Pre-Operative Pectoralis Muscle Quantity and Attenuation by Computed Tomography are Predictive of Recurrent Gastrointestinal Bleeding on Left Ventricular Assist Device Support: A Multicenter Analysis

R. Araujo-Gutierrez, L. M. Potter, L. Teigen, Jessica N Schultz, J. D. Estep, R. John, C. Martin, Rebecca J Cogswell, B. Trachtenberg

Research output: Contribution to journalArticlepeer-review

Abstract

PURPOSE: Pectoralis muscle mass and tissue attenuation obtained on preoperative CT scans are powerful predictors of mortality after LVAD implantation. Gastrointestinal (GI) bleeding remains a common problem on mechanical support. It is unknown whether these skeletal muscle measures, which correlate with frailty and tissue quality, are associated with the development of recurrent GI bleeding. METHODS: We performed a retrospective, multi-centered study which included patients with chest CTs performed ≤ 3 months prior to LVAD implantation at the University of Minnesota (n=143) and Houston Methodist Hospital (n=133). Unilateral pectoralis muscle mass indexed to body surface area (PMI) and attenuation (approximated by mean Hounsfield units; PHUm) were measured on preoperative chest CT scans. GIB events were captured for the first two years of LVAD support. Negative binomial regression analyses were performed to determine the association between pectoralis muscle measures and number of GIB events on LVAD support. RESULTS: The mean age of the study cohort was 59 + /- 13 years, 43 % were bridge to transplant and 62 % had ischemic cardiomyopathy. Thirty-two patients had at last one GI bleed while on LVAD support over 2 years. Both pectoralis muscle mass and tissue attenuation were associated with the incidence rate of GI bleeding on LVAD support. Each 5 unit increase in PHUm was associated with reduction in the incidence rate of GIB (adjusted 18 % reduction, 95 % CI 6-28 %, p = 0.005). Each unit increase in PMI was associated with a reduction in the incidence of GIB (adjusted 19 % reduction, 95 % CI 3- 34 %, p = 0.029). The final models were adjusted for age, sex, INTERMACS profile, BTT status, creatinine and albumin. CONCLUSION: Preoperative pectoralis muscle size and attenuation were associated with the development of recurrent GI bleeding after LVAD implantation in this multicenter cohort. This one time, internal assessment of patient substrate appears to predict not only mortality after LVAD, but morbidity as well.

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