet, activity level and anatomical location.

Sarcopenia using pectoralis muscle area and lymphocyte-to-monocyte ratio (LMR) are independent prognostic factors in patients for nonmetastatic breast cancer.

Sarcopenia is defined as loss of skeletal muscle mass and strength. This can lead to adverse clinical outcomes in patients with advanced cancer. The lymphocyte-to-monocyte ratio (LMR), a converted inflammatory response, is associated with poor prognosis in patients with malignancies. Herein, we examined the prognostic influence of sarcopenia status assessed by pectoralis muscle area (PMA), inflammatory status calculated by LMR, and its association with disease-free survival (DFS) in a cohort of women diagnosed with nonmetastatic breast cancer. A total of 293 patients with nonmetastatic breast cancer who underwent primary mass resection and radiotherapy between January 2011 and December 2017 were enrolled. The cross-sectional area of the muscle (cm2) at PMA was measured using computed tomography before radiation therapy. Baseline monocyte and lymphocyte counts were obtained from the complete blood count to calculate the LMR. Most of the patients (248/293, 84.6%) underwent breast conservation surgery. Lymph node involvement at diagnosis (hazard ratio [HR], 5.08; P < .001), low LMR (HR, 2.79; P = .007), and low PMA (HR, 3.80; P < .001) were independent poor prognostic factors in multivariate analysis. The mean DFS of sarcopenic and nonsarcopenic patients was 89.8 months and 118.8 months, respectively (P < .001). Sarcopenic patients with low LMR showed the worst outcomes, whereas nonsarcopenic patients with high LMR showed the best outcomes. Low PMA and low LMR were independent poor prognostic factors for DFS in patients with nonmetastatic breast cancer.

Which Body Composition Parameters on Computed Tomography Are More Successful in Predicting the Prognosis of COVID-19 Patients?

The aims of the study are to compare the body composition parameters (BCPs), which have been reported to have a prognostic impact, in COVID-19 patients, and to determine the most influential BCP(s) on the prognosis. Unenhanced chest computed tomography examinations of COVID-19 cases were assessed regarding the severity of pneumonia, pectoralis muscle area and density (PMA, PMD), visceral adipose tissue area (VAA), waist circumference, waist to paravertebral muscle circumference ratio, coronary artery calcification severity, and paravertebral muscle area at the T5 vertebral level. A second observer repeated measurements and an intraclass correlation coefficient score were used for interobserver agreement. The relationship between data and patient outcomes (intubation, death) was investigated using multivariable logistic regression analysis. The area under the receiver operating characteristic curve (AUC) was used to evaluate the performance of BCPs in predicting outcomes. A total of 238 (121 males, median age, 48 years [interquartile range, 36-63 years]) consecutive COVID-19 patients with chest computed tomography were investigated. Twenty-four patients (10.08%) were intubated, and 15 patients (6.3%) died during at least 1 month of follow-up. Waist to paravertebral muscle circumference ratio, PMA, PMD, and T5 vertebral level were significantly associated with intubation in the multivariable analysis. Pectoralis muscle density and PMA were significantly associated with death. Pectoralis muscle density showed the highest AUC for the prediction of intubation and death (AUC of 0.814 and 0.871, respectively). There was a good to excellent agreement between observers (intraclass correlation coefficient range, 0.899-0.998). Pectoralis muscle density is the most influential BCP in predicting intubation and death in COVID-19 patients.

Deep learning radiomics under multimodality explore association between muscle/fat and metastasis and survival in breast cancer patients.

Sarcopenia is correlated with poor clinical outcomes in breast cancer (BC) patients. However, there is no precise quantitative study on the correlation between body composition changes and BC metastasis and survival. The present study proposed a deep learning radiomics (DLR) approach to investigate the effects of muscle and fat on distant metastasis and death outcomes in BC patients. Image feature extraction was performed on 4th thoracic vertebra (T4) and 11th thoracic vertebra (T11) on computed tomography (CT) image levels by DLR, and image features were combined with clinical information to predict distant metastasis in BC patients. Clinical information combined with DLR significantly predicted distant metastasis in BC patients. In the test cohort, the area under the curve of model performance on clinical information combined with DLR was 0.960 (95% CI: 0.942-0.979, P < 0.001). The patients with distant metastases had a lower pectoral muscle index in T4 (PMI/T4) than in patients without metastases. PMI/T4 and visceral fat tissue area in T11 (VFA/T11) were independent prognostic factors for the overall survival in BC patients. The pectoralis muscle area in T4 (PMA/T4) and PMI/T4 is an independent prognostic factor for distant metastasis-free survival in BC patients. The current study further confirmed that muscle/fat of T4 and T11 levels have a significant effect on the distant metastasis of BC. Appending the network features of T4 and T11 to the model significantly enhances the prediction performance of distant metastasis of BC, providing a valuable biomarker for the early treatment of BC patients.

Impact of pectoralis muscle loss on cardiac outcome and survival in Cancer patients who received anthracycline based chemotherapy: retrospective study

IntroductionThe impact of pectoralis muscle mass index (PMI) on cardiac events is not well studied in cancer patients, especially in those who have received chemotherapy with high potential cardiac toxicity such as anthracyclines.MethodsIndividuals aged ≥18 years with a diagnosis of breast cancer, sarcoma, or lymphoma who received anthracycline-based chemotherapy at the University of Minnesota MHealth Fairview between 2009 and 2014. Eligible patients had to have two CT scans: a baseline CT scan within 6 months prior to chemotherapy and a follow-up CT scan within 2 years after treatment. The PMI was calculated as the right pectoralis muscle area indexed to height squared. Multivariable linear regression was used to analyze factors associated with PMI at follow-up, overall mortality, and major cardiac events (MACE).ResultsA total of 474 patients (breast cancer 192; lymphoma 184; sarcoma 98) participated with a median age of 61 years at the time of baseline CT scan; 161 (34%) were male. Almost all patients received anthracyclines except 12% who received trastuzumab only. The median baseline PMI was 5.8 cm2/m2 (4.9, 7.7) which decreased 10.5% after chemotherapy, to 5.2 cm2/m2 (4.4, 6.4). Baseline PMI was not significantly associated with OS, but we detected lower risks of MACE with larger PMI at baseline. Greater baseline PMI was associated with greater follow-up PMI, but also with greater relative PMI loss. Female gender, older age, and history of smoking were also associated with greater PMI losses.ConclusionGreater pre-treatment pectoralis muscle index in patients treated with anthracyclines have a lower risk of MACE. Early identification of sarcopenia using PMI could trigger proactive engagement for intervention and risk-stratified therapies.

Prognostic Role of the Pectoralis Musculature in Patients with COVID-19. A Multicenter Study

Rationale and ObjectivesTo evaluate the impact of low skeletal muscle mass in patients with COVID-19 on relevant outcomes like 30-day mortality, need for intubation and need for intensive care unit admission.Materials and MethodsFor this study, data from six centers were acquired. The acquired sample comprises 1138 patients. There were 547 women (48.1%) and 591 men (51.9%) with a mean age of 54.5 ± 18.8 years; median age, 55 years; range, 18–84 years). In every case, thoracic CT without intravenous application of contrast medium was performed. The following parameters of the pectoralis muscles were estimated: muscle area as a sum of the bilateral areas of the pectoralis major and minor muscles, muscle density, muscle index (PMI) (pectoralis muscle area divided by the patient's body height square) as a ratio pectoralis major and minor muscles divided by the patient's body height2, and muscle gauge as PMI x muscle density.ResultsOverall, 220 patients (19.33%) were admitted to the intensive care unit. In 171 patients (15.03%), mechanical lung ventilation was performed. Finally, 154 patients (13.53%) died within the observation time of 30-day. All investigated parameters of pectoralis muscle were lower in the patients with unfavorable courses of Covid-19. All pectoralis muscle parameters were associated with 30-day mortality in multivariate analyses adjusted for age and sex: pectoralis muscle area, HR = 0.93 CI 95% (0.91–0.95) p < 0.001; pectoralis muscle density, HR = 0.94 CI 95% (0.93–0.96) p < 0.001; pectoralis muscle index, HR = 0.79 CI 95% (0.75–0.85) p < 0.001, pectoralis muscle gauge, HR = 0.995 CI 95% (0.99–0.996) p < 0.001.Conclusionin COVID-19, survivors have larger areas and higher index, gauge and density of the pectoralis muscles in comparison to nonsurvivors. However, the analyzed muscle parameters cannot be used for prediction of disease courses.

Preoperative Pectoralis Muscle Index Predicts Distant Metastasis-Free Survival in Breast Cancer Patients.

BackgroundBreast cancer is one of the most commonly diagnosed cancers, and the fourth leading cause of cancer deaths in females worldwide. Sarcopenia is related to adverse clinical outcomes in patients with malignancies. Muscle index is a key parameter in evaluating sarcopenia. However, there is no data investigating the association between muscle index and distant metastasis in breast cancer. The aim of this study was to explore whether muscle index can effectively predict distant metastasis and death outcomes in breast cancer patients.Study DesignThe clinical data of 493 breast cancer patients at the Harbin Medical University Cancer Hospital between January 2014 and December 2015 were retrospectively analyzed. Quantitative measurements of pectoralis muscle area and skeletal muscle area were performed at the level of the fourth thoracic vertebra (T4) and the eleventh thoracic vertebra (T11) of the chest computed tomography image, respectively. The pectoralis muscle index (PMI) and skeletal muscle index (SMI) were assessed by the normalized muscle area (area/the square of height). Survival analysis was performed using the log-rank test and Cox proportional hazards regression analysis.ResultThe patients with metastases had lower PMI at T4 level (PMI/T4) and SMI at T11 level (SMI/T11) compared with the patients without metastases. Moreover, there were significant correlations between PMI/T4 and lymphovascular invasion, Ki67 expression, multifocal disease, and molecular subtype. In addition, multivariate analysis revealed that PMI/T4, not SMI/T11, was an independent prognostic factor for distant metastasis-free survival (DMFS) and overall survival (OS) in breast cancer patients.ConclusionsLow PMI/T4 is associated with worse DMFS and OS in breast cancer patients. Future prospective studies are needed.

Impact of Skeletal Muscle Measurements by Chest Computed Tomography on Survival and Postoperative Complications in Patients with Soft Tissue Sarcoma

This study aims to evaluate whether sarcopenia, measured by chest computed tomography (CT), affects survival outcomes and postoperative complications in soft tissue sarcoma (STS) patients undergoing surgery. In this retrospective study, CT scans of 79 patients were reviewed to measure pectoralis and T12 vertebra muscle area. Both were then adjusted for height (cm2/m2) as pectoralis muscle index (PMI) and T12 vertebra muscle index (TMI). Analyses were performed by dichotomizing muscle indices at gender-specific 50th percentile; PMI and TMI < 50th percentile were defined as low, and ≥50th percentile as high. Overall postsurgical complication rate (PCR) was 16%. Median length of hospital stay (LOHS) was 10 days (3–90). PMI and TMI were significantly lower in women (p = 0.02, p = 0.04). Median body mass index was significantly higher in high PMI and TMI groups (p = 0.01 for both). PCR and LOHS were similar between low and high PMI and TMI groups. Median follow-up was 29 months, 37 patients had recurrence and 23 died. No significant difference was noted between low and high PMI and TMI groups, in terms of disease-free or overall survival. PMI and TMI as measured by chest CT had no impact on survival outcomes or postoperative complications in localized STS.

Reference values of skeletal muscle area for diagnosis of sarcopenia using chest computed tomography in Asian general population.

BackgroundDiagnostic cutoff points for sarcopenia in chest computed tomography (CT) have not been established although CT is widely used for investigating skeletal muscles. This study aimed to determine reference values for sarcopenia of thoracic skeletal muscles acquired from chest CT scans and to analyse variables related to sarcopenia using the cutoff values determined in a general Asian population.MethodsWe retrospectively reviewed chest CT scans of 4470 participants (mean age 54.8 ± 9.9 years, 65.8% male) performed at a check‐up centre in South Korea (January 2016–August 2017). To determine cutoffs, 335 participants aged 19–39 years (mean age 35.2 ± 3.6 years, 75.2% male) were selected as the healthy and younger reference group, and 4135 participants aged ≥40 years (mean age 56.4 ± 8.4 years, 65.1% male) were selected as the study group. We measured the following: cross‐sectional area (CSA) of the pectoralis, intercostalis, paraspinal, serratus, and latissimus muscles at the 4th vertebral region (T4CSA); T4CSA divided by height2 (T4MI); pectoralis muscle area (PMCSA); and PMCSA divided by height2 (PMI) at the 4th vertebral region. Sarcopenia cutoff was defined as sex‐specific values of less than −2 SD below the mean from the reference group.ResultsIn the reference group, T4CSA, T4MI, PMCSA, and PMI cutoffs for sarcopenia were 100.06cm2, 33.69cm2/m2, 29.00cm2, and 10.17cm2/m2 in male, and 66.93cm2, 26.01cm2/m2, 18.29cm2, and 7.31cm2/m2 in female, respectively. The prevalence of sarcopenia in the study group measured with T4CSA, T4MI, PMCSA and PMI cutoffs were 11.4%, 8.7%, 8.5%, and 10.1%, respectively. Correlations were observed between appendicular skeletal mass divided by height2 measured by bioelectrical impedance analysis (BIA) and T4CSA (r = 0.82; P < 0.001)/T4MI (r = 0.68; P < 0.001), and ASM/height 2 measured by BIA and PMCSA (r = 0.72; P < 0.001)/PMI (r = 0.63; P < 0.001). In the multivariate logistic regression models, sarcopenia defined by T4CSA/T4MI were related to age [odds ratio (95% confidence interval), P‐values: 1.09 (1.07–1.11), <0.001/1.05 (1.04–1.07), <0.001] and diabetes [1.60 (1.14–2.25), 0.007/1.47 (1.01–2.14), 0.043]. Sarcopenia defined by PMCSA/PMI were related to age [1.09 (1.08–1.10), <0.001/1.05 (1.03–1.06), <0.001], male sex [0.23 (0.18–0.30), <0.001/0.47 (0.32–0.71), <0.001], diabetes [2.30 (1.73–3.05), <0.001/1.63 (1.15–2.32), 0.007], history of cancer [2.51 (1.78–3.55), <0.001/1.61 (1.04–2.48), 0.033], and sufficient physical activity [0.67 (0.50–0.89), 0.007/0.74 (0.56–0.99), 0.042].ConclusionsThe reference cutoff values of a general population reported here will enable sex‐specific standardization of thoracic muscle mass quantification and sarcopenia assessment.

Validation for measurements of skeletal muscle areas using low-dose chest computed tomography

Various methods were suggested to measure skeletal muscle areas (SMAs) using chest low-dose computed tomography (chest LDCT) as a substitute for SMA at 3rd lumbar vertebra level (L3-SMA). In this study, four SMAs (L1-SMA, T12-erector spinae muscle areas, chest wall muscle area at carina level, pectoralis muscle area at aortic arch level) were segmented semi-automatically in 780 individuals taking concurrent chest and abdomen LDCT for healthcare screening. Four SMAs were compared to L3-SMA and annual changes were calculated from individuals with multiple examinations (n = 101). Skeletal muscle index (SMI; SMA/height2) cut-off for sarcopenia was determined by lower 5th percentile of young individuals (age ≤ 40 years). L1-SMA showed the greatest correlation to L3-SMA (men, R2 = 0.7920; women, R2 = 0.7396), and the smallest annual changes (0.3300 ± 4.7365%) among four SMAs. L1-SMI cut-offs for determining sarcopenia were 39.2cm2/m2 in men, and 27.5cm2/m2 in women. Forty-six men (9.5%) and ten women (3.4%) were found to have sarcopenia using L1-SMI cut-offs. In conclusion, L1-SMA could be a reasonable substitute for L3-SMA in chest LDCT. Suggested L1-SMI cut-offs for sarcopenia were 39.2cm2/m2 for men and 27.5cm2/m2 for women in Asian.

Combination of Skeletal Muscle Mass and Density Predicts Postoperative Complications and Survival of Patients With Non-Small Cell Lung Cancer.

Few studies have assessed the comprehensive skeletal muscle depletion associated with loss of muscle quantity (sarcopenia) and reduced muscle quality in cancer patients. This study aimed to clarify the impact of skeletal muscle depletion on outcomes after non-small cell lung cancer surgery. Data for 341 patients with pathologic stages 1 to 3A non-small cell lung cancer who underwent lobectomy and mediastinal lymph node dissection from 2009 to 2013 were retrospectively reviewed. The integrative pectoralis muscle index (IPMI) was assessed by multiplying the normalized pectoralis muscle area (area/body mass index) and mean radiodensity on chest images. Postoperative outcomes were compared among sex-specific quartiles of IPMI. The trend of continuous and categorical variables was analyzed using the Jonckheere-Terpstra test and the Cochrane-Armitage test, respectively. Respiratory strength declined with decreasing quartiles of IPMI (P < 0.001). The risk of major complications escalated with the decrease of IPMI among four quartiles (7.1 %, 16.7 %, 18.4 %, and 22.4 %; P = 0.008). The hospital stay was prolonged for patients with reduced IPMI (P = 0.001). Patients in the lowest and highest quartiles had the worst and best 5-year overall survival, respectively, compared with those in the two intermediate quartiles of IPMI (67.0 %, 87.9 %, and 81.2 %, respectively; P=0.001). Multivariate analysis identified the lowest quartile of IPMI as an independent poor prognostic factor (hazard ratio, 1.88; 95 % confidence interval, 1.11-3.19; P = 0.020). Comprehensive skeletal muscle profiling, including morphometric mass and componential density on chest imaging, has the potential to refine risk stratification and prognostication in non-small cell lung cancer.

30s sit-to-stand power is positively associated with chest muscle thickness in COVID-19 survivors.

IntroductionAfter hospitalization, early detection of musculoskeletal sequelae might help healthcare professionals to improve and individualize treatment, accelerating recovery after COVID-19. The objective was to determine the association between the 30s sit-to-stand muscle power (30s-STS) and cross-sectional area of the chest muscles (pectoralis) in COVID-19 survivors.MethodThis cross-sectional study collected routine data from COVID-19 survivors one month after hospitalization: 1) a chest computed tomography (CT) scan and 2) a functional capacity test (30s-STS). The pectoralis muscle area (PMA) was measured from axial CT images. For each gender, patients were categorized into tertiles based on PMA. The 30s-STS was performed to determine the leg extension power. The allometric and relative STS power were calculated as absolute 30s-STS power normalized to height squared and body mass. The two-way ANOVA was used to compare the gender-stratified tertiles of 30s-STS power variants.ResultsFifty-eight COVID-19 survivors were included (mean age 61.2 ± 12.9 years, 30/28 (51.7%/48.3%) men/women). The two-way ANOVA showed significant differences between the PMA tertiles in absolute STS power (p = .002) and allometric STS power (p = .001). There were no significant gender x PMA tertile interactions (all variables p > .05). The high tertile of PMA showed a higher allometric STS power compared to the low and middle tertile, p = .002 and p = .004, respectively. Absolute STS power and allometric STS power had a moderate correlation with the PMA, r = 0.519 (p < .001) and r = 0.458 (p < .001) respectively.ConclusionThe 30s-STS power is associated with pectoralis muscle thickness in both male and female COVID-19 survivors. Thus, this test may indicate global muscle-wasting and may be used as a screening tool for lower extremity functional capacity in the early stages of rehabilitation planning in COVID-19 survivors.

Impact of Pectoral Muscle Values on Clinical Outcomes in Patients With Severe Covid-19 Disease.

The effect of sarcopenia on patients with severe Covid-19 disease is unknown. We aimed to assess the influence of baseline computed tomography (CT)-based body composition parameters (pectoralis muscle area, pectoralis muscle index, skeletal muscle gauge) on clinical variables in patients with severe Covid-19 disease. Chest CT scans of adult patients with confirmed Covid-19 who were hospitalized from March 2020 to May 2021 at a level-one medical center in Germany were retrospectively analyzed. Pectoralis muscle area, pectoralis muscle index and skeletal muscle gauge were measured on the first CT scan after admission. Body composition parameters were assessed for association with clinical variables and 30-day mortality. A total of 46 patients were included. None of the body composition parameters was a predictor for 30-day mortality, duration of hospital stay, duration of intensive care unit treatment, or duration of invasive mechanical ventilation. Pectoralis muscle composition parameters in CT chest scans did not predict outcomes in adult patients with severe Covid-19 infection.

CT pectoralis muscle area is associated with DXA lean mass and correlates with emphysema progression in a tobacco-exposed cohort

IntroductionMuscle loss is an important extrapulmonary manifestation of COPD. Dual energy X-ray absorptiometry (DXA) is the method of choice for body composition measurement but is not widely used for muscle...

Longitudinal Association Between Muscle Loss and Mortality in Ever Smokers

Body composition measures, specifically low weight or reduced muscle mass, are associated with mortality in COPD, but the effect of longitudinal body composition changes is undefined. Is the longitudinal loss of fat-free mass (FFM) associated with increased mortality, including in those with initially normal or elevated body composition metrics? Participants with complete data for at least one visit in the COPDGene study (n= 9,268) and the ECLIPSE study (n= 1,760) were included and monitored for 12 and 8 years, respectively. Pectoralis muscle area (PMA) was derived from thoracic CT scans and used as a proxy for FFM. A longitudinal mixed submodel for PMA and a Cox proportional hazards submodel for survival were fitted on a joint distribution, using a shared random intercept parameter and Markov chain Monte Carlo parameter estimation. Both cohorts demonstrated a left-shifted distribution of baseline FFM, not reflected in BMI, and an increase in all-cause mortality risk associated with longitudinal loss of PMA. For each 1-cm2 PMA loss, mortality increased 3.1%(95%CI, 2.4%-3.7%; P< .001) in COPDGene, and 2.4%(95%CI, 0.9%-4.0%; P< .001) in ECLIPSE. Increased mortality risk was independent of enrollment values for BMI and disease severity [BODE (body mass, airflow obstruction, dyspnea, and exercise capacity) index quartiles] and was significant even in participants with initially greater than average PMA. Longitudinal loss of PMA is associated with increased all-cause mortality, regardless of BMI or initial muscle mass. Consideration of novel screening tests and further research into mechanisms contributing to muscle decline may improve risk stratification and identify novel therapeutic targets in ever smokers.

QUANTITATIVE COMPUTER TOMOGRAPHY MEASURES OF BODY COMPOSITION AND THE ASSOCIATION WITH MORTALITY, ALL CAUSE, COPD AND PNEUMONIA RELATED HOSPITAL ADMISSION IN A LARGE LUNG CANCER SCREENING COHORT

TOPIC: Imaging TYPE: Original Investigations PURPOSE: Patients at high-risk for lung cancer and qualified for CT lung cancer screening (CTLS) are at risk for numerous cardio-pulmonary comorbidities. CT quantified muscle area has been shown to be associated with mortality, lung cancer, chronic obstructive pulmonary disease (COPD) severity and exacerbations. We sought to examine if quantitatively assessed measures of body composition on CTLS scans can identify patients at increased risk for mortality, and all cause, COPD and pneumonia related hospitalization in a large clinical CTLS cohort. METHODS: Patients (n=1703) from Lahey Hospital and Medical Center who underwent CTLS from January 12, 2012 through September 30, 2014 and had an in network primary care physician were included. Clinical outcomes data was collected through September 30, 2019. Quantitative measurements of pectoralis muscle area (PMA) and subcutaneous fat area (SFA) were performed on a single axial slice of the CT above the aortic arch with the Chest Imaging Platform Workstation software. PMA, SFA and liver density were dichotomized into quartiles separately for each sex and combined to account for baseline differences between sexes. Multivariable Cox regression models were used to evaluate the association between quantitative measures of body composition and mortality, hospitalization, COPD-related, and pneumonia-related hospitalization. To adjust for multiplicity Bonferroni correction was utilized and p-value significance was set at ≤ 0.004. All statistical analyses were performed using STATA14.1. RESULTS: Of the 1,703 patients who met the inclusion criteria and underwent CTLS, a total of seven patients were excluded secondary to failure of the Chest Imaging Platform program to analyze the scans. There were a total of 137 (8.1%) deaths during the study, 652 (38.4%) of the subjects were admitted to the hospital at least once, 74 (4.4%) were admitted for COPD and 97 (5.7%) were admitted for pneumonia related hospitalizations. The lowest quartile of PMA was found to be associated with an increased risk for mortality and COPD related hospital admission HR 3.10 (1.84, 5.21), p<0.001 and HR 3.24 (1.45, 7.22), p =0.004. The lowest quartile of liver density was found to be associated with an increased risk for all cause, COPD and pneumonia related hospital admission HR 1.73 (1.34, 2.24), p<0.001, HR 3.32 (1.53, 7.20), p =0.002 and HR 2.95 (1.46, 5.97), p =0.003. CONCLUSIONS: Quantitative measure of PMA are associated with an increased risk for mortality and COPD related hospital admission. Liver density measurements are associated with an increased risk for all cause, COPD and pneumonia related hospital admissions. CLINICAL IMPLICATIONS: Quantitative measurements of body composition on CTLS exams in these patients can be used to extrapolate risk for mortality and hospital admissions. Allowing clinicians to identify at risk patients, impacting clinical decision making and patient care. DISCLOSURES: No relevant relationships by Alissa Ali, source=Web Response Grant funding relationship with Genentech Please note: 9/10/2020 Added 04/23/2021 by Lee Gazourian, source=Web Response, value=Grant/Research Support Consultant relationship with Veracyte Please note: 2019-2021 Added 06/23/2021 by Carla Lamb, source=Web Response, value=Honoraria No relevant relationships by Timothy Liesching, source=Web Response No relevant relationships by William Long, source=Web Response Speaker/Speaker's Bureau relationship with Covidien Please note: $1001 - $5000 by andrea mckee, source=Web Response, value=Salary Speaker/Speaker's Bureau relationship with Covidien Please note: $1-$1000 by andrea mckee, source=Web Response, value=Travel Advisor relationship with AstraZeneca Please note: 2019-2021 Added 04/22/2021 by Brady McKee, source=Web Response, value=Advisor Fee No relevant relationships by Elizabeth Pagura, source=Web Response No relevant relationships by Lori Lyn Price, source=Web Response No relevant relationships by Shawn Regis, source=Web Response research relationship with Veracyte Please note: 1/1/18-present Added 06/23/2021 by Kimberly Rieger-Christ, source=Web Response, value=Grant/Research Support No relevant relationships by Giulia Rizzo, source=Web Response Owner/Founder relationship with Quantitative Imaging Solutions Please note: 2015 Added 04/30/2021 by Raúl San José Estépar, source=Web Response, value=Ownership interest No relevant relationships by Ava Sanayei, source=Web Response No relevant relationships by Cristina Stefanescu, source=Web Response No relevant relationships by Will Thedinger, source=Web Response No relevant relationships by Christoph Wald, source=Web Response, value=Honoraria Removed 04/22/2021 by Christoph Wald, source=Web Response My spouse/partner as a Employee relationship with biogen Please note: >$100000 by George Washko, source=Web Response, value=Salary Owner/Founder relationship with Quantitative Imaging Solutions Please note: >$100000 by George Washko, source=Web Response, value=Ownership interest Advisory Committee Member relationship with Boehringer Ingelheim Please note: $1001 - $5000 by George Washko, source=Web Response, value=Consulting fee Consultant relationship with Vertex Please note: $5001 - $20000 by George Washko, source=Web Response, value=Consulting fee Advisory Committee Member relationship with PulmonX Please note: $1001 - $5000 by George Washko, source=Web Response, value=Consulting fee Advisory Committee Member relationship with CSL Behring Please note: $1001 - $5000 by George Washko, source=Web Response, value=Consulting fee Consultant relationship with Johnson and Johnson Please note: $5001 - $20000 by George Washko, source=Web Response, value=Consulting fee

Pectoralis muscle area and its association with indices of disease severity in interstitial lung disease

RationaleThe pathophysiology of interstitial lung disease (ILD) impacts body composition, whereby ILD severity is linked to lower lean mass. ObjectivesTo determine i) if pectoralis muscle area (PMA) is a surrogate for whole-body lean mass in ILD, ii) whether PMA is associated with ILD severity, and iii) if the longitudinal change in PMA is associated with pulmonary function and mortality in ILD. MethodsPatients with ILD (n = 164) were analyzed retrospectively. PMA was quantified from a chest computed tomography scan. Peripheral oxygen saturation (SpO2), 6-min walk distance (6MWD), and pulmonary function were obtained as part of routine clinical care. Dyspnea and quality of life were assessed using the UCSD Shortness of Breath Questionnaire and European Quality of Life 5 Dimensions questionnaire, respectively. ResultsPMA was associated with whole-body lean mass (p < 0.001). After adjusting for age, sex, height, body mass, and prednisone status, PMA was associated with %-predicted forced vital capacity (FVC), %-predicted diffusion capacity (DLCO), resting and exertional SpO2, and dyspnea (all p < 0.05), but not forced expiratory volume in 1 s (FEV1), FEV1/FVC, 6MWD, or quality of life (all p > 0.05). The annual negative PMA slope was associated with annual negative slopes in FVC, FEV1, and DLCO (all p < 0.05), but not FEV1/FVC (p = 0.46). Annual slope in PMA was associated with all-cause mortality (hazard ratio = −0.80, 95% CI:0.889–0.959; p < 0.001). ConclusionIn patients with ILD, PMA is a suitable surrogate for whole-body lean mass. A lower PMA is associated with indices of ILD severity, which supports the notion that ILD progression may involve sarcopenia.

Anthropometric analysis of body habitus and outcomes in critically ill COVID-19 patients.

AimsThis study aimed to determine whether anthropometric markers of thoracic skeletal muscle and abdominal visceral fat tissue correlate with outcome parameters in critically ill COVID-19 patients.MethodsWe retrospectively analysed thoracic CT-scans of 67 patients in four ICUs at a university hospital. Thoracic skeletal muscle (total cross-sectional area (CSA); pectoralis muscle area (PMA)) and abdominal visceral fat tissue (VAT) were quantified using a semi-automated method. Point-biserial-correlation-coefficient, Spearman-correlation-coefficient, Wilcoxon rank-sum test and logistic regression were used to assess the correlation and test for differences between anthropometric parameters and death, ventilator- and ICU-free days and initial inflammatory laboratory values.ResultsDeceased patients had lower CSA and PMA values, but higher VAT values (p < 0.001). Male patients with higher CSA values had more ventilator-free days (p = 0.047) and ICU-free days (p = 0.017). Higher VAT/CSA and VAT/PMA values were associated with higher mortality (p < 0.001), but were negatively correlated with ICU length of stay in female patients only (p < 0.016). There was no association between anthropometric parameters and initial inflammatory biomarker levels. Logistic regression revealed no significant independent predictor for death.ConclusionOur study suggests that pathologic body composition assessed by planimetric measurements using thoracic CT-scans is associated with worse outcome in critically ill COVID-19 patients.

Respiratory exacerbations are associated with muscle loss in current and former smokers

ObjectivesMuscle wasting is a recognised extra-pulmonary complication in chronic obstructive pulmonary disease and has been associated with increased risk of death. Acute respiratory exacerbations are associated with reduction of muscle...

CT Attenuation and Cross-sectional-area Index of the Pectoralis Are Associated With Prognosis in Sarcoma Patients.

To identify prognostic imaging biomarkers from staging chest computed tomography (CT) in patients with sarcomas. CT scans for baseline staging, and surveillance 1-year CT scans in patients newly diagnosed with sarcoma were evaluated. Pectoralis muscle area (PMA), pectoralis muscle index (PMI) and pectoralis CT attenuation density (PMT) were measured. Cox proportional-hazard models were used to determine the association with progression-free survival (PFS) and overall survival (OS). There were 147 patients (53.1% male) who were followed for a median 1,414 days (range=219-4851 days). Approximately 47.6% (70/147) of patients progressed and 29.9% (44/147) died. Multivariable Cox-proportional hazards models adjusting for gender, tumor grade and chemotherapy treatment showed that a higher baseline PMT and baseline PMI were associated with increased OS. Higher baseline PMI and PMT are associated with increased overall survival in patients with sarcoma.