Resident doctor - Cardiac surgery Université de Montréal Montréal, Quebec, Canada
Background: Sarcopenia is defined as a reduction in skeletal muscle mass and physical capacity. It is associated with increased mortality and morbidity following cardiac surgery. The impact of sarcopenia has been poorly studied in heart transplantation and in patients with a left ventricular assist device (LVAD). Our objective is to determine whether there is an association between sarcopenia and a patient-centered outcome, the percentage of days alive and out of the hospital (%DAOH) at 1-year post-transplantation in LVAD recipients.
METHODS AND RESULTS: All LVAD recipients who underwent a heart transplantation between 2012 and 2024 at our institution were reviewed. Patients with an abdominal computed tomography (CT) within three months before heart transplantation were included. The skeletal muscle index (SMI) was measured at the L3 level on the pre-transplant CT scan using a validated software tool, CoreSlicer version 1.0.0 (Figure 1). Sarcopenia was defined as an SMI of < 52.4 cm²/m² for men and < 38.5 cm²/m² for women. The primary outcome was the percentage of DAOH. The number of DAOH 365 days after heart transplantation and daily patient location (home, index hospital, non-index hospital, skilled nursing facility, rehabilitation center, hospice) were calculated. The percentage of DAOH was indexed to each patient’s post-transplantation (percentage of DAOH-AF) follow-up time. Patients were stratified by sarcopenic status.
Twenty-two (22) patients were included (median age: 54, 95% male). Nine patients were sarcopenic (41%). The mean age and body mass index (BMI) were comparable between the two groups. The time between LVAD implantation and transplantation was shorter in sarcopenic patients (208 ± 155 days vs 369 ± 218 days). The mean SMI was lower in sarcopenic patients than in non-sarcopenic patients (45.68 ± 5.85 vs 58.95 ± 4.45 cm²/m²). The mean % DAOH at one year was numerically lower in the sarcopenic group (70.65 % ± 36.80 %) compared to the non-sarcopenic group (83.16 % ± 25.19 %; p=0,219). Sarcopenic patients also had significantly longer total hospital stays (42.50 ± 56.42 days vs 27.17 ± 18.42 days ; p=0,45). Linear regression showed that a higher SMI was significantly associated with increased %DAOH {coefficient: +1.22; p = 0.039} (Figure 2).
Conclusion: We found a correlation between the skeletal muscle index and the percentage of daoh in LVAD patients undergoing heart transplantation. The SMI might be a simple and objective additional parameter to help identify sarcopenic patients who may benefit from a rehabilitation program and improve post-transplant outcomes.
