Pectoral Mass Research Articles

Accessory thoracic muscles in human fetuses.

Typically, the anterior thoracic wall musculature is composed of the pectoralis major and pectoralis minor. Embryologically, these two muscles are originated from a common pectoral muscle mass; therefore, disruption of the normal development and differentiation could give rise to an aberrant or accessory muscle. The main aim of this study is to demonstrate and classify the accessory muscles of the pectoralis region in human fetuses. Fifty spontaneously aborted human fetuses (25 male and 25 female, 100 sides) aged 18-38 weeks of gestation at death, and fixed in 10% formalin solution were examined. Following parental approval, the fetuses were donated to the Medical University anatomy program. The pectoralis major and minor muscle's morphology, the possible occurrence of accessory muscles of pectoral region and its morphology, their origins, and insertions, as well as the morphometric details, were assessed. The pectoralis major and minor were bilaterally found in all fetuses (100 cases). The accessory muscles of pectoral region were found in 16 cases (16%), and four types were differentiated. The Pectoralis Quartus muscle was the most common type of accessory muscles found in this study and occurred in 8 cases. The axillary arch muscle was observed in 3 cases. The chondrocoracoideus muscle was observed in 3 cases. The sternalis muscle occurred in 2 cases, and one of them was bifurcated. The thoracic region is characterized by a large amount of morphological variations, which are observed not only in adult population, but also among human fetuses. The pectoralis quartus was the most frequent variation in this study. Accessory structures like sternalis muscle, chondrocoracoideus muscle, pectoralis quartus muscle, or axillary arch muscle may have clinical implications, and knowledge about them is very useful for clinicians, especially plastic surgeons, thoracic surgeons, and orthopedics.

The evolution and impact of sarcopenia in severe aplastic anaemia survivors following allogeneic haematopoietic cell transplantation.

Sarcopenia is a potential risk factor for adverse outcomes in haematopoietic cell transplantation (HSCT) recipients. We aimed to explore longitudinal body changesin muscle and adipose mass and their prognostic value in allogeneic HSCT-treated severe aplastic anaemia (SAA) patients. We retrospectively analysed consecutive SAA patients who underwent allogeneic HSCT between January 2017 and March 2022. Measurements of pectoral muscle and corresponding subcutaneous fat mass were obtained via chest computed tomography at baseline and at 1month, 3months, 6months, and 12months following HSCT. Sarcopenia was defined as pectoral muscle index (PMI) lower than the sex-specific median at baseline. Changes in body composition over time were evaluated by generalized estimating equations. Cox regression models were used to investigate prognostic factors affecting overall survival (OS) and failure-free survival (FFS). A nomogram was constructed from the Cox regression model for OS. We included 298 adult SAA patients (including 129 females and 169 males) with a median age of 31years [interquartile range (IQR), 24-39years] at baseline. Sarcopenia was present in 148 (148/298, 50%) patients at baseline, 218 (218/285, 76%) patients post-1month, 209 (209/262, 80%) patients post-3month, 169 (169/218, 78%) patients post-6month, and 129 (129/181, 71%) patients post-12month. A significant decrease in pectoral muscle mass was observed in SAA patients from the time of transplant to 1year after HSCT, and the greatest reduction occurred in post 1-3months (P<0.001). The sarcopenia group exhibited significantly lower 5-year OS (90.6% vs. 100%, log-rank P=0.039) and 5-year FFS (89.2% vs. 100%, log-rank P=0.021) than the nonsarcopenia group at baseline. Sarcopenia at baseline (hazard ratio, HR, 6.344; 95% confidence interval, CI: 1.570-25.538; P=0.01; and HR, 3.275; 95% CI: 1.159-9.252; P=0.025, respectively) and the delta value of the PMI at 6months post-transplantation (ΔPMI6) (HR, 0.531; 95% CI: 0.374-0.756; P<0.001; and HR, 0.666; 95% CI: 0.505-0.879; P=0.004, respectively) were demonstrated to be independent prognostic factors for OS and FFS in SAA patients undergoing HSCT, and were used to construct the nomogram. The C-index of the nomogram was 0.75, and the calibration plot showed good agreement between the predictions made by the nomogram and actual observations. Sarcopenia persists in SAA patients from the time of transplant to the 1-year follow-up after HSCT. Both sarcopenia at baseline and at 6months following HSCT are associated with poor clinical outcomes, especially in patients with persistent muscle mass loss up to 6months after transplantation.

Pectoral muscle mass is not a robust prognostic factor for survival after left ventricular assist device (LVAD) implantation

BackgroundLeft ventricular assist devices (LVAD) are an established treatment for end-stage left ventricular heart failure. Parameters are needed to identify the most appropriate patients for LVADs. This study aimed to evaluate pectoral muscle mass and density as prognostic parameters.MethodsThis single-center study included all patients with LVAD implantation between January 2010 and October 2017 and a preoperative chest CT scan. Pectoral muscle mass was assessed using the Pectoralis Muscle Index (PMI, surface area indexed to height, cm2/m2) and pectoral muscle density by Hounsfield Units (HU). Overall mortality was analyzed with Kaplan–Meier survival analysis and 1-year and 3-year mortality with receiver operating characteristic (ROC) curves and Cox regression models.Results57 patients (89.5% male, mean age 57.8 years) were included. 64.9% of patients had end-stage left ventricular failure due to ischemic heart disease and 35.1% due to dilated cardiomyopathy. 49.2% of patients had preoperative INTERMACS profile of 1 or 2 and 33.3% received mechanical circulatory support prior to LVAD implantation. Total mean PMI was 4.7 cm2/m2 (± 1.6), overall HU of the major pectoral muscle was 39.0 (± 14.9) and of the minor pectoral muscle 37.1 (± 16.6). Mean follow-up was 2.8 years (± 0.2). Mortality rates were 37.5% at 1 year and 48.0% at 3 years. Neither PMI nor HU were significantly associated with overall mortality at 1-year or 3-year.ConclusionsThe results of our study do not confirm the association between higher pectoral muscle mass and better survival after LVAD implantation previously described in the literature.

Case Report: Coccidiosis in Layer Farm, Sumedang

Coccidiosis is a parasitic disease that causes economic losses on chicken farms. A case was found on a farm in Rancaekek, Bandung Regency, where there was a one-year-old laying hen that stopped producing eggs, experienced decreased pectoral muscle mass, and had mild ataxia. The diagnosis was made by necropsy procedure and fecal examination. There were lesions in the small intestine, these lesions manifested as ballooning filled with orange mucus and the presence of petechial hemorrhages on the luminal wall and decreased pectoral muscle mass was found. A Fecal examination was performed using the floating method and the McMaster calculation. The results of the fecal examination revealed Eimeria sp. oocysts and Trichostongylus tenuis eggs. The diagnosis of this case is coccidiosis infection caused by two species of Eimeria sp., namely Eimeria maxima and Eimeria tenella. This infection has resulted in a nutritional deficiency, manifested by a decrease in pectoral muscle mass.

Comparison of the Phenotypic Flexibility of Muscle and Body Condition of Migrant and Resident White-Crowned Sparrows.

AbstractSeasonally breeding birds express variations of traits (phenotypic flexibility) throughout their life history stages that represent adaptations to environmental conditions. Changes of body condition during migration have been well studied, whereas alterations of skeletal and cardiac muscles, body mass, and fat scores have yet to be characterized throughout the spring or fall migratory stages. Additionally, we examined flexible patterns of muscle, body mass, and fat score in migrant white-crowned sparrows (Zonotrichia leucophrys gambelii) in comparison with those in a resident subspecies (Zonotrichia leucophrys nuttalli) during the stages they share to evaluate the influence of different life histories. Migrants showed hypertrophy of the pectoralis muscle fiber area on the wintering grounds in late prealternate molt, yet increased pectoralis muscle mass was not detected until birds readied for spring departure. While pectoralis profile and fat scores enlarged at predeparture in spring and fall, pectoralis, cardiac, and body masses were greater only in spring stages, suggesting seasonal differences for migratory preparation. Gastrocnemius mass showed little change throughout all stages, whereas gastrocnemius fiber area declined steadily but rebounded in fall on the wintering grounds, where migrants become more sedentary. In general, residents are heavier birds with larger leg structures, while migrants sport longer wings and greater heart mass. Phenotypic flexibility was most prominent among residents with peaks of pectoralis, gastrocnemius, and body masses during the winter stage, when local weather is most severe. Thus, the subspecies express specific patterns of phenotypic flexibility with peaks coinciding with the stages of heightened energy demands: the winter stage for residents and the spring stages for migrants.

Preoperative Sarcopenia Assessment Using Pectoralis Muscle Mass Indicated Poor Mid-term Cardiac Surgery Prognosis

Background: Many studies have defined sarcopenia based on psoas muscle mass using abdominal computed tomography (CT). We hypothesized that sarcopenia can be assessed by measuring pectoralis muscle mass on chest CT and aimed to examine its relationship with the postoperative prognosis of cardiac surgery. Methods: This retrospective study included 189 patients who underwent cardiac surgery via median sternotomy between July 2020 and June 2022. We excluded patients &lt;70 years old, urgent/emergent cases, no chest CT within 90 days before surgery, and cases in which evaluation of the pectoralis muscle was impossible with CT. The pectoralis muscle area (PMA) was measured using a preoperative chest CT. The sarcopenia cut-off value was defined as the lowest sex-specific tertile in PMA at the level of the 4th thoracic vertebrae. Results: Eighty patients were included. The lower tertile were classified as the sarcopenia group (SG) (n = 26) and the rest as the non-sarcopenia group (NSG) (n = 54). In the SG, 1-year survival was significantly worse than that in NSG (NSG: 92.7% vs. SG: 54.9%, p &lt; 0.0001). In the multivariate model, sarcopenia was an independent risk factor for mid-term all-cause death (hazard ratio, 4.89; 95% confidence interval: 1.14–21.0, p = 0.033). Conclusion: Preoperative sarcopenia defined using PMA was associated with poor mid-term survival after elective cardiac surgery via median sternotomy. The pectoralis muscle mass observed through a chest CT could be used for preoperative risk scoring in older patients undergoing cardiac surgery.

Supplementing a grain diet with insects instead of fruits sustains the body condition of an omnivorous bird.

Omnivores utilize dietary sources which differ in nutrients, hence dietary limitations due to environmental change or habitat alteration could cause nutrient limitations, and thus deterioration of body condition if omnivory is obligate. We investigated how the body condition of the omnivorous Village weaver Ploceus cucullatus (weavers), which forages predominantly on grains, responds to the supplementation of its grain diet with insects instead of fruits. Forty wild-caught weavers held in aviaries were fed a combination of grains and fruits, or grains and insects ad libitum for 8 weeks. We determined diet preference by recording the number of birds on each diet option per minute for 1 h and the amount of food left-over after 3 h of foraging. Fortnightly, we assessed indices of body condition including body mass, pectoral muscle, and fat scores, packed cell volume (PCV), and hemoglobin concentration (HBC). We modeled the number of foragers, food left-over, and body condition indices as functions of diet, while accounting for time (weeks) and sex effects. Grains were the preferred diet, but males ate more fruits and insects than females. Weavers fed on grains and fruits lost body and pectoral muscle mass and accumulated less fat than those fed on grains and insects. This effect was sex-dependent: females supplemented with fruits lost more pectoral muscle mass than males of the same group and males but not females, supplemented with insects accumulated more fat reserve than those supplemented with fruits. PCV and HBC did not differ between diets but increased over the 8 weeks. Weavers are likely obligate rather than facultative omnivores, with insects as being a more nutritive supplement than fruits. Nutrient limitation arising from environmental change or habitat alteration could impair body condition and affect physiological function to environmental seasonality in obligate omnivores like the weavers.

CT-defined pectoralis muscle mass and muscle density are associated with mortality in acute pulmonary embolism. A multicenter analysis

Computed tomography (CT) defined muscle mass can be used as a surrogate parameter for sarcopenia. The present study used thoracic CT to assess pectoralis muscle area and density as an imaging biomarker for prognosis of 30-day mortality in patients with acute pulmonary embolism (PE) METHODS: The clinical database was retrospectively screened for patients with thoracic CT in 3 centers. Pectoralis musculature was measured on axial slices of the thoracic CT at the level of T4 of contrast enhanced pulmonary angiography CT. Skeletal muscle area (SMA), skeletal muscle index (SMI), muscle density and gauge were calculated. Overall, 981 patients (440 female, 44.9%) with a mean age of 63.5±15.9 years were included into the study and 144 patients (14.6%) died within the 30-days period. Every pectoral muscle value was higher in survivors compared to non-survivors (exemplarily for SMI 9.9±3.5cm2/m2 versus 7.8±2.6cm2/m2, p<0.001). Moreover, 91 patients were defined as hemodynamically instable (9.3%). Comparable, every pectoral muscle parameter was higher in patients with hemodynamically stable course compared to instable course. Different muscle variables are related to 30-day mortality: SMA, OR=0.94 (95%CI= (0.92; 0.96), p<0.001); SMI, OR=0.78 (95%CI= (0.72; 0.84), p<0.001); muscle density, OR=0.96 (95%CI= (0.94; 0.97), p<0.001); muscle gauge OR=0.96 (95%CI= (0.94; 0.99), p<0.001). SMI and muscle density were independently associated with 30-days mortality: SMI, OR=0.81 (95%CI= (0.75; 0.88), p<0.001); muscle density: OR=0.96 (95%CI= (0.95; 0.98), p<0.001). Parameters of the pectoralis musculature are associated with 30-day mortality in patients with acute PE. These findings should lead to an independent validation study and ultimately to the inclusion into clinical routine as a prognostic factor.

CHARAKTERYSTYKA BIOMETRYCZNA CZERNICY AYTHYA FULIGULA (LINNAEUS, 1758) Z POMORZA ZACHODNIEGO (POLSKA)

The purpose of this work was to perform morphometric characteristics of the Tufted Duck Aythya fuligula obtained in Western Pomerania, according to their sex and age. The research material consisted of 197 Tufted Ducks obtained in December 2013. The biometric characteristics was performed on the basis of 20 measurements of linear and mass quantities. All internal organs measured and most of the individual body parts of the Tufted Duck were slightly larger in the case of males. Despite the differences in the body size of males and females, the studied birds showed similar variability in both length and mass. The differences between adult and young Tufted Ducks were not so well defined. Adult Tufted Ducks had significantly larger body mass, pectoral muscle mass and lung mass than juveniles. No significant differences were found in the linear values of the examined features.

Effects of corticosterone administration on the body condition and blood parameters of the house sparrow, Passer domesticus.

Glucocorticoids are steroid hormones produced by the adrenal glands and released into the bloodstream in response to stressful situations. In birds, corticosterone (CORT) is the main glucocorticoid released under stress. Throughout their lives, animals in nature are continually exposed to noxious stimuli known as stressful events. Any alteration of homeostatic stability is a stressful situation and this alteration triggers physiological changes to restore homeostasis. Glucocorticoids are one of the components of the complex set of physiological and behavioral responses to stress. In this work, we use CORT supplied in drinking water to evaluate its effect in blood parameters and physiology in house sparrows (Passer domesticus). To accomplish this, P. domesticus were administered three different doses of CORT in drinking water for 72 h. Body mass, organ mass, pectoral muscle mass, leg muscle mass, and blood parameters (CORT, triglycerides, glucose and uric acid, heterophils/lymphocytes ratio, hematocrit, and serum protein profile) were determined before and after CORT treatment. A 15% decrease in body mass with a significant decrease in pectoral mass were observed after the higher CORT treatment, as well as a decrease in the plasma concentration of uric acid. Lastly, we found a reversal of the heterophils/lymphocytes ratio and a decrease in hematocrit. It was possible to establish first data for baseline and CORT-alteration values in serum protein profile for P. domesticus. Baseline and altered values of blood parameters and serum protein profile could be an important tool in field ecology because they provide important data to assess the physiological condition in wild birds.

Body mass index and natriuretic peptides trends before and after left ventricular assist device

AbstractBackgroundIt is unknown to what degree of sarcopenia related to heart failure (HF) is reversible with resolution of the HF syndrome. We evaluated whether (1) weight loss prior to left ventricular assist device (LVAD) is associated with pre‐operative sarcopenia as quantified on pre‐operative chest CTs and (2) determine the relationship between weight recovery (increase) after LVAD implantation and reduction of NT‐proBNP levels.MethodsIn a large single‐centre cohort (n = 502), CT measures of sarcopenia (pectoralis muscle mass indexed to body surface area and tissue attenuation) were correlated with pre‐LVAD BMI trend (n = 190). BMI and NT‐proBNP trends before and after LVAD implantation were evaluated (n = 403). Linear effects modelling was performed to test the association between NT‐proBNP and BMI trends.ResultsA downtrending BMI prior to LVAD was associated with pectoralis muscle tissue attenuation (P &lt; 0.05). BMI declined prior to LVAD, declined further early post‐implant, and then increased between 100 and 300 days post‐implant (average per cent change in BMI in Year 1, 7.6%, 95% CI: 6.3–8.8%). NT‐proBNP decreased during the first 100 post LVAD days (−5.4%, 95% CI: −6.6 to −4.2%). Post‐LVAD NT‐proBNP and BMI trends were significantly associated, with a decrease of 1 unit log NT‐proBNP associated with an increase in BMI of 0.81 kg/m2 (CI: 0.53–1.09, P &lt; .001). The rise in post‐LVAD BMI occurred after the reduction in NT‐proBNP levels. Patients who failed to gain weight post‐LVAD had the highest 6‐month post‐LVAD natriuretic peptides (lowest per cent BMI gain tertile NT‐proBNP: 2208 vs. highest 1635 pg/mL, P &lt; 0.001).ConclusionsWeight recovery during LVAD support occurs after the reduction in natriuretic peptide levels. Failure to gain weight during LVAD support was associated with persistently elevated natriuretic peptide levels. These data collectively suggest that recovery of body mass may be dependent upon recovery of the HF syndrome.

Injection-Site Sarcoma in Three Village Weaver Birds (Ploceus cucullatus) Associated with Autogenous Yersinia pseudotuberculosis Vaccination

Post-vaccinal sarcomas have been reported in cats and rarely in other domestic mammals, but not in birds. Three village weaver birds (Ploceus cucullatus) presented with poor flying ability and abnormal wing carriage attributable to large, unilateral pectoral masses. All had received at least one dose of autogenous Yersinia pseudotuberculosis vaccine into the affected pectoral muscle 74-408 days previously. Following euthanasia, gross post-mortem examination revealed locally invasive subcutaneous tumours extending through the sternum into the coelomic cavity. Cytology and histology revealed neoplasms of pleomorphic spindloid neoplastic cells with foci of coagulative necrosis and cavitation, sometimes containing faintly refractile non-polarizing granular material, both extracellularly and after phagocytosis by surrounding cells, including multinucleated giant cells. Immunohistochemistry in one bird supported a striated muscle cell origin. Findings of anaplastic sarcoma with intralesional foreign crystalline material resembled typical injection-site sarcomas in cats. This is the first report of presumptive vaccine-associated sarcoma in a non-mammalian species.

Coping with captivity: takeoff speed and load-lifting capacity are unaffected by substantial changes in body condition for a passerine bird.

Captivity presumably challenges the physiological equilibrium of birds and thus influences flight ability. However, the extent to which captive birds exhibit altered features underpinning maximum flight performance remains largely unknown. Here, we studied changes in physiological condition and load-lifting performance in the Eurasian tree sparrow (Passer montanus) over 15, 30 and 45 days of captivity. Sparrows showed body mass constancy over time but also an increased hematocrit at 15 days of captivity; both relative pectoralis mass and pectoralis fat content increased at 30 days. However, maximum takeoff speed and maximum lifted load remained largely unchanged until 45 days of captivity. Wingbeat frequency was independent of captivity duration and loading condition, whereas body angle and stroke plane angle varied only with maximum loading and not with duration of captivity. Overall, these results suggest that captive birds can maintain maximum flight performance when experiencing dramatic changes in both internal milieu and external environment.

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.

Pre-operative sarcopenia is predictive of recurrent gastrointestinal bleeding on left ventricular assist device support: A multicenter analysis.

Whether pre left ventricular assist device (LVAD) sarcopenia is associated with higher incidence of gastrointestinal bleeding (GIB) on LVAD support remains unknown. To study the association between preoperative sarcopenia and post LVAD GIB events, we performed a retrospective, multi-centered study including patients with chest CTs performed ≤ 3 months prior to LVAD implantation at the University of Minnesota (n=143) and Houston Methodist Hospital (n=133). To quantify sarcopenia, unilateral pectoralis muscle mass indexed to body surface area (PMI) and attenuation (approximated by mean Hounsfield units; PHUm) were measured on pre-operative chest CT scans. Negative binomial regression analyses were performed to determine the association between pectoralis muscle measures and number of GIB events to 2 years of LVAD support. The study cohort included 276 LVAD recipients with 43 % designated as bridge to transplant at the time of LVAD implantation. High pectoralis muscle mass and tissue attenuation were both protective against GIB events. Each 5 unit increase in PHUm was associated with an adjusted 19 % reduction in the incidence rate of GIB (95 % CI 7-29 %, p=0.002). Each unit increase in PMI was associated with an adjusted 17 % reduction in the incidence of GIB (95 % CI 1- 29 %, p=0.04). The models were adjusted for age, sex, INTERMACS profile, bridge to transplant status, creatinine, albumin and implanting center. Preoperative sarcopenia, as quantified by pectoralis muscle size and attenuation, was associated with the development of recurrent GI bleeding after LVAD implantation. These CT quantitative measures appear to predict not only early mortality but morbidity on LVAD as well.

Body Mass Index And Natriuretic Peptides Trends Before And After Left Ventricular Assist Device: Evidence That Gains In Body Mass Follow On Resolution Of Heart Failure

Purpose To evaluate the hypothesis that weight gain after left ventricular assist device (LVAD) occurs after the nadir of natriuretic peptides (nt-proBNP), and that persistently elevated natriuretic peptides is associated with failure to gain weight after LVAD implantation. Methods Body mass index (BMI) and nt-proBNP trends before and after LVAD in a single center continuous flow cohort (n=505) were computed and plotted using Locally Estimated Scatterplot Smoothing (LOESS). Linear mixed effects modeling was performed to test the association between nt-proBNP and BMI. CT measures of sarcopenia (pectoralis muscle mass index to body surface area and tissue attenuation, n=194) was correlated with pre-LVAD BMI trend. Results The plots of BMI and log nt-proBNP for the entire cohort before and after LVAD are demonstrated (Figure). The rise in BMI did not occur until after the nadir of post implant nt-proBNP. Downward slope of BMI prior to LVAD was associated with lower pectoralis muscle measures prior to implantation. Patients who failed to gain weight post LVAD had the highest 6 month post LVAD natuetic peptides (lowest pecent BMI gain tertile nt-proBNP: 2,208 vs. highest 1,635 pg/mL, p <0.001). Post LVAD nt-pro BNP and BMI trends were significantly associated (a decrease of 1 unit log nt-proBNP was associated with an increase in 0.81 BMI, 95 % CI: 0.53-1.09, p < 0.001). Conclusions Weight gain post LVAD did not occur until the nadir of natriuretic peptides. Failure to gain weight post LVAD was associated with persistently elevated natriuretic peptides. These data collectively suggest that gains in body mass may be dependent on resolution of heart failure. To evaluate the hypothesis that weight gain after left ventricular assist device (LVAD) occurs after the nadir of natriuretic peptides (nt-proBNP), and that persistently elevated natriuretic peptides is associated with failure to gain weight after LVAD implantation. Body mass index (BMI) and nt-proBNP trends before and after LVAD in a single center continuous flow cohort (n=505) were computed and plotted using Locally Estimated Scatterplot Smoothing (LOESS). Linear mixed effects modeling was performed to test the association between nt-proBNP and BMI. CT measures of sarcopenia (pectoralis muscle mass index to body surface area and tissue attenuation, n=194) was correlated with pre-LVAD BMI trend. The plots of BMI and log nt-proBNP for the entire cohort before and after LVAD are demonstrated (Figure). The rise in BMI did not occur until after the nadir of post implant nt-proBNP. Downward slope of BMI prior to LVAD was associated with lower pectoralis muscle measures prior to implantation. Patients who failed to gain weight post LVAD had the highest 6 month post LVAD natuetic peptides (lowest pecent BMI gain tertile nt-proBNP: 2,208 vs. highest 1,635 pg/mL, p <0.001). Post LVAD nt-pro BNP and BMI trends were significantly associated (a decrease of 1 unit log nt-proBNP was associated with an increase in 0.81 BMI, 95 % CI: 0.53-1.09, p < 0.001). Weight gain post LVAD did not occur until the nadir of natriuretic peptides. Failure to gain weight post LVAD was associated with persistently elevated natriuretic peptides. These data collectively suggest that gains in body mass may be dependent on resolution of heart failure.

The Sarcopenia Index Correlates with Computed Tomography Quantified Muscle Measures in Patients with Advanced Heart Failure

<h3>Purpose</h3> Patients with heart failure (HF) and sarcopenia and/or cachexia have a high mortality. No biomarkers are proven to diagnose or screen for sarcopenia in patients with HF. The purpose of this analysis is to assess the correlation between the sarcopenia index (SI) and CT quantified muscle measurements in advanced HF patients. <h3>Methods</h3> We prospectively collected serum creatinine, cystatin C and pre-operative chest CT scans in 60 patients as part of routine LVAD evaluation between 5/19 to 3/21. The sarcopenia index was calculated using the following equation: (serum creatinine value/cystatin C value) × 100. To quantify muscle mass and quality, unilateral pectoralis muscle mass indexed to body surface area (PMI) and attenuation (approximated by mean Hounsfield units; PHUm) were measured on pre-operative chest CTs. The correlation between the SI and muscle measures was evaluated with linear regression. <h3>Results</h3> Seventy three percent were men (44/60) and 67 % (40/60) were designated as destination therapy. There was a significant correlation between the SI and both pectoralis muscle measures (Figure). Each 10 unit increase in SI was associated with a 0.43 cm²/m² increase in PMI (95 % CI 0.11-0.76 increase, p=0.009) and a 3.47 HU increase in PHUm (95 % CI 2.08-4.87, p< 0.0001). <h3>Conclusion</h3> This is the first study to demonstrate a correlation between the SI and CT derived muscle measurements in an advanced HF population. A HF sarcopenia biomarker has multiple potential clinical applications, including facilitating nutritional/rehabilitation interventions before wasting is clinically evident, as well as triggering earlier referral for advanced HF therapies.

Pectoralis Muscle Mass on Chest CT at Admission Predicts Prognosis in Patients with Pneumonia.

Methods A retrospective cohort study was performed in patients aged 18 years or older with pneumonia who underwent chest CT within 24 hours of admission between April 2014 and March 2019. We measured the thickness, area, and volume of the pectoralis major and minor muscles at the level of the aortic arch. Factors associated with mortality were examined using logistic regression analysis. Results A total of 483 patients (mean age 77 ± 14 years, 300 men (62%)) were included, and fifty-one patients (11%) died during admission. In univariate analysis, decreased thickness, area, and volume of the pectoralis major and minor muscles were associated with higher in-hospital mortality. Multivariate analysis with adjustment for age, gender, serum albumin, and A-DROP revealed that thinner pectoralis major and minor muscles were independent factors of poor prognosis (odds ratio: 0.878, 95% confidence interval (CI): 0.783–0.985, P=0.026 and odds ratio: 0.842, 95% CI: 0.733–0.968, P=0.016, respectively). Approximately 25% of the patients died when the pectoralis minor muscle thickness was 5 mm or less, and no patients died when it was 15 mm or more. Conclusion The pectoralis muscle mass may be an independent prognostic factor in hospitalized patients with pneumonia.

Thoracic skeletal muscle quantification using computed tomography and prognosis of elderly ICU patients

In elderly ICU patients, the prevalence of skeletal muscle loss is high. Longitudinal effect of thoracic muscles, especially in elderly ICU patients, are unclear although skeletal muscle loss is related with the short- and long-term outcomes. This study aimed to evaluate whether pectoralis muscle mass loss could be a predictor of prognosis in elderly ICU patients. We retrospectively evaluated 190 elderly (age > 70 years) patients admitted to the ICU. We measured the cross-sectional area (CSA) of the pectoralis muscle (PMCSA) at the fourth vertebral region. CT scans within two days before ICU admission were used for analysis. Mortality, prolonged mechanical ventilation, and longitudinal changes in Sequential Organ Failure Assessment (SOFA) scores were examined. PMCSA below median was significantly related with prolonged ventilation (odds ratio 2.92) and a higher SOFA scores during the ICU stay (estimated mean = 0.94). PMCSA below median was a significant risk for hospital mortality (hazards ratio 2.06). In elderly ICU patients, a low ICU admission PMCSA was associated with prolonged ventilation, higher SOFA score during the ICU stay, and higher mortality. Adding thoracic skeletal muscle CSA at the time of ICU admission into consideration in deciding the therapeutic intensity in elderly ICU patients may help in making medical decisions.

Cardiopulmonary exercise testing has greater prognostic value than sarcopenia in oesophago‐gastric cancer patients undergoing neoadjuvant therapy and surgical resection

Sarcopenia (low skeletal muscle mass), myosteatosis (low skeletal muscle radiation-attenuation) and fitness are independently associated with postoperative outcomes in oesophago-gastric cancer. This study aimed to investigate (1) the effect of neoadjuvant therapy (NAT) on sarcopenia, myosteatosis and cardiopulmonary exercise testing (CPET), (2) the relationship between these parameters, and (3) their association with postoperative morbidity and survival. Body composition analysis used single slice computed tomography (CT) images from chest (superior to aortic arch) and abdominal CT scans (third lumbar vertebrae). Oxygen uptake at anaerobic threshold (VO2 at AT) and at peak exercise (VO2 Peak) were measured using CPET. Measurements were performed before and after NAT and an adjusted regression model assessed their association. Of the 184 patients recruited, 100 underwent surgical resection. Following NAT skeletal muscle mass, radiation-attenuation and fitness reduced significantly (p < 0.001). When adjusted for age, sex, and body mass index, only pectoralis muscle mass was associated with VO2 Peak (p = 0.001). VO2 at AT and Peak were associated with 1-year survival, while neither sarcopenia nor myosteatosis were associated with morbidity or survival. Skeletal muscle and CPET variables reduced following NAT and were positively associated with each other. Cardiorespiratory function significantly contributes to short-term survival after oesophago-gastric cancer surgery.