Risultati per: Dalla presbifagia alla sarcopenia, il trattamento in medicina generale

Introduction
Sarcopenia represents a central biological substratum of frailty, which increases the incidence of adverse events and mortality after surgery for oesophageal cancer, gastrectomy and pancreatic surgery. Recently, sarcopenia has been suggested as a predictor of outcomes in patients undergoing transcatheter aortic valve implantation (TAVI). However, since relevant data were variable, we aimed to perform a systematic review and meta-analysis of the current literature to evaluate sarcopenia as a predictor of post-TAVI outcomes.

Methods and analysis
Two investigators will conduct independent searches in PubMed, EMBASE, Web of Science, MEDLINE and the Cochrane Library, from database inception to October 2022. The search will not be limited by language or region. Eligible studies will include reports investigating post-TAVI outcomes in patients with sarcopenia, who are aged >18 years and diagnosed using a CT scan. The primary outcome is short-term mortality (30-day mortality), while the secondary outcomes include long-term mortality ( >30 days), length of intensive care unit (ICU) stay, need for ICU admission (the number of patients in the sarcopenia or non-sarcopenia group requiring ICU admission), length of hospital stay and overall complications. Included studies will be assessed for risk of bias according to the Quality in Prognosis Studies critical assessment tool and certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation. The analysis will be done with Review Manager (V.5.4) software. If testing reveals little or no statistical heterogeneity, a fixed-effect model will be used for data synthesis; otherwise, a random-effect model may be employed. On encountering substantial heterogeneity, subgroup analysis and leave-one-out jackknife sensitivity analysis will be used to verify the robustness of the results. The obtained results will be presented as forest plots while Cochran’s Q test and I2 test will be used to calculate the heterogeneity ( >50% indicating strong heterogeneity).

Ethics and dissemination
No ethical approval is needed for this study since we will be using data from previously published studies. The results will be disseminated in a peer-reviewed journal.

PROSPERO registration number
CRD42022349525.

Circulation, Volume 146, Issue Suppl_1, Page A12725-A12725, November 8, 2022. Introduction:Low serum albumin is a marker of protein malnutrition and is commonly associated with worse outcomes in various clinical settings. Furthermore, significant overlap exists between malnutrition and sarcopenia, which can be an independent predictor of worse outcomes.Hypothesis:We assessed the hypothesis that the presence of sarcopenia with low albumin (SLA) would lead to synergistically worse outcomes in patients with acute decompensated heart failure (ADHF).Methods:Patients hospitalized for ADHF from 2017 to 2019 with computed tomography of the abdomen/pelvis within 30 days and albumin level within 24 hours before discharge were studied (n=181). Given the high prevalence of hypoalbuminemia, low albumin was defined as the lower fiftieth percentile. Semi-automatic measurements of skeletal muscle area were made at L3 (Figure 1A) and adjusted using height squared to obtain skeletal muscle index (SMI). Sarcopenia was defined as the lowest sex-stratified SMI tertile.Results:The prevalence of sarcopenia alone was 11.6%, low albumin alone 28.7%, and SLA 20.4%. The groups had similar demographics but differed in BMI (lowest in sarcopenia alone, p

Circulation, Volume 146, Issue Suppl_1, Page A11454-A11454, November 8, 2022. Introduction:Sarcopenia is associated with worse outcomes in various clinical situations. Traditional markers of strength and frailty have been used for pre-operative risk stratification in transcatheter aortic valve replacement (TAVR). However, the availability of computed tomography (CT) scans provides an opportunity to obtain direct skeletal muscle measurements.Hypothesis:We hypothesized that sarcopenia would lead to worse outcomes in patients following TAVR.Methods:Patients undergoing TAVR between January to July 2018 with pre-procedural chest CT were included. Semi-automatic measurements of skeletal muscle area (SMA) were made at the twelfth thoracic vertebra. SMA was normalized by height to obtain skeletal muscle index (SMI, cm2/m2). Sarcopenia was defined as the lowest sex-stratified SMI tertile. Strength and functional testing data had been collected as part of the routine pre-TAVR evaluation. The primary outcome of interest was all-cause mortality.Results:A total of 76 patients were included, 26 sarcopenic based on SMI. Table 1 shows comparisons between the groups. During a median follow-up of 1496 (1401-1562) days, 10 (38.5%) deaths occurred in the sarcopenic group and 9 (18.0%) in the non-sarcopenic group. Figure 1 demonstrates this significant difference by Log-Rank testing (p=0.042). The secondary outcomes of length of stay and 30-day readmission did not differ between the groups on unadjusted comparison.Conclusions:Sarcopenia was associated with increased mortality in patients who underwent TAVR. A larger study is underway to assess the potential of muscle measurements serving as an additional pre-operative risk stratification tool.

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