CLINICAL IMPLICATIONS OF BODY COMPOSITION AND EXERCISE CAPACITY FOLLOWING PULMONARY ENDARTERECTOMY.

Abstract

BACKGROUND\nPulmonary endarterectomy (PEA) is a curative procedure for patients with chronic thromboembolic pulmonary hypertension. Body composition and exercise capacity have been associated with adverse outcomes in patients undergoing cardiothoracic surgeries, but their significance with PEA is unclear. We evaluated the association of body composition and 6-minute walk distance (6MWD) with disease severity, hospital length of stay, discharge disposition and post-operative functional recovery.\n\n\nMETHODS\nRetrospective, single-center cohort study of patients who underwent PEA (Jan/2014-Dec/2017). Body composition (skeletal muscle mass and adiposity cross sectional area, body mass index) was quantified using thoracic computed tomography with Slice-O-Matic software. Association of body composition measures and 6MWD with clinical outcomes was evaluated using multivariable regression models.\n\n\nRESULTS\n127 patients (58±14 years; 42% males, Body Mass Index: 31±7 kg/m2, 6MWD: 361±165 m) were included. Muscle and 6MWD were associated with disease severity measures. Of those surviving hospitalization (n=125), a greater 6MWD was associated with a shorter hospital stay (1.9 median days per 100m, p<0.001) and higher likelihood of being discharged directly home from hospital (OR: 2.1 per 100m, p= 0.004), independent of age, sex and body mass index. Those with a lower pre-operative 6MWD (per 100m) had a greater increase in their post-operative 6MWD (52m, p< 0.0001), independent of age, sex, and body mass index. Body composition measures were not associated with hospital outcomes or exercise capacity in the first-year post-operatively.\n\n\nCONCLUSIONS\nExercise capacity was a more prognositc marker of PEA outcomes compared to body composition. Future research is needed to explore pre-PEA rehabilitation strategies.