Heart, Lung and Circulation

Prognostic Effect of Thoracic Sarcopaenia on Short- and Long-Term Clinical Outcomes in Patients Who Underwent Cardiac Valve Surgery

Published:August 10, 2022DOI:


      As the proportion of elderly patients increases, higher incidence of malnutrition is found among patients with valvular heart disease. Sarcopaenia is one of the main manifestations of malnutrition. Studies have shown the certain predictive effect of sarcopaenia on the clinical outcome in different cases. This study aims to clarify the impact of computed tomography (CT)-derived thoracic sarcopaenia on clinical outcomes of patients who underwent cardiac valve surgery.


      The clinical data of 216 patients who underwent cardiac valve surgery from December 2015 to June 2020 were retrospectively collected. Skeletal muscle mass at 12th thoracic vertebra level was measured to diagnose thoracic sarcopaenia. Postoperative complications and follow-up data were collected. Medium follow-up was 3.2 years.


      The prevalence of thoracic sarcopaenia was 16.7% in this study. The incidence of total complications and in-hospital mortality were higher in thoracic sarcopaenia group (p=0.024 and p=0.014, respectively). Multivariate analysis revealed that thoracic sarcopaenia is a significant predictor for postoperative complications (OR 2.319; 95% CI 1.003–5.366; p=0.049). Decreased long-term survival was observed in patients with thoracic sarcopaenia. Thoracic sarcopaenia (HR 4.178; 95% CI 2.062–8.465; p<0.001) was determined to be an independent risk factor for late mortality.


      Thoracic sarcopaenia defined by chest CT was independently associated with higher incidence of postoperative complications and long-term mortality. Routine preoperative evaluation of thoracic sarcopaenia deserves further consideration to enhance the predictive performance for operation risk.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Heart, Lung and Circulation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Nkomo V.T.
        • Gardin J.M.
        • Skelton T.N.
        • Gottdiener J.S.
        • Scott C.G.
        • Enriquez-Sarano M.
        Burden of valvular heart diseases: a population-based study.
        Lancet. 2006; 368: 1005-1011
        • Bronicki R.A.
        • Hall M.
        Cardiopulmonary bypass-induced inflammatory response: pathophysiology and treatment.
        Pediatr Crit Care Med. 2016; 17: S272-S278
        • Iung B.
        • Vahanian A.
        Epidemiology of acquired valvular heart disease.
        Can J Cardiol. 2014; 30: 962-970
        • Andell P.
        • Li X.
        • Martinsson A.
        • Andersson C.
        • Stagmo M.
        • Zoller B.
        • et al.
        Epidemiology of valvular heart disease in a Swedish nationwide hospital-based register study.
        Heart. 2017; 103: 1696-1703
        • Goldfarb M.
        • Lauck S.
        • Webb J.G.
        • Asgar A.W.
        • Perrault L.P.
        • Piazza N.
        • et al.
        Malnutrition and mortality in frail and non-frail older adults undergoing aortic valve replacement.
        Circulation. 2018; 138: 2202-2211
        • Hill A.
        • Nesterova E.
        • Lomivorotov V.
        • Efremov S.
        • Goetzenich A.
        • Benstoem C.
        • et al.
        Current evidence about nutrition support in cardiac surgery patients-what do we know?.
        Nutrients. 2018; 10: 597
        • Ogawa M.
        • Izawa K.P.
        • Satomi-Kobayashi S.
        • Kitamura A.
        • Ono R.
        • Sakai Y.
        • et al.
        Poor preoperative nutritional status is an important predictor of the retardation of rehabilitation after cardiac surgery in elderly cardiac patients.
        Aging Clin Exp Res. 2017; 29: 283-290
        • Cruz-Jentoft A.J.
        • Bahat G.
        • Bauer J.
        • Boirie Y.
        • Bruyere O.
        • Cederholm T.
        • et al.
        Sarcopenia: revised European consensus on definition and diagnosis.
        Age Ageing. 2019; 48: 16-31
        • Cederholm T.
        • Barazzoni R.
        • Austin P.
        • Ballmer P.
        • Biolo G.
        • Bischoff S.C.
        • et al.
        ESPEN guidelines on definitions and terminology of clinical nutrition.
        Clin Nutr. 2017; 36: 49-64
        • von Haehling S.
        • Doehner W.
        • Anker S.D.
        Nutrition, metabolism, and the complex pathophysiology of cachexia in chronic heart failure.
        Cardiovasc Res. 2007; 73: 298-309
        • Kaplan S.J.
        • Zhao K.L.
        • Koren M.
        • Bentov I.
        • Reed M.J.
        • Pham T.N.
        Thresholds and mortality associations of paraspinous muscle sarcopenia in older trauma patients.
        JAMA Surg. 2020; 155: 662-664
        • Zhi J.
        • Shan Q.
        • Liang L.
        • Liu H.
        • Huang H.
        Low skeletal muscle area as a prognostic marker for chronic obstructive pulmonary disease in elderly patients admitted to ICU.
        Sci Rep. 2019; 919117
        • Lenchik L.
        • Barnard R.
        • Boutin R.D.
        • Kritchevsky S.B.
        • Chen H.
        • Tan J.
        • et al.
        Automated muscle measurement on chest CT predicts all-cause mortality in older adults from the National Lung Screening Trial.
        J Gerontol A Biol Sci Med Sci. 2021; 76: 277-285
        • Dindo D.
        • Demartines N.
        • Clavien P.A.
        Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.
        Ann Surg. 2004; 240: 205-213
        • Derstine B.A.
        • Holcombe S.A.
        • Ross B.E.
        • Wang N.C.
        • Su G.L.
        • Wang S.C.
        Skeletal muscle cutoff values for sarcopenia diagnosis using T10 to L5 measurements in a healthy US population.
        Sci Rep. 2018; 811369
        • Shen Z.
        • Liu Z.
        • Zang W.
        • Zhang P.
        • Zou H.
        • Dong W.
        • et al.
        Thoracic sarcopenia predicts clinical outcomes in patients underwent coronary artery bypass grafting: A 6-year cohort study.
        Asian J Surg. 2022;
        • Livshits G.
        • Kalinkovich A.
        Inflammaging as a common ground for the development and maintenance of sarcopenia, obesity, cardiomyopathy and dysbiosis.
        Ageing Res Rev. 2019; 56100980
        • Gargiulo P.
        • Paolillo S.
        • Ferrazzano F.
        • Prastaro M.
        • La Mura L.
        • De Roberto A.M.
        • et al.
        Prognostic value of hormonal abnormalities in heart failure patients.
        Heart Fail Clin. 2019; 15: 371-375
        • Anker S.D.
        • Chua T.P.
        • Ponikowski P.
        • Harrington D.
        • Swan J.W.
        • Kox W.J.
        • et al.
        Hormonal changes and catabolic/anabolic imbalance in chronic heart failure and their importance for cardiac cachexia.
        Circulation. 1997; 96: 526-534
        • Go A.S.
        • Mozaffarian D.
        • Roger V.L.
        • Benjamin E.J.
        • Berry J.D.
        • Blaha M.J.
        • et al.
        Heart disease and stroke statistics--2014 update: a report from the American Heart Association.
        Circulation. 2014; 129: e28-e292
        • Nishi I.
        • Seo Y.
        • Hamada-Harimura Y.
        • Yamamoto M.
        • Ishizu T.
        • Sugano A.
        • et al.
        Geriatric nutritional risk index predicts all-cause deaths in heart failure with preserved ejection fraction.
        ESC Heart Fail. 2019; 6: 396-405
        • Hershkovich S.
        • Stark A.H.
        • Levi C.S.
        • Weiner D.
        • Gur O.
        • Rozen G.S.
        A tailored automated nutrition screening tool for rapid identification of risk in acute-care hospital settings.
        Eur J Clin Nutr. 2017; 71: 284-286
        • Deng X.
        • Zhang S.
        • Shen S.
        • Deng L.
        • Shen L.
        • Qian J.
        • et al.
        Association of controlling nutritional status score with 2-year clinical outcomes in patients with st elevation myocardial infarction undergoing primary percutaneous coronary intervention.
        Heart Lung Circ. 2020; 29: 1758-1765
        • Koh L.Y.
        • Hwang N.C.
        Frailty in cardiac surgery.
        J Cardiothorac Vasc Anesth. 2019; 33: 521-531
        • Hirji S.A.
        • Salenger R.
        • Boyle E.M.
        • Williams J.
        • Reddy V.S.
        • Grant M.C.
        • et al.
        Expert consensus of data elements for collection for enhanced recovery after cardiac surgery.
        World J Surg. 2021; 45: 917-925
        • Mariscalco G.
        • Wozniak M.J.
        • Dawson A.G.
        • Serraino G.F.
        • Porter R.
        • Nath M.
        • et al.
        Body mass index and mortality among adults undergoing cardiac surgery: a nationwide study with a systematic review and meta-analysis.
        Circulation. 2017; 135: 850-863
        • Johnson A.P.
        • Parlow J.L.
        • Whitehead M.
        • Xu J.
        • Rohland S.
        • Milne B.
        Body mass index, outcomes, and mortality following cardiac surgery in Ontario, Canada.
        J Am Heart Assoc. 2015; 4e002140
        • Lopez-Delgado J.C.
        • Munoz-Del Rio G.
        • Flordelis-Lasierra J.L.
        • Putzu A.
        Nutrition in adult cardiac surgery: preoperative evaluation, management in the postoperative period, and clinical implications for outcomes.
        J Cardiothorac Vasc Anesth. 2019; 33: 3143-3162
        • Boirie Y.
        Physiopathological mechanism of sarcopenia.
        J Nutr Health Aging. 2009; 13: 717-723
        • Buchman A.S.
        • Boyle P.A.
        • Wilson R.S.
        • Gu L.
        • Bienias J.L.
        • Bennett D.A.
        Pulmonary function, muscle strength and mortality in old age.
        Mech Ageing Dev. 2008; 129: 625-631
        • Okazaki T.
        • Ebihara S.
        • Mori T.
        • Izumi S.
        • Ebihara T.
        Association between sarcopenia and pneumonia in older people.
        Geriatr Gerontol Int. 2020; 20: 7-13
        • Rieck A.E.
        • Cramariuc D.
        • Boman K.
        • Gohlke-Barwolf C.
        • Staal E.M.
        • Lonnebakken M.T.
        • et al.
        Hypertension in aortic stenosis: implications for left ventricular structure and cardiovascular events.
        Hypertension. 2012; 60: 90-97
        • Baumgartner H.
        • Iung B.
        • Otto C.M.
        Timing of intervention in asymptomatic patients with valvular heart disease.
        Eur Heart J. 2020; 41: 4349-4356
        • Sepehri A.
        • Beggs T.
        • Hassan A.
        • Rigatto C.
        • Shaw-Daigle C.
        • Tangri N.
        • et al.
        The impact of frailty on outcomes after cardiac surgery: a systematic review.
        J Thorac Cardiovasc Surg. 2014; 148: 3110-3117
        • Urbanowicz T.K.
        • Michalak M.
        • Gasecka A.
        • Olasinska-Wisniewska A.
        • Perek B.
        • Rodzki M.
        • et al.
        A risk score for predicting long-term mortality following off-pump coronary artery bypass grafting.
        J Clin Med. 2021; 10: 3032