Prognostic value of body composition parameters by computed tomography in patients with lower extremity arterial disease: a single-center retrospective-prospective analysis

Background: In this study, we examine the associations between cross-sectional areas (CSAs) of skeletal muscle (SM), subcutaneous, visceral, and total adipose tissue (SAT, VAT, and TAT) measured by computed tomography (CT), and clinical outcomes in patients with lower extremity arterial disease (LEAD). Methods: Images obtained by lower extremity CT arteriography in 177 consecutive LEAD patients were retrospectively reviewed. The CSAs of SM, SAT, VAT, and TAT were determined at various body levels using OsiriX software. The outcomes measured were: target lesion revascularization (TLR), leg amputation, and composite endpoints. Results: A high prevalence of sarcopenia (45.2%), low SAT (48.0%), high VAT (44.6%), and high TAT (55.4%) was found among the patients studied. Patients who underwent leg revascularization had a lower SAT CSA at the third and fourth lumbar vertebrae (L3, L4), thigh, and calf compared to those who did not undergo vascular intervention. Compared to patients without a major adverse cardiovascular and limb event (MACLE), those with a MACLE had lower SM, SAT, VAT, and TAT values. Low SM and SAT CSAs were also associated with risk of TLR, MACLE, symptom severity, and impairment in functional status. These relationships remained statistically significant after adjustment for the presence of diabetes mellitus, hypertension, and chronic kidney disease, but disappeared after adjusting for smoking. Conclusions: Low SM and SAT CSAs were related to symptom severity, impairment in functional status, and prognosis. Analysis of body component CSAs by CT seems to be a valuable method of stratifying LEAD patients.