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Mitochondrial Dysfunction Contributes to Sustained Muscle Loss After Cardiac Surgery: A Prospective Observational

Ashley N Thomas1, Antonis Kalakoutas2, Martin Yates1

  • 1Barts Heart Centre, St Bartholomew's Hospital, Barts NHS Trust, London, UK.

Journal of Cachexia, Sarcopenia and Muscle
|August 22, 2025
PubMed
Summary
This summary is machine-generated.

Cardiac surgery patients often lose muscle mass and strength, impacting recovery. Mitochondrial dysfunction markers at baseline and post-surgery predict poor muscle outcomes, highlighting a need for targeted interventions.

Keywords:
aortic surgical procedurescritical illness myopathymetabolomicsmitochondriamuscle regenerationmuscle strength recoverymuscular atrophypathology

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Area of Science:

  • Cardiology
  • Metabolomics
  • Muscle Physiology

Background:

  • Cardiac surgery is a major systemic insult leading to significant muscle loss (sarcopenia).
  • Muscle mass and strength loss after surgery is highly variable (0%-40% rectus femoris cross-sectional area).
  • Understanding muscle recovery beyond the first week is crucial for patient outcomes.

Purpose of the Study:

  • To investigate muscle phenotype, body composition, and quality of life up to outpatient follow-up after cardiac surgery.
  • To correlate muscle recovery with protein and metabolomic markers.
  • To identify predictors of poor muscle outcomes post-cardiac surgery.

Main Methods:

  • Recruitment of patients undergoing elective aortic valve surgery.
  • Assessment of muscle mass (RFcsa), strength (handgrip, knee extension, spirometry), body composition, and quality of life pre-operatively, at 7 days, and at follow-up.
  • Plasma metabolome analysis at multiple time points (Days 0, 3, 7, and follow-up).

Main Results:

  • Mean rectus femoris cross-sectional area (RFcsa) loss was 6.44% at Day 7 and 9.69% at follow-up.
  • Muscle strength and functionality recovered to baseline by follow-up, contrasting with persistent muscle bulk loss in some patients.
  • Quality of life correlated positively with muscle bulk and strength at follow-up.
  • Mitochondrial dysfunction markers (short-chain acyl-carnitines) correlated with muscle loss and reduced strength.

Conclusions:

  • A significant proportion of patients experience persistent muscle bulk loss despite strength recovery after aortic surgery.
  • Baseline and acute mitochondrial dysfunction predict poor muscle outcomes up to outpatient follow-up.
  • These findings highlight the importance of monitoring muscle mass and identifying patients at risk for sarcopenia post-cardiac surgery.