Surrogates of Muscle Mass on Cardiac MRI Correlate with Exercise Capacity in Patients with Fontan Circulation

Background: Sarcopenia is an increasingly recognized marker of frailty in cardiac patients. Patients with a history of congenital heart disease and Fontan procedure have a higher risk of developing progressive muscle wasting. Our objective was to determine if we could use routine cardiac MRI (CMR) f...

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Main Authors: Kevin L. Smith, Emile B. Gordon, Megan E. Gunsaulus, Adam Christopher, Laura J. Olivieri, Sameh S. Tadros, Tyler Harris, Anita P. Saraf, Jacqueline Kreutzer, Brian Feingold, Tarek Alsaied
Format: Article
Language:English
Published: MDPI AG 2023-04-01
Series:Journal of Clinical Medicine
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Online Access:https://www.mdpi.com/2077-0383/12/7/2689
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author Kevin L. Smith
Emile B. Gordon
Megan E. Gunsaulus
Adam Christopher
Laura J. Olivieri
Sameh S. Tadros
Tyler Harris
Anita P. Saraf
Jacqueline Kreutzer
Brian Feingold
Tarek Alsaied
author_facet Kevin L. Smith
Emile B. Gordon
Megan E. Gunsaulus
Adam Christopher
Laura J. Olivieri
Sameh S. Tadros
Tyler Harris
Anita P. Saraf
Jacqueline Kreutzer
Brian Feingold
Tarek Alsaied
author_sort Kevin L. Smith
collection DOAJ
description Background: Sarcopenia is an increasingly recognized marker of frailty in cardiac patients. Patients with a history of congenital heart disease and Fontan procedure have a higher risk of developing progressive muscle wasting. Our objective was to determine if we could use routine cardiac MRI (CMR) for the surveillance of muscle wasting. Methods: A retrospective study of all Fontan patients (n = 75) was conducted at our institution, with CMR performed from 2010 to 2022 and exercise stress testing performed within 12 months (4.3 ± 4.2 months). The skeletal muscle area (SMA) for the posterior paraspinal and anterior thoracic muscles were traced and indexed for body surface area (BSA). Patients were stratified by percentile into the upper and lower quartiles, and the two groups were compared. Multivariable regression was performed to control for sex and age. Results: There was a significant positive association of both anterior (r = 0.34, <i>p</i> = 0.039) and paraspinal (r = 0.43, <i>p</i> = 0.007) SMA to peak VO<sub>2</sub>. Similarly, paraspinal but not anterior SMA was negatively associated with the V<sub>E</sub>/V<sub>CO2</sub> (r = –0.45, <i>p</i> = 0.006). The upper quartile group had significantly more males (18/19 vs. 8/20; <i>p</i> = 0.0003) and demonstrated a significantly higher peak VO<sub>2</sub> (32.2 ± 8.5 vs. 23.8 ± 4.7, <i>p</i> = 0.009), a higher peak RER (1.2 ± 0.1 vs. 1.1 ± 0.04, <i>p</i> = 0.007), and a significantly lower V<sub>E</sub>/V<sub>CO2</sub> (32.9 ± 3.6 vs. 40.2 ± 6.2, <i>p</i> = 0.006) compared to the lowest quartile. The association of SMA to VO<sub>2</sub> peak and V<sub>E</sub>/V<sub>CO2</sub> was redemonstrated after controlling for sex and age. Conclusion: Thoracic skeletal muscle area may be an effective surrogate of muscle mass and is correlated to several measures of cardiorespiratory fitness post-Fontan. CMR would be an effective tool for the surveillance of sarcopenia in post-Fontan patients given its accessibility and routine use in these patients.
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spelling doaj.art-e84fc5d875254bfeba3fe547254a6e292023-11-17T17:00:36ZengMDPI AGJournal of Clinical Medicine2077-03832023-04-01127268910.3390/jcm12072689Surrogates of Muscle Mass on Cardiac MRI Correlate with Exercise Capacity in Patients with Fontan CirculationKevin L. Smith0Emile B. Gordon1Megan E. Gunsaulus2Adam Christopher3Laura J. Olivieri4Sameh S. Tadros5Tyler Harris6Anita P. Saraf7Jacqueline Kreutzer8Brian Feingold9Tarek Alsaied10Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USADepartment of Radiology, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USADepartment of Pediatric Cardiology, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USADepartment of Pediatric Cardiology, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USADepartment of Pediatric Cardiology, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USADepartment of Radiology, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USADepartment of Pediatric Cardiology, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USADepartment of Pediatric Cardiology, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USADepartment of Pediatric Cardiology, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USADepartment of Pediatric Cardiology, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USADepartment of Pediatric Cardiology, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USABackground: Sarcopenia is an increasingly recognized marker of frailty in cardiac patients. Patients with a history of congenital heart disease and Fontan procedure have a higher risk of developing progressive muscle wasting. Our objective was to determine if we could use routine cardiac MRI (CMR) for the surveillance of muscle wasting. Methods: A retrospective study of all Fontan patients (n = 75) was conducted at our institution, with CMR performed from 2010 to 2022 and exercise stress testing performed within 12 months (4.3 ± 4.2 months). The skeletal muscle area (SMA) for the posterior paraspinal and anterior thoracic muscles were traced and indexed for body surface area (BSA). Patients were stratified by percentile into the upper and lower quartiles, and the two groups were compared. Multivariable regression was performed to control for sex and age. Results: There was a significant positive association of both anterior (r = 0.34, <i>p</i> = 0.039) and paraspinal (r = 0.43, <i>p</i> = 0.007) SMA to peak VO<sub>2</sub>. Similarly, paraspinal but not anterior SMA was negatively associated with the V<sub>E</sub>/V<sub>CO2</sub> (r = –0.45, <i>p</i> = 0.006). The upper quartile group had significantly more males (18/19 vs. 8/20; <i>p</i> = 0.0003) and demonstrated a significantly higher peak VO<sub>2</sub> (32.2 ± 8.5 vs. 23.8 ± 4.7, <i>p</i> = 0.009), a higher peak RER (1.2 ± 0.1 vs. 1.1 ± 0.04, <i>p</i> = 0.007), and a significantly lower V<sub>E</sub>/V<sub>CO2</sub> (32.9 ± 3.6 vs. 40.2 ± 6.2, <i>p</i> = 0.006) compared to the lowest quartile. The association of SMA to VO<sub>2</sub> peak and V<sub>E</sub>/V<sub>CO2</sub> was redemonstrated after controlling for sex and age. Conclusion: Thoracic skeletal muscle area may be an effective surrogate of muscle mass and is correlated to several measures of cardiorespiratory fitness post-Fontan. CMR would be an effective tool for the surveillance of sarcopenia in post-Fontan patients given its accessibility and routine use in these patients.https://www.mdpi.com/2077-0383/12/7/2689cardiac MRIFontansarcopeniaexercise stress testcardiorespiratory fitnessmuscle mass
spellingShingle Kevin L. Smith
Emile B. Gordon
Megan E. Gunsaulus
Adam Christopher
Laura J. Olivieri
Sameh S. Tadros
Tyler Harris
Anita P. Saraf
Jacqueline Kreutzer
Brian Feingold
Tarek Alsaied
Surrogates of Muscle Mass on Cardiac MRI Correlate with Exercise Capacity in Patients with Fontan Circulation
Journal of Clinical Medicine
cardiac MRI
Fontan
sarcopenia
exercise stress test
cardiorespiratory fitness
muscle mass
title Surrogates of Muscle Mass on Cardiac MRI Correlate with Exercise Capacity in Patients with Fontan Circulation
title_full Surrogates of Muscle Mass on Cardiac MRI Correlate with Exercise Capacity in Patients with Fontan Circulation
title_fullStr Surrogates of Muscle Mass on Cardiac MRI Correlate with Exercise Capacity in Patients with Fontan Circulation
title_full_unstemmed Surrogates of Muscle Mass on Cardiac MRI Correlate with Exercise Capacity in Patients with Fontan Circulation
title_short Surrogates of Muscle Mass on Cardiac MRI Correlate with Exercise Capacity in Patients with Fontan Circulation
title_sort surrogates of muscle mass on cardiac mri correlate with exercise capacity in patients with fontan circulation
topic cardiac MRI
Fontan
sarcopenia
exercise stress test
cardiorespiratory fitness
muscle mass
url https://www.mdpi.com/2077-0383/12/7/2689
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