Sarcopenia Predicts Cardiac Diastolic Dysfunction in Newly Diagnosed Oesophageal Cancer: Retrospective Cohort Study

Introduction: Sarcopenia is a high-impact condition in oesophageal cancer which can cause morbidity and mortality. It is well studied in striated muscle but impact on cardiac muscle is unknown. Cardiac dysfunction can majorly impact cancer symptoms, treatment tolerance, and survival.
Aim: The primary aim of this study was to explore the relationship between sarcopenia and cardiac structure and function in a consecutive prospective cohort of treatment-naïve patients with oesophageal adenocarcinoma treated with curative intent at the National Centre in Ireland.
Methods and Results: Treatment-naïve patients with oesophageal adenocarcinoma were recruited in an upper gastrointestinal surgery referral centre. Sarcopenia was measured on positive emission tomography. Cardiac muscle mass and function were assessed on echocardiography.
Fifty-four participants were included. Ten were sarcopenic at baseline. Median skeletal muscle index (SMI) was 59 cm2/m2. Systolic function was normal; diastolic function was present (reduced E/A ratio; prolonged isovolumic relaxation time (IVRT)). Myocardial longitudinal strain was reduced. Myocardial performance index, IVRT, pulmonary artery pressure, left
ventricular (LV) relaxation velocity, LV mass index and septal thickness differed in those with and without sarcopenia. Moderate correlation was seen between body composition measures and both IVRT and LV filling pressure. Lower SMI independently predicted prolonged IVRT. Baseline sarcopenia independently predicted increased left ventricular mass index on multivariable analysis. Sarcopenia and visceral obesity were independently associated with increased pulmonary artery pressure.
Conclusion: Cardiac function was assessed in treatment-naïve oesophageal adenocarcinoma with and without sarcopenia. Diastolic dysfunction was present on pre-treatment echocardiograms, predicted by sarcopenia. It is insufficient to assess systolic cardiac function alone in cancer. Assessment of sarcopenia and diastolic cardiac function could identify subclinical cardiac dysfunction and target reversible complications in potentially curable oesophageal cancer.