Psoas muscle quantified muscle status and long-term mortality after cardiovascular interventions

Abstract

Background Psoas muscle area (PMA) and density (PMD) measured using computed tomography are potential surrogates for evaluating sarcopenia-related mortality risk among patients undergoing cardiovascular interventions. However, the optimal measurement method remains unclear.

Methods A retrospective registry study of three observational cohorts comprising 2248 patients undergoing cardiovascular interventions (n = 828 for abdominal aortic aneurysms, n = 983 transcatheter aortic valve implantations, and 437 patients undergoing open surgery for thoracic aortic and aortic valve pathology) was conducted. Age-independent associations between mortality and PMA, PMD, PMA indexed to height or body surface area, and the combination of PMA and PMD (lean PMA) were meta-analyzed (using individual participant data) across cohorts after sex stratification with median follow-up times ranging from three to five years for each cohort.

Results

In the meta-analysis, psoas muscle measurements were significantly associated with mortality among men (p < 0.05), with high heterogeneity in the associations across all cohorts. There was very little difference in the association between PMA and PMD and mortality (HR 0.83, 95% CI 0.69–0.99, p = 0.002; HR 0.85, 95% CI 0.77–0.94, p = 0.041 for one SD increase in PMA and PMD in the random effects model). Combining PMA and PMD into one composite variable by multiplying their values together showed the most robust association in terms of the magnitude of the effect size in men (HR, 0.77; 95% CI 0.73–0.87, p < 0.001). Indexing PMA to body size did not result in any significant differences in this association. Among women, psoas muscle measurements were not associated with long-term mortality in this meta-analysis.

Conclusions

Different psoas muscle measurements were significantly and very similarly associated with mortality among men but not among women. No single measurement stands out, although combining PMA and PMD seems to be a slightly stronger estimate in terms of effect size and should be considered in further studies.

KEY MESSAGES

Significant sarcopenia affecting survival in patients undergoing heavy invasive operations may be preoperatively assessed using images of psoas muscle (PM) from routine computerized tomography but the optimal method for evaluation is unclear.

 A meta-analysis of individual participant data of over two thousand patients undergoing cardiovascular interventions shows that different PM measurements of surface area and density were significantly and very similarly associated with mortality among men but not among women.

 Combining PM area with PM density to one estimate of lean psoas muscle area seems to provide the strongest hazard estimate among men.

Keywords:

• Sarcopenia
• muscle mass
• psoas muscle area
• psoas muscle density
• mortality

Acknowledgements

None.

Authors’ contributions

Otto Järvinen and Jussi Hernesniemi was involved in the conception and design, data collection, analysis and interpretation of the data, the drafting of the paper and revising it critically for intellectual content. Juho Tynkkynen was involved in design, analysis and interpretation of the data, the drafting of the paper and revising it critically for intellectual content

Marko Virtanen, Pasi Maaranen, Iisa Lindström, Damir Vakhitov and Jari Laurikka were involved in data collection, the drafting of the paper and revising it critically for intellectual content. Niku Oksala was involved in the conception and design, analysis and interpretation of the data, the drafting of the paper and revising it critically for intellectual content.

All authors have given their final approval of the version to be published. All authors agree to be accountable for all aspects of the work.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability STATEMENT

The data that support the findings of this study are available in anonymized form from the corresponding author [JAH] upon reasonable request.

Additional information

Funding

This study was supported by the Competitive State Research Financing of the Expert Responsibility Area of the Tampere University Hospital.