Original Article

Exploring the Correlation between Pulmonary Hypertension and Pectoralis Muscle Area and Density

Abstract

Background: Sarcopenia is a predictor of mortality in multiple conditions, but the potential prognostic value of sarcopenia indices in pulmonary hypertension (PH) has not been clarified. This study aimed to determine whether there is an association between computed tomography (CT) scan-measured pectoralis muscle area (PMA) and density (PMD) and adverse clinical outcomes in PH patients.
Methods: In this cross-sectional study, the medical records of PH patients (clinical classes I and IV) referred to Rajaie Cardiovascular Institute from March 2016 through March 2021 were retrospectively reviewed. CT scan-measured PMA and PMD were compared between survivors and non-survivors, along with blood biomarkers and right heart catheterization variables. Binary logistic regression analysis was performed to identify potential predictors of mortality.
Results: A total of 45 patients with PH (34 survivors and 11 non-survivors) were included in the analysis. PMA was not significantly different between the two groups (P=0.12), whereas PMD differed weakly between survivors and non-survivors (survivors: 45 HU [25.8–51.3] vs. non-survivors: 31 HU [23–36]; P=0.062). In logistic regression analysis, none of the sarcopenia indices predicted mortality (P >0.05). Nonetheless, phosphodiesterase-5 (PDE-5) inhibitor use, right atrial pressure, and systemic arterial oxygen saturation were identified as potential predictors (P<0.05).
Conclusions: Although CT scan-measured PMA and PMD showed only a weak correlation with the prognosis of PH, these factors may serve as potential markers of mortality in patients with idiopathic and chronic thromboembolic PH. Further confirmation is needed through future studies with larger sample sizes.

1. Hoeper MM, Humbert M, Souza R, Idrees M, Kawut SM, Sliwa-Hahnle K, et al. A global view of pulmonary hypertension. Lancet Respir Med. 2016;4(4):306-22.
2. Poch D, Mandel J. Pulmonary Hypertension. Ann Intern Med. 2021;174(4):ITC49-ITC64.
3. Farber HW, Miller DP, McGoon MD, Frost AE, Benton WW, Benza RL. Predicting outcomes in pulmonary arterial hypertension based on the 6-minute walk distance. J Heart Lung Transplant. 2015;34(3):362-8.
4. Benza RL, Miller DP, Gomberg-Maitland M, Frantz RP, Foreman AJ, Coffey CS, et al. Predicting survival in pulmonary arterial hypertension: insights from the Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL). Circulation. 2010;122(2):164-72.
5. Stępnowska E, Lewicka E, Dąbrowska-Kugacka A, Miękus P, Raczak G. Prognostic factors in pulmonary arterial hypertension: Literature review. Adv Clin Exp Med. 2017;26(3):549-53.
6. Bustamante-Labarta M, Perrone S, De La Fuente RL, Stutzbach P, De La Hoz RP, Torino A, et al. Right atrial size and tricuspid regurgitation severity predict mortality or transplantation in primary pulmonary hypertension. J Am Soc Echocardiogr. 2002;15(10 Pt 2):1160-4.
7. Zhong XJ, Jiang R, Yang L, Yuan P, Gong SG, Zhao QH, et al. Peak oxygen uptake is a strong prognostic predictor for pulmonary hypertension due to left heart disease. BMC Cardiovasc Disord. 2022;22(1):137.
8. Mirtajaddini M, Naderi N, Chenaghlou M, Taghavi S, Amin A. The prediction of right atrial pressure using electrocardiogram: a novel approach. ESC Heart Fail. 2021;8(6):5040-4.
9. Mirtajaddini M, Naderi N, Mohammadi K, Taghavi S, Maharloo M, Mazloomzadeh S, et al. Predicting cardiac index using the electrocardiogram in pulmonary hypertension patients. Res Cardiovasc Med. 2022;11(3):76-80.
10. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16-31.
11. Bak SH, Kwon SO, Han SS, Kim WJ. Computed tomography-derived area and density of pectoralis muscle associated disease severity and longitudinal changes in chronic obstructive pulmonary disease: a case control study. Respir Res. 2019;20(1):226.
12. Hocaoglu E, Ors S, Yildiz O, Inci E. Correlation of pectoralis muscle volume and density with severity of COVID-19 pneumonia in adults. Acad Radiol. 2021;28(2):166-72.
13. Sjøblom B, Grønberg BH, Wentzel-Larsen T, Baracos VE, Hjermstad MJ, Aass N, et al. Skeletal muscle radiodensity is prognostic for survival in patients with advanced non-small cell lung cancer. Clin Nutr. 2016;35(6):1386-93.
14. Hayashi N, Ando Y, Gyawali B, Shimokata T, Maeda O, Fukaya M, et al. Low skeletal muscle density is associated with poor survival in patients who receive chemotherapy for metastatic gastric cancer. Oncol Rep. 2016;35(3):1727-31.
15. Galiè N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS). Eur Heart J. 2016;37(1):67-119.
16. Augustine DX, Coates-Bradshaw LD, Willis J, Harkness A, Ring L, Grapsa J, et al. Echocardiographic assessment of pulmonary hypertension: a guideline protocol from the British Society of Echocardiography. Echo Res Pract. 2018;5(3):G11-G24.
17. Xu J, Wan CS, Ktoris K, Reijnierse EM, Maier AB. Sarcopenia Is Associated with Mortality in Adults: A Systematic Review and Meta-Analysis. Gerontology. 2022;68(4):361-76.
18. Zhang Y, Zhang J, Ni W, Yuan X, Zhang H, Li P, et al. Sarcopenia in heart failure: a systematic review and meta-analysis. ESC Heart Fail. 2021;8(2):1007-17.
19. Sepúlveda-Loyola W, Osadnik C, Phu S, Morita AA, Duque G, Probst VS. Diagnosis, prevalence, and clinical impact of sarcopenia in COPD: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle. 2020;11(5):1164-76.
20. Wang Y, Tan S, Yan Q, Gao Y. Sarcopenia and COVID-19 Outcomes. Clin Interv Aging. 2023;18:359-73.
21. Ubachs J, Ziemons J, Minis-Rutten IJG, Kruitwagen R, Kleijnen J, Lambrechts S, et al. Sarcopenia and ovarian cancer survival: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle. 2019;10(6):1165-74.
22. Shu X, Lin T, Wang H, Zhao Y, Jiang T, Peng X, et al. Diagnosis, prevalence, and mortality of sarcopenia in dialysis patients: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle. 2022;13(1):145-58.
23. McDonald ML, Diaz AA, Ross JC, San Jose Estepar R, Zhou L, Regan EA, et al. Quantitative computed tomography measures of pectoralis muscle area and disease severity in chronic obstructive pulmonary disease. A cross-sectional study. Ann Am Thorac Soc. 2014;11(3):326-34.
24. Riou M, Pizzimenti M, Enache I, Charloux A, Canuet M, Andres E, et al. Skeletal and respiratory muscle dysfunctions in pulmonary arterial hypertension. J Clin Med. 2020;9(2):410.
25. Breda AP, Pereira de Albuquerque AL, Jardim C, Morinaga LK, Suesada MM, Fernandes CJ, et al. Skeletal muscle abnormalities in pulmonary arterial hypertension. PLoS One. 2014;9(12):e114101.
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IssueVol 20 No 2 (2025) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/jthc.v20i2.19708
Keywords
Pulmonary Hypertension Pectoralis Muscle Area Pectoralis Muscle Density Sarcopenia Right heart Catheterization
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How to Cite
1.
Mirtajaddini M, Naderi N, Jalali SS, Hosseinpour A, Pouraliakbar H, Taghavi S, Omidvar R, Bakhshandeh H, Attar A, Sadeghi T, Ghorbani F. Exploring the Correlation between Pulmonary Hypertension and Pectoralis Muscle Area and Density. Res Heart Yield Transl Med. 2024;20(2):126-136.