Abstract 11787: The Association Between Preoperative Sarcopenia and Outcomes After Cardiac Transplantation

Introduction: Sarcopenia, or reduced muscle mass and function, is underdiagnosed in advanced heart failure and is not routinely assessed. In patients receiving a left ventricular assist device (LVAD), preoperative sarcopenia, defined using CT-derived pectoralis muscle area index (muscle area indexed to height), was an independent predictor of post-operative mortality. The association between preoperative sarcopenia and outcomes after cardiac transplantation is unknown.

Aims/Hypotheses: The primary aim was to determine if preoperative sarcopenia, diagnosed using pectoralis muscle area index, is an independent predictor of days alive & out of the hospital at 1-year post-cardiac transplant. We hypothesize that patients with preoperative sarcopenia will have fewer days alive & out of the hospital compared to those without.

Methods: Patients who underwent cardiac transplantation from January 2018 to June 2022 with available preoperative chest CT scans (68% of total cohort) were included. Sarcopenia was diagnosed as pectoralis muscle area index in the lowest sex-specific tertile (male < 5.7 cm ² /m ² ; female < 4.4 cm ² /m ² ). The primary endpoint was days alive & out of the hospital at 1-year post-transplant.

Results: 172 patients were included of whom 32.7% met criteria for sarcopenia. Patients with sarcopenia were more likely white with lower body mass index (BMI) (23.5 vs 27.7 kg/m ² ). Patients with sarcopenia had fewer days alive & out of the hospital compared to those without, with a median difference of 16.5 days (320.5 vs. 337 days, p=0.004). Patients with sarcopenia had a longer index hospitalization (28.5 vs. 22 days) and were more likely to be discharged to a facility other than home (40.4% vs. 12.3%). In a linear regression model, sarcopenia was a significant univariable and the strongest multivariable predictor of days alive & out of the hospital at 1-year when controlling for diabetes status (β = -14.4, 95% CI -28, -1.2, p = 0.032).

Conclusions: Preoperative sarcopenia, diagnosed using pectoralis muscle area index, is an independent predictor of poor outcomes after cardiac transplant. This parameter is easily measurable from commonly obtained preoperative CT scans and may be considered in the transplant evaluation as a marker of risk.