Pre‐operative pectoralis muscle area index is associated with biomarkers of inflammation and endotoxemia and predicts clinical outcomes after left ventricular assist device implantation: A cohort study

• Published in: Artificial organs 2024-12, Vol.48 (12), p.1494-1501
• Main Authors: Carey, Matthew R., Ladanyi, Annamaria, Nishikawa, Mia, Bordon, Abraham, Leb, Jay S., Pinsino, Alberto, Driggin, Elissa, Latif, Farhana, Sayer, Gabriel T., Clerkin, Kevin J., Takeda, Koji, Uriel, Nir, Colombo, Paolo C., Yuzefpolskaya, Melana
• Format: Article
• Language: English
• Subjects: Adiponectin; Adult; advanced heart failure; Aged; Area; Biomarkers; Biomarkers - blood; CD14 antigen; Chest; Cohort analysis; Cohort Studies; Computed tomography; Endotoxemia; Endotoxemia - blood; Endotoxemia - diagnosis; Endotoxemia - etiology; Female; Heart; Heart Failure; Heart-Assist Devices - adverse effects; Humans; Inflammation; Inflammation - blood; Inflammation - etiology; Interleukin 6; left ventricular assist device; Length of Stay - statistics & numerical data; Male; Middle Aged; Muscles; Patient Readmission - statistics & numerical data; pectoralis muscle area index; Pectoralis Muscles; Preoperative Period; readmissions; Sarcopenia; Tomography, X-Ray Computed; Tumor necrosis factor-α; Ventricle; Ventricular assist devices
• ISSN: 0160-564X; 1525-1594; 1525-1594
• DOI: 10.1111/aor.14836

Background Pre‐left ventricular assist device (LVAD) pectoralis muscle assessment, an estimate of sarcopenia, has been associated with postoperative mortality and gastrointestinal bleeding, though its association with inflammation, endotoxemia, length‐of‐stay (LOS), and readmissions remains underexplored. Methods This was a single‐center cohort study of LVAD patients implanted 1/2015–10/2018. Preoperative pectoralis muscle area was measured on chest computed tomography (CT), adjusted for height squared to derive pectoralis muscle area index (PMI). Those with PMI in the lowest quintile were defined as low‐PMI cohort; all others constituted the reference cohort. Biomarkers of inflammation (interleukin‐6, adiponectin, tumor necrosis factor‐α [TNFα]) and endotoxemia (soluble (s)CD14) were measured in a subset of patients. Results Of the 254 LVAD patients, 95 had a preoperative chest CT (median days pre‐LVAD: 7 [IQR 3–13]), of whom 19 (20.0%) were in the low‐PMI cohort and the remainder were in the reference cohort. Compared with the reference cohort, the low‐PMI cohort had higher levels of sCD14 (2594 vs. 1850 ng/mL; p = 0.04) and TNFα (2.9 vs. 1.9 pg/mL; p = 0.03). In adjusted analyses, the low‐PMI cohort had longer LOS (incidence rate ratio 1.56 [95% confidence interval 1.16–2.10], p = 0.004) and higher risk of 90‐day and 1‐year readmissions (subhazard ratio 5.48 [1.88–16.0], p = 0.002; hazard ratio 1.73 [1.02–2.94]; p = 0.04, respectively). Conclusions Pre‐LVAD PMI is associated with inflammation, endotoxemia, and increased LOS and readmissions. Assessment of pectoralis muscle index, utilizing clinically available computed tomography (CT) scans, prior to left ventricular assist device (LVAD) implantation is associated with levels of inflammation, endotoxemia, and is predictive of hospital readmissions.