**3. Impact of sarcopenia at pre-LVAD on outcome after LVAD implantation**

Clinical studies of sarcopenia in patients with advanced heart failure referred for left ventricular assist device implantation or heart transplantation is summarized in (**Table 1**).

#### **3.1 Skeletal muscle function**

Chung et al. [21] examined the correlation of HGS with outcomes after LVAD implantation, showing that HGS less than 25% of body weight was related to higher



*Sarcopenia in Patients with End-Stage Cardiac Failure Requiring Ventricular Assist Device or… DOI: http://dx.doi.org/10.5772/intechopen.100612*

> **Table 1.**

mortality. Khawaja et al. [22] reported that patients with advanced HF had significantly lower HGS prior to CF-LVAD implantation compared to healthy controls and that the average HGS increased greater than 25% after 6 months after CF-LVAD implantation.

## **3.2 Skeletal muscle mass measurement**

Heberton et al. [37] first introduced the assessment of skeletal muscle mass in the field of LVAD therapy and reported that sarcopenia by measuring psoas muscle area at L3-L4 vertebrae was significantly related to longer hospital stay and higher mortality after implantation of HeartMate II LVAD. On the other hand, Teigen et al. reported that pectoralis muscle mass and tissue quality by measuring Hounsfield units (PHUm) and size-indexed to body surface area were highly associated with post-LVAD mortality and surpassed any other variables in the University of Minnesota dataset [32]. This group further added an external dataset to create a user-friendly, multivariable post-LVAD mortality-prediction score, the so-called the Minnesota Pectoralis Risk Score (MPRS) [39]. This final model included PHUm, pectoralis muscle index (PMI), African American race, serum creatinine and total bilirubin, body mass index (BMI), BTT or DT, and the presence or absence of contrast. The estimated 1-year survival for patients after LVAD implantation by MPRS risk category (tertiles) was the following—low, medium, and high risks were 95, 79, and 58%, respectively (P < 0.0001 by log-rank test). These skeletal muscle measures appear to add important prognostic value to pre-LVAD risk assessment [39]. A further study by them [41] described that INTERMACS 3 and four patients with the highest PMI had the best survival after CF-LVAD implantation. Tsuji et al. [40] also reported that muscle wasting defined by skeletal muscle index on CT scan at L3 level was also associated with post-LVAD mortality. From these findings, CT scan quantification of sarcopenia may help us to identify the optimal timing of LVAD implantation.

### **3.3 Creatinine excretion rate index**

Iwasaki et al. [36] reported that reduced CER index was significantly related to a higher rate of mortality and intracranial hemorrhage after CF-LVAD implantation. Preoperative reduced CER index might be an independent predictor of intracranial hemorrhage after CF-LVAD implantation.
