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Diagnosing Sarcopenia on Thoracic Computed Tomography

Quantitative Assessment of Skeletal Muscle Mass in Patients Undergoing Transcatheter Aortic Valve Replacement
Published:March 29, 2017DOI:https://doi.org/10.1016/j.acra.2017.02.008

      Rationale and Objectives

      This study aims to assess the use of skeletal muscle mass measurements at two thoracic levels to diagnose sarcopenia on computed tomography (CT) chest examinations and to analyze the impact of these measurements on clinical outcome parameters following transcatheter aortic valve replacement.

      Materials and Methods

      This study retrospectively included 157 patients who underwent preoperative CT examinations. The total muscle area was measured on transverse CT images at the 3rd lumbar and 7th and 12th thoracic levels with skeletal muscle indices (SMIs) calculated at each level. SMIs were then compared to clinical outcome parameters, and thoracic cutoff values for sarcopenia at the 7th and 12th thoracic levels were calculated.

      Results

      Correlation between SMIs at the third lumbar vertebra (L3) and the 12th thoracic vertebra (T12) was stronger (r = 0.724, P < 0.001) than that between L3 and the seventh thoracic vertebra (T7) (r = 0.594, P < 0.001). SMIs at L3 and T12 significantly correlated with prolonged length of stay. Thoracic cutoff values for the 12th thoracic level were 42.6 cm2/m2 (men) and 30.6 cm2/m2 (women), and those for the 7th thoracic level were 46.5 cm2/m2 (men) and 32.3 cm2/m2 (women).

      Conclusions

      Skeletal muscle measurements at the T12 level could permit the diagnosis of sarcopenia and could be used to correlate sarcopenia with outcome parameters in patients undergoing CT limited to the chest.

      Key Words

      Abbreviations and Acronyms:

      BMI (body mass index), CT (computed tomography), L3 (third lumbar vertebra), SC (subcutaneous tissue area), SMI3 (skeletal muscle index at L3), SMI7 (skeletal muscle index at T7), SMI12 (skeletal muscle index at T12), STS (Society for Thoracic Surgeons 2008 Cardiac Surgery Risk Models), T12 (12th thoracic vertebra), TAVR (transcatheter aortic valve replacement), VF (visceral adipose tissue area)
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      References

        • Cruz-Jentoft A.J.
        • Baeyens J.P.
        • Bauer J.M.
        • et al.
        Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People.
        Age Ageing. 2010; 39: 412-423
        • Goodpaster B.H.
        • Park S.W.
        • Harris T.B.
        • et al.
        The loss of skeletal muscle strength, mass, and quality in older adults: the health, aging and body composition study.
        J Gerontol A Biol Sci Med Sci. 2006; 61: 1059-1064
        • Kumar A.
        • Moynagh M.R.
        • Multinu F.
        • et al.
        Muscle composition measured by CT scan is a measurable predictor of overall survival in advanced ovarian cancer.
        Gynecol Oncol. 2016; 142: 311-316
        • Englesbe M.J.
        • Lee J.S.
        • He K.
        • et al.
        Analytic morphomics, core muscle size, and surgical outcomes.
        Ann Surg. 2012; 256: 255-261
        • Psutka S.P.
        • Carrasco A.
        • Schmit G.D.
        • et al.
        Sarcopenia in patients with bladder cancer undergoing radical cystectomy: impact on cancer-specific and all-cause mortality.
        Cancer. 2014; 120: 2910-2918
        • Onoue Y.
        • Izumiya Y.
        • Hanatani S.
        • et al.
        A simple sarcopenia screening test predicts future adverse events in patients with heart failure.
        Int J Cardiol. 2016; 215: 301-306
        • Gariballa S.
        • Alessa A.
        Sarcopenia: prevalence and prognostic significance in hospitalized patients.
        Clin Nutr. 2013; 32: 772-776
        • Hong W.
        • Cheng Q.
        • Zhu X.
        • et al.
        Prevalence of sarcopenia and its relationship with sites of fragility fractures in elderly Chinese men and women.
        PLoS ONE. 2015; 10: e0138102
        • Dahya V.
        • Xiao J.
        • Prado C.M.
        • et al.
        Computed tomography-derived skeletal muscle index: a novel predictor of frailty and hospital length of stay after transcatheter aortic valve replacement.
        Am Heart J. 2016; 182: 21-27
        • Lieffers J.R.
        • Bathe O.F.
        • Fassbender K.
        • et al.
        Sarcopenia is associated with postoperative infection and delayed recovery from colorectal cancer resection surgery.
        Br J Cancer. 2012; 107: 931-936
        • Lexell J.
        Human aging, muscle mass, and fiber type composition.
        J Gerontol A Biol Sci Med Sci. 1995; 50 (Spec No): 11-16
        • Baumgartner R.N.
        • Waters D.L.
        • Gallagher D.
        • et al.
        Predictors of skeletal muscle mass in elderly men and women.
        Mech Ageing Dev. 1999; 107: 123-136
        • Fearon K.
        • Strasser F.
        • Anker S.D.
        • et al.
        Definition and classification of cancer cachexia: an international consensus.
        Lancet Oncol. 2011; 12: 489-495
        • Shen W.
        • Punyanitya M.
        • Wang Z.
        • et al.
        Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross-sectional image.
        J Appl Physiol. 2004; 97: 2333-2338
        • Metzler B.
        • Winkler B.
        SYNTAX, STS and EuroSCORE—how good are they for risk estimation in atherosclerotic heart disease?.
        Thromb Haemost. 2012; 108: 1065-1071
        • Mitsiopoulos N.
        • Baumgartner R.N.
        • Heymsfield S.B.
        • et al.
        Cadaver validation of skeletal muscle measurement by magnetic resonance imaging and computerized tomography.
        J Appl Physiol. 1998; 85: 115-122
        • Prado C.M.
        • Lieffers J.R.
        • Bowthorpe L.
        • et al.
        Sarcopenia and physical function in overweight patients with advanced cancer.
        Can J Diet Pract Res. 2013; 74: 69-74
        • Mourtzakis M.
        • Prado C.M.
        • Lieffers J.R.
        • et al.
        A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care.
        Appl Physiol Nutr Metab. 2008; 33: 997-1006
        • Kuroki L.M.
        • Mangano M.
        • Allsworth J.E.
        • et al.
        Pre-operative assessment of muscle mass to predict surgical complications and prognosis in patients with endometrial cancer.
        Ann Surg Oncol. 2015; 22: 972-979
        • Higashi T.
        • Hayashi H.
        • Taki K.
        • et al.
        Sarcopenia, but not visceral fat amount, is a risk factor of postoperative complications after major hepatectomy.
        Int J Clin Oncol. 2016; 21: 310-319
        • Kim E.Y.
        • Kim Y.S.
        • Park I.
        • et al.
        Evaluation of sarcopenia in small-cell lung cancer patients by routine chest CT.
        Support Care Cancer. 2016; 24: 4721-4726
        • Oh J.K.
        • Ahn M.I.
        • Kim H.L.
        • et al.
        Retrodiaphragmatic portion of the lung: how deep is the posterior costophrenic sulcus on posteroanterior chest radiography?.
        Clin Radiol. 2009; 64: 786-791
        • Suwatanapongched T.
        • Gierada D.S.
        • Slone R.M.
        • et al.
        Variation in diaphragm position and shape in adults with normal pulmonary function.
        Chest. 2003; 123: 2019-2027
        • Salgado R.A.
        • Leipsic J.A.
        • Shivalkar B.
        • et al.
        Preprocedural CT evaluation of transcatheter aortic valve replacement: what the radiologist needs to know.
        Radiographics. 2014; 34: 1491-1514
        • Mok M.
        • Allende R.
        • Leipsic J.
        • et al.
        Prognostic value of fat mass and skeletal muscle mass determined by computed tomography in patients who underwent transcatheter aortic valve implantation.
        Am J Cardiol. 2016; 117: 828-833
        • Paknikar R.
        • Friedman J.
        • Cron D.
        • et al.
        Psoas muscle size as a frailty measure for open and transcatheter aortic valve replacement.
        J Thorac Cardiovasc Surg. 2016; 151: 745-750
        • Morley J.E.
        • Anker S.D.
        • von Haehling S.
        Prevalence, incidence, and clinical impact of sarcopenia: facts, numbers, and epidemiology-update 2014.
        J Cachexia Sarcopenia Muscle. 2014; 5: 253-259
        • Chiba Y.
        • Saitoh S.
        • Takagi S.
        • et al.
        Relationship between visceral fat and cardiovascular disease risk factors: the Tanno and Sobetsu study.
        Hypertens Res. 2007; 30: 229-236
        • Despres J.P.
        Cardiovascular disease under the influence of excess visceral fat.
        Crit Pathw Cardiol. 2007; 6: 51-59
        • Despres J.P.
        Body fat distribution and risk of cardiovascular disease: an update.
        Circulation. 2012; 126: 1301-1313
        • Stenholm S.
        • Harris T.B.
        • Rantanen T.
        • et al.
        Sarcopenic obesity: definition, cause and consequences.
        Curr Opin Clin Nutr Metab Care. 2008; 11: 693-700