Validation of SARC-F-Proxy for the Screening of Sarcopenia in Older Patients with Cognitive Impairment.

Objectives: The SARC-F is a validated questionnaire for the screening of sarcopenia in an older population. However, the clinical relevance of this self-reported questionnaire in patients with cognitive problems is questionable. This study aims to validate the SARC-F-Proxy as an alternative screening tool for sarcopenia in patients with cognitive impairment. Methods: This cross-sectional study included hospitalised community-dwelling older adults aged 60 years or older with confirmed cognitive impairment. Three SARC-F questionnaires were completed: one by patients, one by informal caregivers and one by formal caregivers. Muscle strength, mass and physical performance were measured by handgrip strength, anthropometric measurements, and gait speed respectively. The recently updated EWGSOP2 diagnostic criteria were used as the "gold standard" for diagnosis of sarcopenia. Results: The prevalence of sarcopenia using SARC-F-Proxy was 75.4% for SARC-F-Proxy-Formal caregiver and 66% for SARC-F-Proxy-Informal caregiver. SARC-F-Proxy had high sensitivity (85.9% for SARC-F-Proxy-Formal caregiver and 77% for SARC-F-proxy-informal caregiver) and low specificity (46.5% for SARC-F-Proxy-Formal caregiver and 54.7% for SARC-F-Proxy-Informal caregiver). Conclusions: the proxy-reported SARC-F questionnaire can be applied as a surrogate for the SARC-F in the screening of sarcopenia in hospitalised community-dwelling older people with known or suspected cognitive impairment. Second, the results in this study suggest a higher reliability when the proxy-reported questionnaire is performed by the formal caregiver.

The relation between mortality, intramuscular adipose tissue and sarcopenia in hospitalized geriatric patients.

INTRODUCTION: One of the biggest healthcare challenges that arises with increasing age expectations is sarcopenia. However, as a multi-dimensional construct with both neurological and musculoskeletal factors involved, the exact contribution of these different components of sarcopenia to mortality outcomes is not clear. Therefore, in mortality assessment, it is advisable to use subitems of sarcopenia such as the intramuscular adipose tissue (IMAT), instead of using sarcopenia as a construct itself. IMAT is negatively correlated with strength and performance, and positively correlated with mortality, both all-cause and cardiovascular. In this study, IMAT and its relation to long-term mortality, muscle strength and function is studied. MATERIALS AND METHODS: Patients admitted to the University Geriatrics Department during 6 months were screened for muscle mass, strength and function through computed tomography (upper leg), Jamar dynamometer and short physical performance battery, respectively. After 4 years, health status (mortality) was obtained by telephone. RESULTS: Three hundred and two patients were included (69.6% female). Mean IMAT was 29.3 ± 12.3%. There was a positive correlation between IMAT and mortality in the male 70-79-year-old age group (n = 20), but not in the whole cohort. IMAT was negatively correlated with muscle strength and function. CONCLUSION: IMAT is negatively correlated with muscle strength and muscle function. IMAT is correlated with mortality in a specific subgroup of this cohort. This data adds to the discussion of the value of IMAT in the construct of sarcopenia. More studies need to be done regarding the evolution of IMAT in function of time and functional decline.

Prognostic value of the high-sensitivity troponin T assay after percutaneous intervention of chronic total occlusions.

AIMS: The prognostic value of postprocedural high-sensitivity troponin T (hs-TnT) after percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) is currently unclear. We aimed to assess the prognostic value of elevated hs-TnT after elective CTO-PCI. METHODS: The current study included 409 patients undergoing elective CTO-PCI between September 2011 and August 2016 at two centres who had postprocedural hs-TnT measurements available. Clinical, angiographic and procedural characteristics were correlated with any or at least five times the 99th percentile hs-TnT elevation, as well as a 1-year combined endpoint of major adverse cardiac and cerebrovascular events (MACCE) and mortality. RESULTS: Post-CTO-PCI hs-TnT elevation was observed in 85% (n = 349/409) and at least five times hs-TnT elevation occurred in 42% (n = 172/409) of cases. hs-TnT elevation was more frequent in more complex patients (postcoronary artery bypass grafting, peripheral vascular disease, chronic kidney disease, heart failure and multivessel disease) as well as in the more complex CTO procedures (higher Japanese CTO complexity, use of retrograde and antegrade dissection re-entry techniques). After 1 year of follow-up (FU), MACCE was not associated with postprocedural hs-TnT elevation, both any elevation (10.9 vs. 11.7%; P = 0.846) and at least five times hs-TnT elevation (15.7 vs. 11.7%; P = 0.451; hazard ratio = 1.375, confidence interval: 0.599-3.157, P = 0.453), compared with no elevation. A nonsignificant trend towards higher mortality in the at least five times hs-TnT vs. no elevation group (4.7 vs. 0%; P = 0.091) was observed. CONCLUSION: In patients undergoing CTO-PCI, postprocedural hs-TnT elevation is frequent, but is not correlated with higher MACCE and mortality rates after 1-year FU in our small study population, suggestive of the limited long-term impact of troponin elevation.

Outcomes of the amphilimus-eluting polymer-free stent for chronic total occlusion treatment: a multicentre experience.

AIMS: Late stent thrombosis and delayed vessel wall healing remain an important issue in coronary vessels treated with drug-eluting stents (DES), especially when long-vessel segments need to be covered, like in chronic total occlusions (CTO). Avoiding polymer use to avoid chronic inflammatory responses is a potential solution to reduce target vessel failure (TVF). We aimed to validate the clinical safety and efficacy at 1 year of the polymer-free Cre8 DES vs. nonpolymer-free DES for the percutaneous treatment of CTO. METHODS: Between September 2011 and August 2016, patients were prospectively enrolled in three CTO centres. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), including cardiac death, any myocardial infarction, stent thrombosis, TVF and target vessel revascularization. RESULTS: A total of 102 Cre8 and 133 non-Cre8 patients were enrolled. At 1 year, a low cumulative MACCE was observed in the Cre8 group (6.9%, respectively). Moreover, a numerical trend towards better MACCE was observed in the Cre8 group vs. the non-Cre8 group (6.9 vs. 14.3%; P = 0.065). The clinically driven TVF rate was not statistically different between Cre8 and non-Cre8 patients (6.9 vs. 9.8%; P = 0.373). A borderline significant difference regarding mortality was observed in favour of Cre8 patients (0 vs. 3.8%; P = 0.049). CONCLUSION: Low rates of MACCE and TVF up to 1 year were observed in the Cre8 group, supportive of the use of polymer-free DES for lesions with high complexity.

The mortality determinants of sarcopenia and comorbidities in hospitalized geriatric patients.

OBJECTIVES: Determine the influence of muscle mass, muscle strength, physical performance, nutritional status and certain comorbidities on the four years mortality risk of hospitalized geriatric patients. DESIGN: Retrospective cohort study. SETTING: During hospitalization of the included geriatric patients, the determinants of sarcopenia and nutritional status were obtained. PARTICIPANTS: A total of 302 patients hospitalized at the geriatric department of the Saint-Elisabeth hospital in Antwerp (Belgium) from 01/08/2012 until 31/01/2013. MEASUREMENTS: Muscle mass was measured using a CT scan. The muscle strength was obtained by measuring the handgrip strength using a Jamar dynamometer. The physical performance was measured by performing the SPPB. The nutritional status was surveyed by using the MNA-SF. Comorbidities were obtained through medical records. RESULTS: The variables gender (HR= 0.609; 95% CI 0.442-0.838), nutritional status (HR= 2.953; 95% CI 1.924-4.531), muscle mass (HR= 0.443; 95% CI 0.251-0.780), muscle strength (HR= 0.215; CI 95% 0.079-0.587), physical performance (HR= 0.407; 95% CI 0.237-0.702) and heart failure (HR= 1.440; 95% CI 1.022-2.029) have been shown to be significant. CONCLUSION: The determinants gender, nutritional status and physical performance have the greatest prognostic value.