Seth Garton
Exercise Physiologist
University of Iowa, United States
Disclosure information not submitted.
Ravi Ashwath, MD
Clinical Professor, Pediatric Cardiology
Stead Family Children's Hospital, University of Iowa, United States
Disclosure information not submitted.
Jennier Maldonado
Research Coordinator
University of Iowa, United States
Disclosure information not submitted.
Krista Young
Pediatric Cardiologist
University of Iowa, United States
Disclosure information not submitted.
Colleen Lancial
Clinical Nurse ACHD
University of Iowa, United States
Disclosure information not submitted.
Osamah Aldoss
Pediatric Cardiologist
University of Iowa, United States
Disclosure information not submitted.
Prashob Porayette
Pediatric and ACHD Cardiologist
University of Iowa, United States
Disclosure information not submitted.
Title: Skeletal Muscle Parameters Influence ICU Admission and Stay in Adults With Congenital Heart Disease
Introduction: Muscle wasting is a common problem encountered in the Intensive Care Unit (ICU). Adults with congenital heart disease (ACHD) have increased risk of ICU stay over their lifetime. We investigated the correlation between thoracic skeletal muscle characteristics and length of ICU stay (LOS) in the ACHD population.
Methods: In this retrospective study, we reviewed ACHD patients between the ages of 18-50 years who underwent cardiac pulmonary exercise test (CPET) and chest MRI/CT within one year of each other between Jan 2010-Dec 2019. SMA was measured on CT/MRI images by drawing ROI at T10-T12 vertebral levels and compared with published healthy US population data. SMI: SMA indexed to patients’ height squared. CT SMRA: mean skeletal muscle radiation attenuation (inversely related to muscle fat content). These parameters were investigated for correlation with number of ICU admissions and LOS (days).
Results: 42 patients (55% males;mean age 28.2±8.1years) met inclusion criteria. The most common CHD diagnosis was tetralogy of Fallot (29%). Males had significantly lower SMA and SMI at T10 (p=0.002; p=0.007, respectively) and T11 level (p=0.007;p=0.02,respectively) compared to healthy population.
The total number of ICU admission negatively correlated with SMRA at T12 (r=-0.7, R2=0.49, p=0.02). Similarly, total LOS correlated with SMRA at T11 (r=-0.87,R2=0.76,p=0.02) and T12 (r=-0.85,R2=0.73,p=0.03) levels, suggesting increased muscle fat content influences LOS and number of ICU admissions.
Peak VO2 correlated with SMA at T11 (r=0.37, R2=0.14,p=0.04) and SMRA at T11 (r=0.87,R2=0.77,p< 0.001) and T12 (r=0.67,R2=0.45,p=0.04) levels. Peak O2 pulse significantly correlated with SMA at T10 (r=0.68,R2=0.46,p=< 0.0001), T11 (r=0.73,R2=0.54,p< 0.0001), and T12 (r=0.86,R2=0.74,p=0.001) levels. Similar correlation existed between peak O2 pulse and SMI.
Conclusions: ACHD patients with abnormal thoracic skeletal muscles parameters had increased ICU admission and LOS. This correlated with their exercise capacity after recovery. Careful consideration should take place when an ACHD patient is admitted to the ICU by providing adequate nutrition rehabilitation to maintain skeletal muscle mass.