Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Jul 26, 2020; 12(7): 351-361
Published online Jul 26, 2020. doi: 10.4330/wjc.v12.i7.351
Sonographic muscle mass assessment in patients after cardiac surgery
Stavros Dimopoulos, Vasiliki Raidou, Dimitrios Elaiopoulos, Foteini Chatzivasiloglou, Despoina Markantonaki, Efterpi Lyberopoulou, Ioannis Vasileiadis, Katerina Marathias, Serafeim Nanas, Andreas Karabinis
Stavros Dimopoulos, Dimitrios Elaiopoulos, Despoina Markantonaki, Efterpi Lyberopoulou, Katerina Marathias, Andreas Karabinis, Department of Cardiac Surgery ICU, Onassis Cardiac Surgery Center, Athens 17674, Greece
Stavros Dimopoulos, Vasiliki Raidou, Foteini Chatzivasiloglou, Ioannis Vasileiadis, Serafeim Nanas, Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, National and Kapodistrian University of Athens, Athens 10676, Greece
Author contributions: Dimopoulos S conceptualized and designed the study; Karabinis A supervised the study; Dimopoulos S, Raidou V, Markantonaki D, Marathias K, Vasileiadis I and Nanas S were involved in the data curation and analysis, projet administration and provided scientific review; Dimopoulos S, Raidou V, Elaiopoulos D, Chatzivasiloglou F and Lyberopoulou E performed the research and collected the data; Dimopoulos S and Raidou V wrote the paper, reviewed, edited and revised the final version of the manuscript; all authors have read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by Ethics Committee of the Onassis Cardiac Surgery Center, Athens, Greece, No. 607/17.11.17.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Stavros Dimopoulos, PhD, Doctor, Postdoc, Research Scientist, Senior Researcher, Staff Physician, Department of Cardiac Surgery ICU, Onassis Cardiac Surgery Center, No. 356 L. Syggrou, Athens 17674, Greece. stdimop@gmail.com
Received: February 29, 2020
Peer-review started: February 29, 2020
First decision: April 7, 2020
Revised: May 11, 2020
Accepted: June 17, 2020
Article in press: June 17, 2020
Published online: July 26, 2020
Processing time: 146 Days and 5.9 Hours
Abstract
BACKGROUND

Patients undergoing cardiac surgery particularly those with comorbidities and frailty, experience frequently higher rates of post-operative morbidity, mortality and prolonged hospital length of stay. Muscle mass wasting seems to play important role in prolonged mechanical ventilation (MV) and consequently in intensive care unit (ICU) and hospital stay.

AIM

To investigate the clinical value of skeletal muscle mass assessed by ultrasound early after cardiac surgery in terms of duration of MV and ICU length of stay.

METHODS

In this observational study, we enrolled consecutively all patients, following their admission in the Cardiac Surgery ICU within 24 h of cardiac surgery. Bedside ultrasound scans, for the assessment of quadriceps muscle thickness, were performed at baseline and every 48 h for seven days or until ICU discharge. Muscle strength was also evaluated in parallel, using the Medical Research Council (MRC) scale.

RESULTS

Of the total 221 patients enrolled, ultrasound scans and muscle strength assessment were finally performed in 165 patients (patients excluded if ICU stay < 24 h). The muscle thickness of rectus femoris (RF), was slightly decreased by 2.2% [(95% confidence interval (CI): - 0.21 to 0.15), n = 9; P = 0.729] and the combined muscle thickness of the vastus intermedius (VI) and RF decreased by 3.5% [(95%CI: - 0.4 to 0.22), n = 9; P = 0.530]. Patients whose combined VI and RF muscle thickness was below the recorded median values (2.5 cm) on day 1 (n = 80), stayed longer in the ICU (47 ± 74 h vs 28 ± 45 h, P = 0.02) and remained mechanically ventilated more (17 ± 9 h vs 14 ± 9 h, P = 0.05). Moreover, patients with MRC score ≤ 48 on day 3 (n = 7), required prolonged MV support compared to patients with MRC score ≥ 49 (n = 33), (44 ± 14 h vs 19 ± 9 h, P = 0.006) and had a longer duration of extracorporeal circulation was (159 ± 91 min vs 112 ± 71 min, P = 0.025).

CONCLUSION

Skeletal quadriceps muscle thickness assessed by ultrasound shows a trend to a decrease in patients after cardiac surgery post-ICU admission and is associated with prolonged duration of MV and ICU length of stay.

Keywords: Intensive care unit-acquired weakness; Cardiac surgery; Skeletal muscle wasting; Muscle ultrasound; Quadriceps femoris; Muscle mass

Core tip: Muscle mass wasting may occur in post-cardiac surgery patients affecting outcome. We assessed the clinical significance of muscle mass in post-cardiac surgery after intensive care unit (ICU) admission. Sonographic assessment of quadriceps muscle thickness was performed to 165 post-cardiac surgery patients for 7 d or until ICU discharge. The results of the study showed a trend to a decreased muscle mass in post-cardiac surgery patients. There was also an association between muscle mass andduration of mechanical ventilation support and ICU length of stay. Sonographic assessment seems to be a valid method to quantify quadriceps muscle mass in patients after cardiac surgery.