Thoracic Skeletal Muscle and Exercise Capacity in Adults With Congenital Heart Disease: A Cross-Sectional Imaging Analysis

Jacob D Steffen; Seth Garton; Ravi Ashwath; Jennifer R Maldonado; Krista Young; Colleen Lancial; Osamah Aldoss; Prashob Porayette

doi:10.1002/jcsm.70157

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Thoracic Skeletal Muscle and Exercise Capacity in Adults With Congenital Heart Disease: A Cross-Sectional Imaging Analysis

Journal article

Open access

Peer reviewed

Thoracic Skeletal Muscle and Exercise Capacity in Adults With Congenital Heart Disease: A Cross-Sectional Imaging Analysis

Jacob D Steffen, Seth Garton, Ravi Ashwath, Jennifer R Maldonado, Krista Young, Colleen Lancial, Osamah Aldoss and Prashob Porayette

Journal of cachexia, sarcopenia and muscle, Vol.16(6), e70157

12/2025

DOI: 10.1002/jcsm.70157

PMCID: PMC12683296

PMID: 41355722

Appears in UI Libraries Support Open Access

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Abstract

Background The growing population of adults with congenital heart disease (ACHD) faces lifelong morbidities despite advancements in medical and surgical care. Sarcopenia, characterized by loss of muscle mass and strength, is linked to increased disability, poor quality of life and mortality. This study examines sex-specific thoracic skeletal muscle characteristics in ACHD patients using advanced imaging techniques, comparing them with healthy reference values and investigating their association with exercise capacity. Material and Methods In this single-centre retrospective study, ACHD patients (age 18–50 years) who underwent both cardiopulmonary exercise tests and thoracic CT/MRI within a year were included. Skeletal muscle area (SMA) was manually measured and compared with healthy reference data. Results Among 60 ACHD patients (mean age 28.3 ± 8.3 years; 48% females), males exhibited significantly lower SMA (T10: 116.8 ± 24.6 cm2, p < 0.0001; T11: 114.4 ± 24.7 cm2, p = 0.0002) and skeletal muscle index (SMI) (T10: 37.2 ± 8 cm2/m2, p = 0.005; T11: 36.4 ± 8.1 cm2/m2, p = 0.0014) at T10 and T11 vertebral level, whereas females showed a reduction in SMA at T10 (79.7 ± 14.9 cm2, p = 0.0242) and T12 (74.2 ± 10.7 cm2, p = 0.0015) compared with healthy individuals. Females had significantly lower skeletal muscle radiation attenuation (SMRA) at T10 (16.3 ± 14.6 HU, p < 0.001), T11 (17.1 ± 10.3 HU, p < 0.001) and T12 (25 ± 10.7 HU, p < 0.001) levels, suggesting increased muscle fat content. Peak O2 pulse correlated with SMA at T10 (r = 0.57, R2 = 0.32, p ≤ 0.0001), T11 (r = 0.61, R2 = 0.38, p < 0.0001) and T12 (r = 0.73, R2 = 0.53, p = 0.001) levels. Similar correlations were observed between peak O2 pulse and SMI, whereas peak VO2 correlated with SMA at T10 (r = 0.27, R2 = 0.07, p = 0.0394) and T11 (r = 0.34, R2 = 0.11, p = 0.02) and SMRA across all levels (T10: r = 0.64, R2 = 0.41, p = 0.0076; T11: r = 0.85, R2 = 0.72, p = 0.0003; T12: r = 0.62, R2 = 0.38, p = 0.0327). SMA at T11 had a negative correlation with VE/VCO2 (r = −0.36, R2 = 0.13, p = 0.01). There was no correlation between the number of sternotomies and exercise parameters. Subjects with a pacemaker demonstrated significantly lower peak VO2 (p = 0.04) and VO2 at the anabolic threshold (p = 0.03) compared with ACHD patients without a pacemaker. Conclusions Abnormal skeletal muscle parameters observed on thoracic cross-sectional imaging are associated with diminished exercise capacity in ACHD patients. Assessment of thoracic skeletal muscle characteristics may enable early detection of muscle loss, providing valuable insights into the complex factors contributing to exercise limitations in this population.

Adolescent

Adult

Cross-Sectional Studies

Exercise Test

Exercise Tolerance

Female

Heart Defects, Congenital - complications

Heart Defects, Congenital - diagnostic imaging

Heart Defects, Congenital - physiopathology

Humans

Male

Middle Aged

Muscle, Skeletal - diagnostic imaging

Muscle, Skeletal - physiopathology

Retrospective Studies

Young Adult

UIOWA OA Agreement

Details

Title: Subtitle: Thoracic Skeletal Muscle and Exercise Capacity in Adults With Congenital Heart Disease: A Cross-Sectional Imaging Analysis
Creators: Jacob D Steffen - Division of Pediatric Cardiology, Department of Pediatrics, Stead Family Children's Hospital, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
Seth Garton - Division of Pediatric Cardiology, Department of Pediatrics, Stead Family Children's Hospital, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
Ravi Ashwath - University of Iowa
Jennifer R Maldonado - Children's Hospital of Wisconsin
Krista Young - University of Iowa
Colleen Lancial - University of Iowa Stead Family Children’s Hospital
Osamah Aldoss - University of Iowa
Prashob Porayette - University of Iowa Stead Family Children’s Hospital
Resource Type: Journal article
Publication Details: Journal of cachexia, sarcopenia and muscle, Vol.16(6), e70157
DOI: 10.1002/jcsm.70157
PMID: 41355722
PMCID: PMC12683296
NLM abbreviation: J Cachexia Sarcopenia Muscle
ISSN: 2190-5991
eISSN: 2190-6009
Publisher: Wiley
Language: English
Date published: 12/2025
Academic Unit: Cardiology; Stead Family Department of Pediatrics; Internal Medicine
Record Identifier: 9985090588702771

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