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Lower-extremity muscle wasting in patients with peripheral arterial disease: quantitative measurement and evaluation with CT

  • Computed Tomography
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Abstract

Objectives

Lower-extremity peripheral arterial disease (PAD) results in limb ischemia and is strongly associated with sarcopenia. This study aimed to retrospectively evaluate the association between the quantity of muscle mass in the lower extremities and the severity of vascular stenosis in PAD patients.

Methods

Between January 2018 and August 2021, 128 patients with PAD and 53 individuals without PAD, diagnosed by computed tomography, were enrolled. The severity of stenosis of lower-extremity arteries was measured using a grading system. The muscle and fat mass areas were calculated in the abdomen at the L3 or L4 level, mid-thigh, and lower leg. Multivariable logistic regression was conducted to clarify the risk associated with low muscle mass. The difference in muscle mass between PAD and non-PAD patients was evaluated by using propensity score matching.

Results

A strong positive correlation between the abdomen muscle area and leg muscle area was observed. The muscle area and muscle index of the leg were lower in PAD patients. These changes occurred earlier than in the abdomen muscle area. The group with more severe artery stenosis had more muscle wasting in the lower extremities. Greater age, female, lower BMI, and PAD were associated with low muscle mass. After propensity score matching, the leg muscle area was still lower in PAD patients.

Conclusions

There is a direct association between PAD and regional muscle wasting. This occurs earlier regionally in the lower extremities than in central muscles. Early diagnosis of PAD might prevent progressive muscle loss, improving disease outcome and quality of life.

Key Points

• Peripheral arterial disease is strongly associated with sarcopenia.

• Muscle wasting in the lower extremities is earlier and more prominent than that in the abdomen.

• More severe arterial stenoses are associated with higher muscle wasting in the lower extremities.

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Abbreviations

AMA:

Abdominal muscle area

BMI:

Body mass index

CKD:

Chronic kidney disease

CT:

Computed tomography

CVD:

Cardiovascular disease

Ht:

Height

HTN:

Hypertension

HU:

Hounsfield units

LMA:

Lower-leg muscle area

LMFA:

Lower-leg intramuscular fat area

PAD:

Peripheral arterial disease

PMA:

Psoas muscle area

SFA:

Subcutaneous fat area

TMA:

Thigh muscle area

TMFA:

Thigh intramuscular fat area

VFA:

Visceral fat area

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Funding

This research did not receive any funding from agencies in the public, commercial, or not-for-profit sectors.

Author information

Author notes

  1. Dao-Chen Lin and Pei-Shan Tsai contributed equally to this work; Shih-Chieh Huang and Tung-Hsin Wu contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, MacKay Memorial Hospital, 104217, Taipei, Taiwan

    Pei-Shan Tsai, Ya-Ting Jan & Shih-Chieh Huang

  2. Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, 112304, Taipei, Taiwan

    Pei-Shan Tsai, Ya-Ting Jan & Tung-Hsin Wu

  3. Department of Medicine, Mackay Medical College, 252005, New Taipei City, Taiwan

    Pei-Shan Tsai & Ya-Ting Jan

  4. Mackay Junior College of Medicine, Nursing and Management, 252005, New Taipei City, Taiwan

    Pei-Shan Tsai, Ya-Ting Jan & Yu-Peng Liu

  5. Department of Radiology, Taipei Veterans General Hospital, 112201, Taipei, Taiwan

    Dao-Chen Lin

  6. Division of Endocrine and Metabolism, Department of Medicine, Taipei Veterans General Hospital, 112201, Taipei, Taiwan

    Dao-Chen Lin

  7. School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, 112304

    Dao-Chen Lin

  8. Department of Radiology, Hsinchu Mackay Memorial Hospital, 300044, Hsinchu City, Taiwan

    Yu-Peng Liu

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  1. Pei-Shan Tsai
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Corresponding authors

Correspondence to Tung-Hsin Wu or Shih-Chieh Huang.

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Guarantor

The scientific guarantor of this publication is Shih-Chieh Huang.

Conflict of interest

All authors declare that they have no conflict of interests.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was provided by all patients according to the tenets of the Helsinki Declaration.

Ethical approval

The study was approved by the Institutional Research Ethics Board (IRB) of MacKay Memorial Hospital (IRB number: 22MMHIS059e).

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• Retrospective

• case-control study

• performed at one institution

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Tsai, PS., Lin, DC., Jan, YT. et al. Lower-extremity muscle wasting in patients with peripheral arterial disease: quantitative measurement and evaluation with CT. Eur Radiol 33, 4063–4072 (2023). https://doi.org/10.1007/s00330-022-09356-4

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  • DOI: https://doi.org/10.1007/s00330-022-09356-4

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