PMID- 34994094 OWN - NLM STAT- MEDLINE DCOM- 20220325 LR - 20220325 IS - 2055-5822 (Electronic) IS - 2055-5822 (Linking) VI - 9 IP - 2 DP - 2022 Apr TI - Comparison of feasibility and results of frailty assessment methods prior to left ventricular assist device implantation. PG - 1038-1049 LID - 10.1002/ehf2.13764 [doi] AB - AIMS: Assessing frailty and sarcopenia is considered a valuable cornerstone of perioperative risk stratification in advanced heart failure patients. The lack of an international consensus on a diagnostic standard impedes its implementation in the clinical routine. This study aimed to compare the feasibility and prognostic impact of different assessment tools in patients undergoing continuous-flow left ventricular assist device (cf-LVAD) implantation. METHODS AND RESULTS: We prospectively compared feasibility and prognostic values of six frailty/sarcopenia assessment methods in 94 patients prior to cf-LVAD implantation: bioelectrical impedance analysis (BIA), computed tomography (CT)-based measurement of two muscle areas/body surface area [erector spinae muscle (TMESA/BSA) and iliopsoas muscle (TPA/BSA)], physical performance tests [grip strength, 6 min walk test (6MWT)] and Rockwood Clinical Frailty Scale (RCFS). Six-month mortality and/or prolonged ventilation time >95 h was defined as the primary endpoint. BIA and CT showed full feasibility (100%); physical performance and RCFS was limited due to patients' clinical status (feasibility: 87% grip strength, 62% 6MWT, 88% RCFS). Phase angle derived by BIA showed the best results regarding the prognostic value for 6 month mortality and/or prolonged ventilation time >95 h (odds ratio (OR) 0.66 [95% confidence interval (CI): 0.46-0.92], P = 0.019; area under the curve (AUC) 0.65). It provided incremental value to the clinical risk assessment of EuroSCORE II: C-index of the combined model was 0.75 [95% CI; 0.651-0.848] compared with C-index of EuroSCORE II alone, which was 0.73 (95% CI: 0.633-0.835). Six-month survival was decreased in patients with reduced body cell mass derived by BIA or reduced muscle area in the CT scan compared with patients with normal values: body cell mass 65% (95% CI: 51.8-81.6%) vs. 83% (95% CI: 74.0-93.9%); P = 0.03, TMESA/BSA 65% (95% CI: 51.2-82.2%) vs. 82% (95% CI: 73.2-93.0%); P = 0.032 and TPA/BSA 66% (95% CI: 53.7-81.0%) vs. 85% (95% CI: 75.0-95.8%); P = 0.035. CONCLUSIONS: Bioelectrical impedance analysis parameters and CT measurements were shown to be suitable to predict 6-month mortality and/or prolonged ventilation time >95 h in patients with advanced heart failure prior to cf-LVAD implantation. Phase angle had the best predictive capacity and sarcopenia diagnosed by reduced body cell mass in BIA or muscle area in CT was associated with a decreased 6 month survival. CI - (c) 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. FAU - Roehrich, Luise AU - Roehrich L AUID- ORCID: 0000-0002-8826-075X AD - Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, Berlin, 13353, Germany. AD - DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany. AD - German Heart Foundation, Frankfurt am Main, Germany. FAU - Sundermann, Simon H AU - Sundermann SH AUID- ORCID: 0000-0003-4927-1584 AD - Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, Berlin, 13353, Germany. AD - DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany. AD - Department of Cardiovascular Surgery, Charite-Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin and Humboldt Universitat zu Berlin, Berlin, Germany. FAU - Just, Isabell Anna AU - Just IA AUID- ORCID: 0000-0003-1141-9387 AD - Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, Berlin, 13353, Germany. AD - DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany. FAU - Kopp Fernandes, Laurenz AU - Kopp Fernandes L AD - Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, Berlin, 13353, Germany. FAU - Stein, Julia AU - Stein J AD - Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, Berlin, 13353, Germany. FAU - Solowjowa, Natalia AU - Solowjowa N AUID- ORCID: 0000-0002-0354-659X AD - Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, Berlin, 13353, Germany. FAU - Mulzer, Johanna AU - Mulzer J AUID- ORCID: 0000-0003-0285-263X AD - Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, Berlin, 13353, Germany. FAU - Mueller, Marcus AU - Mueller M AD - Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, Berlin, 13353, Germany. FAU - Hummel, Manfred AU - Hummel M AD - Paulinen Hospital, Berlin, Germany. FAU - Knierim, Jan AU - Knierim J AUID- ORCID: 0000-0002-0514-0016 AD - Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, Berlin, 13353, Germany. FAU - Potapov, Evgenij AU - Potapov E AUID- ORCID: 0000-0002-9720-3175 AD - Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, Berlin, 13353, Germany. AD - DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany. FAU - Falk, Volkmar AU - Falk V AUID- ORCID: 0000-0002-7911-8620 AD - Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, Berlin, 13353, Germany. AD - DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany. AD - Department of Cardiovascular Surgery, Charite-Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin and Humboldt Universitat zu Berlin, Berlin, Germany. AD - Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland. FAU - Schoenrath, Felix AU - Schoenrath F AUID- ORCID: 0000-0002-8221-1295 AD - Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, Berlin, 13353, Germany. AD - DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany. LA - eng SI - ClinicalTrials.gov/NCT04222400 PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20220106 PL - England TA - ESC Heart Fail JT - ESC heart failure JID - 101669191 SB - IM MH - Feasibility Studies MH - *Frailty/complications/diagnosis MH - *Heart Failure/complications MH - *Heart-Assist Devices MH - Humans MH - *Sarcopenia PMC - PMC8934953 OTO - NOTNLM OT - Advanced heart failure OT - Bioelectrical impedance analysis OT - Frailty evaluation OT - Sarcopenia OT - Ventricular assist device COIS- Prof Dr Falk reports grants from Medtronic GmbH, Abbott GmbH & Co. KG, Boston Scientific, Edwards Lifesciences, JOTEC/CryoLife and other financial activities from Berlin Heart, Biotronik SE & Co., Novartis Pharma GmbH, Zurich Heart outside of the submitted work. Dr Schoenrath reports other financial activities from Novartis, Abbott, Orion Pharma, AstraZeneca and non-financial support from Medtronic outside of the submitted work. Ms Roehrich reports grants from the German Heart Foundation during the conduct of the study. Share holdings of Alianz SE, Carl Zeiss Meditec AG, CompuGroup Medical SE & Co. KGaA, Evotec SE, Fresenius Medical Care AG & Co. KGaA outside of the submitted work. Nothing to disclose for the other authors. EDAT- 2022/01/08 06:00 MHDA- 2022/03/26 06:00 PMCR- 2022/01/06 CRDT- 2022/01/07 06:58 PHST- 2021/11/07 00:00 [revised] PHST- 2021/02/05 00:00 [received] PHST- 2021/12/02 00:00 [accepted] PHST- 2022/01/08 06:00 [pubmed] PHST- 2022/03/26 06:00 [medline] PHST- 2022/01/07 06:58 [entrez] PHST- 2022/01/06 00:00 [pmc-release] AID - EHF213764 [pii] AID - 10.1002/ehf2.13764 [doi] PST - ppublish SO - ESC Heart Fail. 2022 Apr;9(2):1038-1049. doi: 10.1002/ehf2.13764. Epub 2022 Jan 6.