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The Annals of Thoracic Surgery Jul 2018Frailty is an important predictor of outcomes after cardiac surgery, but utility is limited by difficult assessment and quantification. We hypothesize that sarcopenia... (Comparative Study)
Comparative Study
BACKGROUND
Frailty is an important predictor of outcomes after cardiac surgery, but utility is limited by difficult assessment and quantification. We hypothesize that sarcopenia defined as psoas muscle cross-sectional area is a useful predictor of surgical aortic valve replacement outcomes in moderate to high-risk patients.
METHODS
Moderate to high risk patients (predicted risk of mortality greater than 3%) who underwent surgical aortic valve replacement with or without coronary artery bypass were extracted from an institutional database (2009 to 2016). Psoas index was calculated as the cross-sectional area of the psoas muscle at the L4 vertebral level normalized to body surface area. Patients were stratified by sarcopenia status, defined as less than 25th sex-specific percentile. Multivariable regression analysis identified risk-adjusted associations with psoas index using The Society of Thoracic Surgeons predicted risk scores.
RESULTS
Of the 240 patients included, the median predicted risk of mortality was 6%, median age 80 years, and 40% were female. Patients with (33.3%) and without (66.7%) sarcopenia had equivalent baseline risk (median predicted risk of mortality 5.7% versus 6.0%, p = 0.29). Patients with sarcopenia had higher 1-year mortality (31.9% versus 16.9% p = 0.03). Psoas index significantly predicted risk-adjusted 1-year mortality (odds ratio 0.84, p = 0.02) and long-term mortality (hazard ratio 0.92, p = 0.04), as well as risk-adjusted major morbidity, prolonged ventilation, length of stay, discharge to a facility, and hospital cost. Finally, psoas index measurements were highly reproducible (Pearson correlation coefficient 0.944).
CONCLUSIONS
Psoas index is an easily obtained and reproducible measure of frailty that predicts risk-adjusted resource utilization, morbidity, and long-term mortality. Psoas index may improve procedural selection and risk adjustment in high-risk patients with aortic valve disease.
Topics: Aged; Aged, 80 and over; Aortic Valve Stenosis; Cohort Studies; Databases, Factual; Female; Frailty; Heart Valve Prosthesis Implantation; Humans; Kaplan-Meier Estimate; Logistic Models; Male; Observer Variation; Organ Size; Postoperative Complications; Predictive Value of Tests; Prognosis; Psoas Muscles; Retrospective Studies; Risk Assessment; Sarcopenia; Survival Analysis; Treatment Outcome
PubMed: 29530777
DOI: 10.1016/j.athoracsur.2018.02.010 -
Updates in Surgery Aug 2021Measurement of the psoas muscle area has been applied to estimate lean muscle mass as a surrogate marker of sarcopenia, but there is a paucity of evidence regarding the...
Measurement of the psoas muscle area has been applied to estimate lean muscle mass as a surrogate marker of sarcopenia, but there is a paucity of evidence regarding the influence of sarcopenia on clinical outcomes following inflammatory bowel disease surgery. The aim of this study was to evaluate the association between MRI enterography defined sarcopenia and postoperative complications in patients undergoing elective ileocaecal resection for Crohn's disease. To obtain cross sectional area measurement of the psoas muscle, the freehand area tool was used to trace the margin of each psoas muscle at the level of L4, with the sum recorded as Total Psoas Area (TPA). The total cross sectional muscle area of the abdominal wall was recorded as Skeletal Muscle Area (SMA), while myosteatosis was measured by normalising the psoas muscle intensity with the mean intensity of the cerebrospinal fluid. The primary outcome was the incidence of 30-day postoperative complications in patients in the lowest quartile of TPA and SMA. 31 patients were included and ten patients (32.25%) developed postoperative complications within 30 days of surgery. The cut-off values for the lowest quartile for TPA were 11.93 cm in men and 9.77 cm in women, including a total of 8 patients (25.8%) with 5 patients in this group (62.5%) developing postoperative complications and 3 patients (37.5%) Clavien-Dindo class ≥ 3 complications. The cut-off values for the lowest quartile for SMA were 73.49 cm in men and 65.85 cm in women, with 4 patients out of 8 (50%) developing postoperative complications. Psoas muscle cross sectional area and skeletal mass area can be estimated on Magnetic Resonance Enterography as surrogate markers of sarcopenia with high inter-observer agreement.
Topics: Crohn Disease; Female; Humans; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Male; Postoperative Complications; Psoas Muscles; Retrospective Studies; Risk Factors; Sarcopenia
PubMed: 32410158
DOI: 10.1007/s13304-020-00790-x -
Scientific Reports Nov 2020Psoas muscle measurements are frequently used as markers of sarcopenia and predictors of health. Manually measured cross-sectional areas are most commonly used, but...
Psoas muscle measurements are frequently used as markers of sarcopenia and predictors of health. Manually measured cross-sectional areas are most commonly used, but there is a lack of consistency regarding the position of the measurement and manual annotations are not practical for large population studies. We have developed a fully automated method to measure iliopsoas muscle volume (comprised of the psoas and iliacus muscles) using a convolutional neural network. Magnetic resonance images were obtained from the UK Biobank for 5000 participants, balanced for age, gender and BMI. Ninety manual annotations were available for model training and validation. The model showed excellent performance against out-of-sample data (average dice score coefficient of 0.9046 ± 0.0058 for six-fold cross-validation). Iliopsoas muscle volumes were successfully measured in all 5000 participants. Iliopsoas volume was greater in male compared with female subjects. There was a small but significant asymmetry between left and right iliopsoas muscle volumes. We also found that iliopsoas volume was significantly related to height, BMI and age, and that there was an acceleration in muscle volume decrease in men with age. Our method provides a robust technique for measuring iliopsoas muscle volume that can be applied to large cohorts.
Topics: Adult; Aged; Aged, 80 and over; Biological Specimen Banks; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Organ Size; Psoas Muscles; United Kingdom
PubMed: 33214629
DOI: 10.1038/s41598-020-77351-0 -
Journal of the American College of... Aug 2010Surgeons frequently struggle to determine patient suitability for liver transplantation. Objective and comprehensive measures of overall burden of disease, such as... (Comparative Study)
Comparative Study
BACKGROUND
Surgeons frequently struggle to determine patient suitability for liver transplantation. Objective and comprehensive measures of overall burden of disease, such as sarcopenia, could inform clinicians and help avoid futile transplantations.
STUDY DESIGN
The cross-sectional area of the psoas muscle was measured on CT scans of 163 liver transplant recipients. After controlling for donor and recipient characteristics using Cox regression models, we described the relationship between psoas area and post-transplantation mortality.
RESULTS
Psoas area correlated poorly with Model for End-Stage Liver Disease score and serum albumin. Cox regression revealed a strong association between psoas area and post-transplantation mortality (hazard ratio = 3.7/1,000 mm(2) decrease in psoas area; p < 0.0001). When stratified into quartiles based on psoas area (holding donor and recipient characteristics constant), 1-year survival ranged from 49.7% for the quartile with the smallest psoas area to 87.0% for the quartile with the largest. Survival at 3 years among these groups was 26.4% and 77.2%, respectively. The impact of psoas area on survival exceeded that of all other covariates in these models.
CONCLUSIONS
Central sarcopenia strongly correlates with mortality after liver transplantation. Such objective measures of patient frailty, such as sarcopenia, can inform clinical decision making and, potentially, allocation policy. Additional work is needed develop valid and clinically relevant measures of sarcopenia and frailty in liver transplantation.
Topics: Adult; Female; Follow-Up Studies; Humans; Incidence; Liver Failure; Liver Transplantation; Male; Michigan; Middle Aged; Postoperative Period; Prognosis; Psoas Muscles; Retrospective Studies; Sarcopenia; Survival Rate; Time Factors; Tomography, X-Ray Computed
PubMed: 20670867
DOI: 10.1016/j.jamcollsurg.2010.03.039 -
In Vivo (Athens, Greece) 2022For prediction of many types of clinical outcome, the skeletal muscle mass can be used as an independent biomarker. Manual segmentation of the skeletal muscles is...
BACKGROUND
For prediction of many types of clinical outcome, the skeletal muscle mass can be used as an independent biomarker. Manual segmentation of the skeletal muscles is time-consuming, therefore we present a deeplearning-based approach for the identification of muscle mass at the L3 level in clinical routine computed tomographic (CT) data.
PATIENTS AND METHODS
We conducted a retrospective study of 130 patient datasets. Individual CT slice analysis at the L3 level was fed into a U-Net architecture. As a result, we obtained segmentations of the musculus rectus abdominis, abdominal wall muscles, musculus psoas major, musculus quadratus lumborum and musculus erector spinae in the CT-slice at the L3 level.
RESULTS
The Dice score was 0.95±0.02, 0.86±0.12, 0.93±0.05, 0.92±0.05, 0.86±0.08 for the erector spine, rectus, abdominal wall, psoas and quadratus lumborum muscles, respectively. For the overall skeletal muscle mass, the test data achieved a Dice score of 0.95±0.03.
CONCLUSION
Our network achieved Dice scores larger than 0.86 for each of the five different muscle types and 0.95 for the overall skeletal muscle mass. The subdivision of muscle types can serve as a basis for obtaining future biomarkers. Our network is publicly available so that it might be beneficial for others to improve the clinical workflow within examination of routine CT scans.
Topics: Abdomen; Deep Learning; Humans; Muscle, Skeletal; Psoas Muscles; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 35738592
DOI: 10.21873/invivo.12896 -
JPEN. Journal of Parenteral and Enteral... Feb 2022To determine the relationship between bioelectrical impedance analysis (BIA) and magnetic resonance imaging (MRI) obtained measures of body composition in children with...
OBJECTIVE
To determine the relationship between bioelectrical impedance analysis (BIA) and magnetic resonance imaging (MRI) obtained measures of body composition in children with nonalcoholic fatty liver disease (NAFLD).
METHODS
Youth with obesity and NAFLD who had BIA and abdominal MRI testing were included. BIA measured skeletal muscle mass (SMM), appendicular lean mass (ALM), trunk muscle mass (TMM), and percent body fat. MRI measured total psoas muscle surface area (tPMSA) and fat compartments. Univariate analysis described the relationship between BIA- and MRI-derived measurements. Multivariable regression analyses built a model with body composition measured via MRI.
RESULTS
115 patients (82 (71%) male, 38 (33%) Hispanic, median age14 years) were included. There was a strong correlation between tPMSA and SMM, ALM, and TMM (correlation coefficients [CCs]: 0.701, 0.689, 0.708, respectively; all P < .001). Higher SMM, ALM, and TMM were associated with higher tPMSA. This association remained after controlling for age, sex, ethnicity, type 2 diabetes mellitus status, and body mass index z-score. Total fat mass by BIA and MRI-determined total, subcutaneous, and intraperitoneal fat area correlated significantly (CCs: 0.813, 0.808, 0.515, respectively; all P < .001). In univariate regression, higher total fat mass by BIA was associated with increased total fat area and increased fat in each of the four regions measured by MRI. After controlling for confounders, the association between total fat mass by BIA and total fat area by MRI persisted.
CONCLUSIONS
BIA measures of muscle and fat mass correlate strongly with MRI measures of tPMSA and fat areas in children with obesity and NAFLD.
Topics: Adolescent; Body Composition; Body Mass Index; Child; Diabetes Mellitus, Type 2; Electric Impedance; Humans; Magnetic Resonance Imaging; Male; Non-alcoholic Fatty Liver Disease; Psoas Muscles
PubMed: 33811369
DOI: 10.1002/jpen.2113 -
Journal of Applied Physiology... Mar 2013Patients with cirrhosis have increased gluconeogenesis and fatty acid oxidation that may contribute to a low respiratory quotient (RQ), and this may be linked to...
Patients with cirrhosis have increased gluconeogenesis and fatty acid oxidation that may contribute to a low respiratory quotient (RQ), and this may be linked to sarcopenia and metabolic decompensation when these patients are hospitalized. Therefore, we conducted a prospective study to measure RQ and its impact on skeletal muscle mass, survival, and related complications in hospitalized cirrhotic patients. Fasting RQ and resting energy expenditure (REE) were determined by indirect calorimetry in cirrhotic patients (n = 25), and age, sex, and weight-matched healthy controls (n = 25). Abdominal muscle area was quantified by computed tomography scanning. In cirrhotic patients we also examined the impact of RQ on mortality, repeat hospitalizations, and liver transplantation. Mean RQ in patients with cirrhosis (0.63 ± 0.05) was significantly lower (P < 0.0001) than healthy matched controls (0.84 ± 0.06). Psoas muscle area in cirrhosis (24.0 ± 6.6 cm(2)) was significantly (P < 0.001) lower than in controls (35.9 ± 9.5 cm(2)). RQ correlated with the reduction in psoas muscle area (r(2) = 0.41; P = 0.01). However, in patients with cirrhosis a reduced RQ did not predict short-term survival or risk of developing complications. When REE was normalized to psoas area, energy expenditure was significantly higher (P < 0.001) in patients with cirrhosis (66.7 ± 17.8 kcal/cm(2)) compared with controls (47.7 ± 7.9 kcal/cm(2)). We conclude that hospitalized patients with cirrhosis have RQs well below the traditional lowest physiological value of 0.69, and this metabolic state is accompanied by reduced skeletal muscle area. Although low RQ does not predict short-term mortality in these patients, it may reflect a decompensated metabolic state that requires careful nutritional management with appropriate consideration for preservation of skeletal muscle mass.
Topics: Adult; Aged; Basal Metabolism; Calorimetry, Indirect; Energy Metabolism; Fasting; Fibrosis; Hospitalization; Humans; Liver Transplantation; Middle Aged; Prospective Studies; Psoas Muscles; Sarcopenia
PubMed: 23288550
DOI: 10.1152/japplphysiol.01042.2012 -
BMJ Case Reports Oct 2016Mammary myofibroblastoma is a rare, benign, mesenchymal neoplasm that was first described in the breast in 1987. However, extra-mammary-type myofibroblastoma (MTMF) was... (Review)
Review
Mammary myofibroblastoma is a rare, benign, mesenchymal neoplasm that was first described in the breast in 1987. However, extra-mammary-type myofibroblastoma (MTMF) was not described until 2001 as a distinct entity. We report a case of extra-MTMF arising from the retroperitoneum, which was encountered in our clinic. We also completed a review of the literature using PubMed in patients with extra-MTMF.
Topics: Aged; Humans; Incidental Findings; Magnetic Resonance Imaging; Male; Neoplasms, Muscle Tissue; Psoas Muscles; Retroperitoneal Neoplasms; Tomography, X-Ray Computed
PubMed: 27742646
DOI: 10.1136/bcr-2016-217862 -
Circulating miR-203 derived from metastatic tissues promotes myopenia in colorectal cancer patients.Journal of Cachexia, Sarcopenia and... Jun 2019Sarcopenia frequently occurs in metastatic cancer patients. Emerging evidence has revealed that various secretory products from metastatic tumours can influence host...
BACKGROUND
Sarcopenia frequently occurs in metastatic cancer patients. Emerging evidence has revealed that various secretory products from metastatic tumours can influence host organs and promote sarcopenia in patients with malignancies. Furthermore, the biological functions of microRNAs in cell-to-cell communication by incorporating into neighbouring or distal cells, which have been gradually elucidated in various diseases, including sarcopenia, have been elucidated.
METHODS
We evaluated psoas muscle mass index (PMI) and intramuscular adipose tissue content (IMAC) using pre-operative computed tomography imaging in 183 colorectal cancer (CRC) patients. miR-203 expression levels in CRC tissues and pre-operative serum were evaluated using quantitative polymerase chain reaction. Functional analysis of miR-203 overexpression was investigated in human skeletal muscle cells (SkMCs), and cells were analysed for proliferation and apoptosis. Expressions of several putative miR-203 target genes (CASP3, CASP10, BIRC5, BMI1, BIRC2, and BIRC3) in SKMCs were validated.
RESULTS
A total of 183 patients (108 men and 75 women) were included. The median age of enrolled patients at diagnosis was 68.0 years (range 35-89 years). High IMAC status significantly correlated with female gender (P = 0.004) and older age (P = 0.0003); however, no other clinicopathological factors correlated with IMAC status in CRC patients. In contrast, decreased PMI significantly correlated with female gender (P = 0.006) and all well-established disease development factors, including advanced T stage (P = 0.035), presence of venous invasion (P = 0.034), lymphovascular invasion (P = 0.012), lymph node (P = 0.001), distant metastasis (P = 0.002), and advanced Union for International Cancer Control tumour-node-metastasis stage classification (P = 0.0004). Although both high IMAC status and low PMI status significantly correlated with poor overall survival (IMAC: P = 0.0002; PMI: P < 0.0001; log-rank test) and disease-free survival (IMAC: P = 0.0003; PMI: P = 0.0002; log-rank test), multivariate Cox's regression analysis revealed that low PMI was an independent prognostic factor for both overall survival (hazard ratio: 4.69, 95% confidence interval (CI): 2.19-10, P = 0.0001) and disease-free survival (hazard ratio: 2.33, 95% CI: 1.14-4.77, P = 0.021) in CRC patients. Serum miR-203 expression negatively correlated with pre-operative PMI level (P = 0.0001, ρ = -0.25), and multivariate logistic regression analysis revealed that elevated serum miR-203 was an independent risk factor for myopenia (low PMI) in CRC patients (odds ratio: 5.16, 95% CI: 1.8-14.8, P = 0.002). Overexpression of miR-203 inhibited cell proliferation and induced apoptosis via down-regulation of BIRC5 (survivin) expression in human SkMC line.
CONCLUSIONS
Assessment of serum miR-203 expression could be used for risk assessment of myopenia, and miR-203 might be a novel therapeutic target for inhibition of myopenia in CRC.
Topics: Adipose Tissue; Adult; Aged; Aged, 80 and over; Apoptosis; Biomarkers; Cell Line; Cell Proliferation; Circulating MicroRNA; Colon; Colorectal Neoplasms; Disease; Disease-Free Survival; Down-Regulation; Female; Humans; Male; MicroRNAs; Middle Aged; Prognosis; Psoas Muscles; Rectum; Risk Assessment; Risk Factors; Sarcopenia; Survivin; Tomography, X-Ray Computed
PubMed: 31091026
DOI: 10.1002/jcsm.12403 -
Medicina (Kaunas, Lithuania) May 2021: Sarcopenia is a recognized prognostic factor for both complications and survival in cancer patients. This study aims to analyze the relationship between sarcopenia...
: Sarcopenia is a recognized prognostic factor for both complications and survival in cancer patients. This study aims to analyze the relationship between sarcopenia measured by psoas muscle index on computer tomography scans and the presence of postoperative complications in colorectal cancer surgery. : In a prospective study we recorded data from 51 patients who underwent colorectal cancer surgery in the Mures County Clinical Hospital, Romania. Total psoas muscle area and psoas density were measured at the level of the third lumbal vertebra (L3) for further index calculation. We also evaluated the general characteristics and laboratory analyses to obtain more information about status of the patients. Short-term postoperative complications were scored according to the Clavien-Dindo classification. : The majority of the 51 patients were male (61%) and the median age was 65 years. More than half of the cancer was located in the rectum (56.9%), a quarter in the right colon (25.5%), the rest in the sigmoid (11.8%), and the left colon (5.9%). Twenty-one patients (41.2%) developed a complication, five (9.8%) of these were Clavien-Dindo grade 3, 4 or 5 (high grade) and sixteen (31.3%) grade 1 or 2 (low grade). The low- and high-grade groups showed a significantly lower right psoas muscle area, left psoas muscle area, total psoas muscle area, and psoas muscle index ( < 0.001 in all cases). Among laboratory analyses, a significantly lower perioperative hematocrit, hemoglobin, and albumin level were found in patients who developed complications. Furthermore we observed that an elevated serum C-reactive protein level was associated with a higher grade of complication ( < 0.043). : The psoas muscle index (PMI) influence on the postoperative outcome is an important factor in our single center prospective study and it appears to be a good overall predictor in colorectal surgery. A lower PMI is directly associated with a low or high grade complication by Clavien-Dindo classification. Perioperative inflammatory and nutritional status evidenced by serum C-reactive protein (CRP) and albumin level influences the presence of postoperative complications.
Topics: Aged; Colorectal Neoplasms; Computers; Female; Humans; Male; Postoperative Complications; Prospective Studies; Psoas Muscles; Retrospective Studies; Romania
PubMed: 34064607
DOI: 10.3390/medicina57050472