{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T02:48:20Z","timestamp":1791427700040,"version":"4.3.3"},"reference-count":45,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"20","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2018,10,16]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Poor lower extremity physical performance is an independent predictor of unfavorable outcome in patients with peripheral artery disease (\n              <jats:styled-content style=\"fixed-case\">PAD<\/jats:styled-content>\n              ); however, few studies have assessed muscle characteristics on imaging directly.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Method and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              A novel 3\u2010dimensional semi\u2010automated protocol was developed to estimate leg muscle volume and density (mean attenuation) from computed tomography images. Patients with\n              <jats:styled-content style=\"fixed-case\">PAD<\/jats:styled-content>\n              who underwent a lower extremity computed tomography scan at a tertiary vascular surgery center were included, and were followed up using hospital records and linked data as part of a retrospective cohort study. The primary outcomes were lower limb events (major amputation or peripheral revascularization) and cardiovascular events (myocardial infarction, stroke, or cardiovascular death). Two hundred and twenty\u2010three patients with\n              <jats:styled-content style=\"fixed-case\">PAD<\/jats:styled-content>\n              were included (median age 69.0\u00a0years; 73% men) and followed for a median of 4.9 [2.6\u20137.0] years. During this time there were 99 index lower limb events and 97 cardiovascular events. Low leg muscle density was associated with increased risk of lower limb (rate ratio 1.41 [1.11\u20131.80] per\n              <jats:styled-content style=\"fixed-case\">SD<\/jats:styled-content>\n              reduction) and cardiovascular events (rate ratio 1.60 [1.29\u20131.99] per\n              <jats:styled-content style=\"fixed-case\">SD<\/jats:styled-content>\n              reduction). Low muscle density remained an independent predictor of cardiovascular (but not lower limb) events, after adjusting for age, sex, traditional cardiovascular risk factors, and angiographic\n              <jats:styled-content style=\"fixed-case\">PAD<\/jats:styled-content>\n              severity (rate ratio 1.39 [1.09\u20131.77] per lower\n              <jats:styled-content style=\"fixed-case\">SD<\/jats:styled-content>\n              ). In contrast, leg muscle volume was not associated with outcomes after adjusting for risk factors and\n              <jats:styled-content style=\"fixed-case\">PAD<\/jats:styled-content>\n              severity.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Low leg muscle density, but not volume, is a strong, independent predictor of major cardiovascular events among people with\n              <jats:styled-content style=\"fixed-case\">PAD<\/jats:styled-content>\n              . Further research is needed to understand the mechanisms underlying these associations.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.118.009943","type":"journal-article","created":{"date-parts":[[2018,10,9]],"date-time":"2018-10-09T09:00:48Z","timestamp":1539075648000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":27,"title":["Association of Computed Tomographic Leg Muscle Characteristics With Lower Limb and Cardiovascular Events in Patients With Peripheral Artery Disease"],"prefix":"10.1161","volume":"7","author":[{"given":"Dylan R.","family":"Morris","sequence":"first","affiliation":[{"name":"Queensland Research Centre for Peripheral Vascular Disease College of Medicine and Dentistry James Cook University Townsville Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tristan A.","family":"Skalina","sequence":"additional","affiliation":[{"name":"Queensland Research 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