Sarcopenia and echocardiographic parameters for prediction of cardiovascular events and mortality in patients undergoing maintenance hemodialysis

Mengyan Zhang; Liuping Zhang; Yezi Hu; Ying Wang; Shengchun Xu; Xiaotong Xie; Tian Xu; Zuolin Li; Hui Jin; Hong Liu

doi:10.7717/peerj.14429

Sarcopenia and echocardiographic parameters for prediction of cardiovascular events and mortality in patients undergoing maintenance hemodialysis

PeerJ. 2022 Nov 23:10:e14429. doi: 10.7717/peerj.14429. eCollection 2022.

Authors

Mengyan Zhang^#¹, Liuping Zhang^#¹, Yezi Hu², Ying Wang¹, Shengchun Xu¹, Xiaotong Xie¹, Tian Xu¹, Zuolin Li¹, Hui Jin², Hong Liu¹

Affiliations

¹ Zhongda Hospital, Southeast University School of Medicine, Institute of Nephrology, Nanjing, Jiangsu Province, China.
² Zhongda Hospital, Southeast University School of Medicine, Institute of Nutrition, Nanjing, Jiangsu Province, China.

^# Contributed equally.

Abstract

Background: Sarcopenia is prevalent and is associated with the occurrence of cardiovascular complications in patients undergoing maintenance hemodialysis (MHD). It is unknown how skeletal muscle may be associated with aspects of myocardial structure and function. This study aimed to evaluate the association between sarcopenia and cardiac structure and function in patients undergoing MHD. We also examined the prognostic role of sarcopenia for mortality and cardiovascular events (CVE) in this population.

Methods: Participants from a single center underwent bioimpedance body composition analysis to measure skeletal muscle and echocardiography to assess myocardial structure and function. Sarcopenia was diagnosed based on the Asian Working Group for Sarcopenia criteria. The end points were all-cause mortality and CVE.

Results: Of the 158 participants, 46 (29.1%) had sarcopenia, 102 (64.6%) had left ventricular diastolic dysfunction (LVDD), and 106 (67.0%) had left ventricular hypertrophy (LVH). Participants with sarcopenia had smaller right ventricular sizes (2.54 ± 0.77 vs 2.76 ± 0.28; P < 0.01), inter-ventricular thickness (1.07 ± 0.19 vs 1.14 ± 0.20; P = 0.039), and left ventricular posterior wall thickness (0.96, 0.89-1.10 vs 1.06, 0.95-1.20; P = 0.018). Skeletal muscle mass was strongly correlated with left ventricular mass (LVM) (r = 0.577; P < 0.0001). Furthermore, the risk of LVDD (OR: 4.92, 95% confidence interval (CI) [1.73-13.95]) and LVH (OR: 4.88, 95% CI [1.08-21.96]) was much higher in the sarcopenic group than in the non-sarcopenic group. During a follow-up period of 18 months, 11 (6.9%) patients died, of which seven died (4.4%) of CVE, and 36 (22.8%) experienced CVE. The presence of sarcopenia (adjusted hazard ratio (HR), 6.59; 95% CI [1.08-39.91]; P = 0.041) and low skeletal muscle index (HR, 3.41; 95% CI [1.01-11.57]; P = 0.049) and handgrip strength (HR, 0.88; 95% CI [0.78-0.99]; P = 0.037) independently predicted death. Sarcopenia was a significant predictor of CVE (HR, 10.96; 95% CI [1.14-105.10]; P = 0.038).

Conclusion: Our findings demonstrated that sarcopenia is associated with LVDD and LVH, and is associated with a higher probability of death and CVE.

Keywords: Cardiovascular events; Echocardiography; Hemodialysis; Mortality; Sarcopenia.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Echocardiography
Hand Strength
Humans
Hypertrophy, Left Ventricular / diagnosis
Renal Dialysis / adverse effects
Sarcopenia* / diagnosis
Ventricular Dysfunction, Left* / diagnostic imaging

Grants and funding

Our work was supported by the grants from the National Natural Science Foundation of China (82000648), the Natural Science Foundation of Jiangsu Province (BK20200363), the Outstanding Youth Cultivation Foundation of Southeast University (2021ZDYYYQPY07), and the Innovative and Entrepreneurial Talent (Doctor) of Jiangsu Province. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.