Introduction
Frailty is a geriatric concept that describes frail older adults and is
regarded as a medical syndrome with a poor prognosis1. The main manifestation of frailty is a decrease in
skeletal muscle mass, i.e., sarcopenia associated with aging. However,
in chronic heart failure, it is often caused by secondary sarcopenia due
to complex pathological conditions, such as cardiac cachexia. Frailty
has been associated with the prognosis of patients with heart failure
(HF), suggesting that it may be a new prognostic indicator that reflects
the clinical outcomes in these patients.
With advancements in medical technology, more HF patients have undergone
left ventricular assist device (LVAD) implantation, and their clinical
outcomes have also improved. With the expected expansion of LVAD
indications, it is necessary to determine the parameters indicative for
LVAD implantation in frailty. In other words, it is indispensable to
preoperatively distinguish whether the frailty of HF patients will be
recoverable after LVAD implantation by improving their hemodynamics.
However, it has not been well established whether patients with severe
frailty will respond to LVAD implantation. Thus, the development of
criteria to assess preoperative frailty in HF patients is expected to
provide an appropriate indication for LVAD implantation and encourage
efforts to prevent unnecessary LVAD implantation, which is not
negligible in medical economics.
This study examines the functionality of the erector spinae muscle (ESM)
mass, which can be assessed using chest computed tomography (CT). This
is usually performed in the context of the preoperative evaluation for
LVAD implantation. ESM mass would be an advantageous prognostic marker,
allowing the preoperative assessment of the precise individual patient
benefit before the LVAD operation. Here, we analyzed the effect of the
preoperative mass of the ESM on the clinical outcomes of LVAD patients
with HF in our cohort.