AB1412 IMAGING TECHNIQUES IN ASSESSING THE MUSCULAR STATUS OF PATIENTS WITH CORONARY HEART DISEASE
Authors: A. Kokov, V. Masenko, A. Kareeva
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Thanks to the tactics of early myocardial revascularization and active secondary prevention, there is a tendency to increase the average age of patients with atherosclerotic coronary lesions. At the same time, muscle tissue deficiency in patients with multivessel disease can affect both the choice of surgical tactics, considering possible complications, and the possibilities of pre- and rehabilitation. <h3>Objectives:</h3> To determine the clinical portrait of a patient with stable coronary artery disease (CHD) and concomitant impaired muscle status using data from computed tomography of the chest. <h3>Methods:</h3> The study included 387 people with coronary artery disease with indications for open myocardial revascularization (men n=283, women n=104), average age 65±0.58 years. Of these, 29.1% (n=113) were obese, 25.3% (n=98) had type 2 diabetes, and 36.6% (n=142) were smokers. 57.1% of patients (n=221) had a history of myocardial infarction. Angina pectoris was diagnosed in 86.3% of patients (n=334), of which 22.9% had FC I (n= 89), FC II – 52.7% (n= 204), FC III – 10.6 % (n= 41). The overwhelming number of patients had a history of arterial hypertension syndrome - 83.5% (n=323). Before surgery, all patients were diagnosed with sarcopenia in accordance with the criteria of the European Working Group on Sarcopenia in the Elderly (EWGSOP2) and a quantitative assessment of skeletal muscles was performed on a computed tomography (Somatom Sensation 64, Siemens, Germany) using data from a routine chest scan. On the resulting scans, the muscle area at the level of the Th8-9 intervertebral disc was determined. Using the obtained value of skeletal muscle area, the muscle body index (BMI) was calculated as the ratio of the area of muscle tissue to the square of the height index. Threshold values below which the percentage of muscle mass from the body composition of the test person is less than the average values of representatives of the adult population of the same sex by two standard deviations or more and corresponds to sarcopenia were taken as 33.85 cm<sup>2</sup>/m<sup>2</sup> for men and 24.85 cm<sup>2</sup>/m<sup>2</sup> for women. The severity of coronary lesions was assessed based on selective coronary angiography (INNOVA 3100, GE, USA). Additional assessment of the coronary arteries using the SYNTAX scale was carried out to objectify the severity of the lesion, considering the location and morphological indicators of arterial stenosis. A comparative analysis of clinical and anamnestic characteristics of groups of patients with sarcopenia and with normal muscle status was performed. <h3>Results:</h3> Sarcopenia was detected in 39.3% (n=152) of patients with stable coronary artery disease. In the sarcopenia group and the group with normal muscle status, there was a predominance of males - in 86.2% and 64.7% (p = 0.01), the presence of hypercholesterolemia - in 51.3% and 31.1% (p = 0).02), type 2 diabetes mellitus – in 21.1% and 28.1% (p=0.06), multi-vessel coronary artery disease – in 25.6% and 17.8% of cases (p=0.018) respectively. In sarcopenia, a 4-fold longer history of diabetes mellitus was noted (p=0.01) and a 2.3-fold longer duration of coronary artery disease (p=0.03). The incidence of obesity with sarcopenia is 3.4 times less (p=0.003). Correlation analysis showed a relationship between muscle status and age (r=-0.674; p=0.002), duration of history of coronary artery disease (r=-0.582; p=0.001) and diabetes (r=-0.748; p&lt;0.001). When assessing the coronary bed, there were no statistically significant differences between the studied groups, either in the number of SYNTAX Scores (p = 0.35) or in the prevalence of risk levels determined by the SYNTAX Score. However, hemodynamically significant coronary lesions involving three coronary arteries were verified in 25.6% of patients with sarcopenia, whereas in the group with normal muscle mass, three-vessel lesions were detected in 17.8% of patients (p = 0.018). <h3>Conclusion:</h3> The clinical and anamnestic image of a patient with stable coronary artery disease and sarcopenia is characterized by an association of reduced muscle mass with male gender, age, hypercholesterolemia, multivessel coronary disease, a long history of diabetes mellitus and angina pectoris. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>