The Association Between Preoperative Pectoralis Muscle Quantity and Outcomes After Cardiac Transplantation

Area of Science:

• Cardiology
• Transplantation Medicine
• Geriatrics

Background:

• Sarcopenia is often overlooked in advanced heart failure and not routinely assessed.
• Preoperative sarcopenia, measured by CT-derived pectoralis muscle area index, predicts mortality in left ventricular assist device patients.
• The impact of preoperative sarcopenia on heart transplant (HT) outcomes remains unclear.

Purpose of the Study:

• To investigate if preoperative sarcopenia, diagnosed via pectoralis muscle area index, independently predicts days alive and out of the hospital (DAOHs) post-heart transplant.
• To assess the association between sarcopenia and post-transplant recovery metrics.

Main Methods:

• Included 169 patients who underwent HT between January 2018 and June 2022 with available preoperative CT scans.
• Diagnosed sarcopenia based on the lowest sex-specific tertile of the pectoralis muscle area index.
• Assessed DAOHs at 1 year post-transplant as the primary endpoint.

Main Results:

• Patients with sarcopenia (n=55) experienced fewer DAOHs (median difference of 17 days; P=0.004).
• Sarcopenia was associated with longer hospitalizations and higher rates of non-home discharge.
• Sarcopenia was a significant univariable and the strongest multivariable predictor of 1-year DAOHs (P<0.0001).

Conclusions:

• Preoperative sarcopenia, identified by pectoralis muscle area index, is an independent predictor of adverse outcomes following heart transplant.
• This easily measurable parameter from preoperative CT scans can be incorporated into heart transplant evaluations.
• Early identification of sarcopenia may allow for targeted interventions to improve post-transplant recovery.