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Jonathan Afilalo - One of the best experts on this subject based on the ideXlab platform.
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Psoas Muscle area and length of stay in older adults undergoing cardiac operations
The Annals of Thoracic Surgery, 2017Co-Authors: Jesse Zuckerman, Matthew Ades, Louis Mullie, Amanda Trnkus, Jeanfrancois Morin, Yves Langlois, Mark Levental, Jose A Morais, Jonathan AfilaloAbstract:Background Frailty assessment can help predict which older adults will experience adverse events after cardiac surgical procedures. Low Muscle mass is a core component of frailty that is suboptimally captured by self-reported weight loss; refined measures using computed tomographic (CT) images have emerged and are predictive of outcomes in noncardiac surgical procedures. The objective of this study was to evaluate the association between CT Muscle area and length of stay (LOS) after cardiac surgical procedures. Methods Frail patients who had a perioperative abdominal or thoracic CT scan were identified. The CT scans were analyzed to measure cross-sectional lean Muscle area at the L4 vertebra (Psoas Muscle area [PMA], lumbar Muscle area [LMA]) and the T4 vertebra (thoracic Muscle area [TMA]). The associations of PMA, LMA, and TMA with frailty markers and postoperative LOS were investigated. Results Eighty-two patients were included; the mean age was 69.2 ± 9.97 years. Low Muscle area was correlated with lower handgrip strength and short physical performance battery (SPPB) scores indicative of physical frailty. Postoperative LOS was correlated with PMA ( R = −0.47, p = 0.004), LMA ( R = –0.41, p = 0.01), and TMA ( R = –0.29, p = 0.03). After adjustment for the predicted risk of prolonged LOS, age, sex, and body surface area, PMA remained significantly associated with LOS (β = –2.35, 95% CI –4.48 to –0.22). The combination of low PMA and handgrip strength, indicative of sarcopenia, yielded the greatest incremental value in predicting LOS. Conclusions Low PMA is a marker of physical frailty associated with increased LOS in older adults undergoing cardiac surgical procedures. Further research is necessary to validate PMA as a prognostic marker and therapeutic target in this vulnerable population.
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Psoas Muscle area predicts all cause mortality after endovascular and open aortic aneurysm repair
European Journal of Vascular and Endovascular Surgery, 2016Co-Authors: Laura Drudi, Matthew Ades, Louis Mullie, Jonathan Afilalo, K Phung, J Zuckerman, Oren K Steinmetz, Daniel I ObrandAbstract:Objective Psoas Muscle area (PMA) is a validated surrogate for Muscle mass that can be easily measured from a clinical CT scan. This study sought to determine whether PMA was associated with post-operative mortality after endovascular or open aortic aneurysm repair. Methods A retrospective review was undertaken of patients who underwent elective endovascular or open aortic aneurysm repair between 2010 and 2015 at a tertiary vascular center in Montreal, Quebec, Canada. Pre-operative CT scan images were analyzed with the CoreSlicer.com software tool to measure PMA at the axial level of the L4 vertebrae. Measurements were made by two independent observers blinded to clinical data. The primary endpoint was all-cause mortality. Results The cohort consisted of 149 patients with a mean age of 75.6 ± 8.8 years. The mean PMA was 24.0 ± 5.8 cm 2 in males, and 14.3 ± 3.1 cm 2 in females. There were 31 deaths over a mean follow-up of 22.4 months. After adjusting for age, sex, revised cardiac risk index, and surgical approach, Cox regression revealed a graded association between PMA and all-cause mortality with a hazard ratio of 0.86 per cm 2 (95% CI 0.79–0.93). Addition of PMA to the model with the clinical covariates resulted in an improvement in C-statistic from 0.57 to 0.67, and BIC from 307 to 301 (with lower BIC values preferred). Conclusions PMA is independently associated with all-cause mortality after elective endovascular and open aortic aneurysm repair, and may be integrated into the pre-operative risk assessment to optimize care in high-risk frail patients.
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Psoas Muscle area and all cause mortality after transcatheter aortic valve replacement the montreal munich study
Canadian Journal of Cardiology, 2016Co-Authors: Samuel Mamane, Louis Mullie, Mark Levental, Jose A Morais, Nicolo Piazza, Giuseppe Martucci, Antonio Vigano, Kristoff Nelson, R Lange, Jonathan AfilaloAbstract:Abstract Background Psoas Muscle area (PMA) is a novel measure of frailty that can be efficiently measured from computed tomography images to help predict risk in older adults referred for transcatheter aortic valve replacement (TAVR). The objective of this study was to determine if PMA would be incrementally predictive of mortality and morbidity after TAVR. Methods The pre-TAVR computed tomography scans of 208 consecutive patients at 2 hospitals in Montreal and Munich were analyzed to measure the cross-sectional area of the left and right Psoas Muscles on a single axial slice at the level of L4. The primary outcome was all-cause mortality assessed according to sex-stratified Cox regression models adjusted for the Society of Thoracic Surgeons predicted risk of mortality. Results The mean age was 80.7 ± 6.8 years with 55% women and a total of 57 deaths over a mean follow-up of 504 days. PMA was lower in nonsurvivors compared with survivors among women (12.9 vs 14.5 cm 2 ; P = 0.047) but not men (21.7 vs 22.4 cm 2 ; P = 0.50). The association between PMA and all-cause mortality in women persisted after adjustment for Society of Thoracic Surgeons risk (hazard ratio, 0.88 per cm 2 ; 95% confidence interval, 0.78-0.99). An association between PMA and bleeding complications was seen in men (odds ratio, 0.78; 95% confidence interval, 0.62-0.97). Sensitivity analyses with PMA normalized to body mass index yielded similar results. Conclusions This study has shown that PMA is a marker of frailty associated with midterm survival in women who undergo TAVR. Further research is warranted to pursue PMA as a prognostic marker and therapeutic target in this vulnerable population.
Gorav Ailawadi - One of the best experts on this subject based on the ideXlab platform.
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Psoas Muscle size predicts risk adjusted outcomes after surgical aortic valve replacement
The Annals of Thoracic Surgery, 2018Co-Authors: Robert B Hawkins, Hunter J Mehaffey, Eric J Charles, John A Kern, Scott D Lim, Nicholas R Teman, Gorav AilawadiAbstract: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.
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usefulness of Psoas Muscle area to predict mortality in patients undergoing transcatheter aortic valve replacement
American Journal of Cardiology, 2016Co-Authors: Mike Saji, John A Kern, Scott D Lim, Michael Ragosta, Damien J Lapar, Emily A Downs, Ravi K Ghanta, John M Dent, Gorav AilawadiAbstract:Frailty has become high-priority theme in cardiovascular diseases because of aging and increasingly complex nature of patients. Low Muscle mass is characteristic of frailty, in which invasive interventions are avoided if possible because of decreased physiological reserve. This study aimed to determine if the Psoas Muscle area (PMA) could predict mortality and to investigate its utility in patients who underwent transcatheter aortic valve replacement (TAVR). We retrospectively reviewed 232 consecutive patients who underwent TAVR. Cross-sectional areas of the Psoas Muscles at the level of fourth lumbar vertebra were measured by computed tomography and normalized to body surface area. Patients were divided into tertiles according to the normalized PMA for each gender (men: tertile 1, 1,708 to 1,178 mm 2 /m 2 ; tertile 2, 1,176 to 1,011 mm 2 /m 2 ; and tertile 3, 1,009 to 587 mm 2 /m 2 ; women: tertile 1, 1,436 to 962 mm 2 /m 2 ; tertile 2, 952 to 807 mm 2 /m 2 ; and tertile 3, 806 to 527 mm 2 /m 2 ). Smaller normalized PMA was independently correlated with women and higher New York Heart Association classification. After adjustment for multiple confounding factors, the normalized PMA tertile was independently associated with mortality at 6 months (adjusted hazard ratio 1.53, 95% confidence interval 1.06 to 2.21). Kaplan–Meier analysis showed that tertile 3 had higher mortality rates than tertile 1 at 6 months (14% and 31%, respectively, p = 0.029). Receiver-operating characteristic analysis showed that normalized PMA provided the increase of C -statistics for predicting mortality for a clinical model and gait speed. In conclusion, PMA is an independent predictor of mortality after TAVR and can complement a clinical model and gait speed.
Louis Mullie - One of the best experts on this subject based on the ideXlab platform.
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Psoas Muscle area and length of stay in older adults undergoing cardiac operations
The Annals of Thoracic Surgery, 2017Co-Authors: Jesse Zuckerman, Matthew Ades, Louis Mullie, Amanda Trnkus, Jeanfrancois Morin, Yves Langlois, Mark Levental, Jose A Morais, Jonathan AfilaloAbstract:Background Frailty assessment can help predict which older adults will experience adverse events after cardiac surgical procedures. Low Muscle mass is a core component of frailty that is suboptimally captured by self-reported weight loss; refined measures using computed tomographic (CT) images have emerged and are predictive of outcomes in noncardiac surgical procedures. The objective of this study was to evaluate the association between CT Muscle area and length of stay (LOS) after cardiac surgical procedures. Methods Frail patients who had a perioperative abdominal or thoracic CT scan were identified. The CT scans were analyzed to measure cross-sectional lean Muscle area at the L4 vertebra (Psoas Muscle area [PMA], lumbar Muscle area [LMA]) and the T4 vertebra (thoracic Muscle area [TMA]). The associations of PMA, LMA, and TMA with frailty markers and postoperative LOS were investigated. Results Eighty-two patients were included; the mean age was 69.2 ± 9.97 years. Low Muscle area was correlated with lower handgrip strength and short physical performance battery (SPPB) scores indicative of physical frailty. Postoperative LOS was correlated with PMA ( R = −0.47, p = 0.004), LMA ( R = –0.41, p = 0.01), and TMA ( R = –0.29, p = 0.03). After adjustment for the predicted risk of prolonged LOS, age, sex, and body surface area, PMA remained significantly associated with LOS (β = –2.35, 95% CI –4.48 to –0.22). The combination of low PMA and handgrip strength, indicative of sarcopenia, yielded the greatest incremental value in predicting LOS. Conclusions Low PMA is a marker of physical frailty associated with increased LOS in older adults undergoing cardiac surgical procedures. Further research is necessary to validate PMA as a prognostic marker and therapeutic target in this vulnerable population.
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Psoas Muscle area predicts all cause mortality after endovascular and open aortic aneurysm repair
European Journal of Vascular and Endovascular Surgery, 2016Co-Authors: Laura Drudi, Matthew Ades, Louis Mullie, Jonathan Afilalo, K Phung, J Zuckerman, Oren K Steinmetz, Daniel I ObrandAbstract:Objective Psoas Muscle area (PMA) is a validated surrogate for Muscle mass that can be easily measured from a clinical CT scan. This study sought to determine whether PMA was associated with post-operative mortality after endovascular or open aortic aneurysm repair. Methods A retrospective review was undertaken of patients who underwent elective endovascular or open aortic aneurysm repair between 2010 and 2015 at a tertiary vascular center in Montreal, Quebec, Canada. Pre-operative CT scan images were analyzed with the CoreSlicer.com software tool to measure PMA at the axial level of the L4 vertebrae. Measurements were made by two independent observers blinded to clinical data. The primary endpoint was all-cause mortality. Results The cohort consisted of 149 patients with a mean age of 75.6 ± 8.8 years. The mean PMA was 24.0 ± 5.8 cm 2 in males, and 14.3 ± 3.1 cm 2 in females. There were 31 deaths over a mean follow-up of 22.4 months. After adjusting for age, sex, revised cardiac risk index, and surgical approach, Cox regression revealed a graded association between PMA and all-cause mortality with a hazard ratio of 0.86 per cm 2 (95% CI 0.79–0.93). Addition of PMA to the model with the clinical covariates resulted in an improvement in C-statistic from 0.57 to 0.67, and BIC from 307 to 301 (with lower BIC values preferred). Conclusions PMA is independently associated with all-cause mortality after elective endovascular and open aortic aneurysm repair, and may be integrated into the pre-operative risk assessment to optimize care in high-risk frail patients.
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Psoas Muscle area and all cause mortality after transcatheter aortic valve replacement the montreal munich study
Canadian Journal of Cardiology, 2016Co-Authors: Samuel Mamane, Louis Mullie, Mark Levental, Jose A Morais, Nicolo Piazza, Giuseppe Martucci, Antonio Vigano, Kristoff Nelson, R Lange, Jonathan AfilaloAbstract:Abstract Background Psoas Muscle area (PMA) is a novel measure of frailty that can be efficiently measured from computed tomography images to help predict risk in older adults referred for transcatheter aortic valve replacement (TAVR). The objective of this study was to determine if PMA would be incrementally predictive of mortality and morbidity after TAVR. Methods The pre-TAVR computed tomography scans of 208 consecutive patients at 2 hospitals in Montreal and Munich were analyzed to measure the cross-sectional area of the left and right Psoas Muscles on a single axial slice at the level of L4. The primary outcome was all-cause mortality assessed according to sex-stratified Cox regression models adjusted for the Society of Thoracic Surgeons predicted risk of mortality. Results The mean age was 80.7 ± 6.8 years with 55% women and a total of 57 deaths over a mean follow-up of 504 days. PMA was lower in nonsurvivors compared with survivors among women (12.9 vs 14.5 cm 2 ; P = 0.047) but not men (21.7 vs 22.4 cm 2 ; P = 0.50). The association between PMA and all-cause mortality in women persisted after adjustment for Society of Thoracic Surgeons risk (hazard ratio, 0.88 per cm 2 ; 95% confidence interval, 0.78-0.99). An association between PMA and bleeding complications was seen in men (odds ratio, 0.78; 95% confidence interval, 0.62-0.97). Sensitivity analyses with PMA normalized to body mass index yielded similar results. Conclusions This study has shown that PMA is a marker of frailty associated with midterm survival in women who undergo TAVR. Further research is warranted to pursue PMA as a prognostic marker and therapeutic target in this vulnerable population.
D Onsager - One of the best experts on this subject based on the ideXlab platform.
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abstract 14490 sarcopenia defined by computed tomography Psoas Muscle area predicts morbidity and mortality in patients undergoing left ventricular assist device implantation
Circulation, 2020Co-Authors: Yojiro Koda, Hidefumi Nishida, A Nguyen, B Chung, Gene Kim, B Smith, S Kalantari, N Sarswat, Jonathan Grinstein, D OnsagerAbstract:Objective: This study aimed to assess the correlation between Psoas-Muscle sarcopenia and clinical outcomes in patients undergoing left ventricular assist device (LVAD) implantation. Methods: Patie...
Niku Oksala - One of the best experts on this subject based on the ideXlab platform.
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Psoas Muscle area and attenuation are highly predictive of complications and mortality after complex endovascular aortic repair
Journal of Vascular Surgery, 2021Co-Authors: Jussi M Karkkainen, Niku Oksala, Gustavo S Oderich, Emanuel R Tenorio, Keouna Pather, Thanila A Macedo, Terri J Vrtiska, Barend Mees, Michael J JacobsAbstract:Abstract Objective The present study evaluated the Psoas Muscle area and attenuation (radiodensity), quantified by computed tomography, together with clinical risk assessment, as predictors of outcomes after fenestrated and branched endovascular aortic repair (FBEVAR). Methods The present single-center study included 504 patients who had undergone elective FBEVAR for pararenal or thoracoabdominal aortic aneurysms. The clinical risk assessment included age, sex, comorbidities, body mass index, glomerular filtration rate, aneurysm size and extent, cardiac stress test results, ejection fraction, and American Society of Anesthesiologists (ASA) score. Preoperative computed tomography was used to measure the Psoas Muscle area and attenuation at the L3 level. The lean Psoas Muscle area (LPMA; area in cm2 multiplied by attenuation in Hounsfield units [HU]) was calculated by multiplying the area by the attenuation. The risk factors for 90-day mortality, major adverse events (MAEs), and long-term mortality were determined using multivariable analysis. MAEs included 30-day or in-hospital death, acute kidney injury, myocardial infarction, respiratory failure, paraplegia, stroke, and bowel ischemia. A novel risk stratification method was proposed according to the strongest predictors of mortality and MAEs on multivariable analysis. Results The 30-day mortality, 90-day mortality, and MAE rates were 2.0%, 5.6%, and 20%, respectively. The independent predictors of 90-day mortality were chronic obstructive pulmonary disease, chronic kidney disease, ASA score, and LPMA. The independent predictors of MAEs were aneurysm diameter, glomerular filtration rate, and LPMA. For long-term mortality, the independent predictors were chronic kidney disease, congestive heart failure, extent I-III thoracoabdominal aortic aneurysms, ASA score, and LPMA. The patients were stratified into three groups according to the ASA score and LPMA: low risk, ASA score II or LPMA >350 cm2HU (n = 290); medium risk, ASA score III and LPMA ≤350 cm2HU (n = 181); and high risk, ASA score IV and LPMA ≤350 cm2HU (n = 33). The 90-day mortality and MAE rates were 1.7% and 16% in the low-, 7.2% and 24% in the medium-, and 30% and 33% in the high-risk patients, respectively (P Conclusions LPMA was a strong predictor of outcomes and the only independent predictor of both mortality and MAEs after FBEVAR. A high Muscle mass was protective against complications, regardless of the ASA score. Risk stratification based on the ASA score and LPMA can be used to identify patients at excessively high operative risk.
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pre operative Psoas Muscle size combined with radiodensity predicts mid term survival and quality of life after fenestrated branched endovascular aortic repair
European Journal of Vascular and Endovascular Surgery, 2019Co-Authors: Jussi M Karkkainen, Niku Oksala, Emanuel R Tenorio, Thanila A Macedo, Barend Mees, Michael J Jacobs, Indrani Sen, Bernardo C Mendes, Randall R Demartino, Gustavo S OderichAbstract:Objective To investigate the association between Psoas Muscle area (PMA) and density (PMD) with survival and quality of life (QoL) after fenestrated-branched endovascular aortic repair (F-BEVAR). Methods The study included 244 consecutive patients enrolled in a prospective study to investigate outcomes of F-BEVAR. Pre-operative computed tomography angiography was used to measure PMA (cm2) and PMD (Hounsfield unit [HU]) at the L3 level. Lean PMA (LPMA) was calculated (PMA × PMD). Patients were divided into two groups using the LPMA cut off point based on a Cox hazard model. Group A was defined as LPMA ≥350 (n = 79) and group B as LPMA Results Patients in group A were younger (mean age 72 ± 8 vs. 76 ± 7 years; p Conclusion A high LPMA was independently and strongly associated with better mid term survival and QoL after F-BEVAR. LPMA may help to identify the best candidates for F-BEVAR among elderly patients.
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Psoas Muscle area and quality are independent predictors of survival in patients treated for abdominal aortic aneurysms
Annals of Vascular Surgery, 2019Co-Authors: Iisa Lindstrom, Niina Khan, Teemu Vanttinen, Mikko Peltokangas, Niko Sillanpaa, Niku OksalaAbstract:Tutkielmaan liittyva artikkeli / Article related to the thesis: Lindstrom I, Khan N, Vanttinen T, Peltokangas M, Sillanpaa N, Oksala N. Psoas Muscle area and quality are independent predictors of survival in patients treated for abdominal aortic aneurysms. Annals of Vascular Surgery. DOI:10.1016/j.avsg.2018.08.096
