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.