Early screening of swallowing dysfunction using computed tomography in older patients with acute heart failure

Background The prevalence of dysphagia is 36% in hospitalized patients with acute heart failure (AHF). However, accurate evaluation may be challenging due to the patient’s general condition and/or heart failure symptoms during the acute phase. Therefore, a screening method that enables objective assessment unaffected by symptoms is necessary. This study focused on imaging evaluation using computed tomography. Purpose This study aimed to verify the usefulness of cross-sectional area of the geniohyoid muscle measured by computed tomography (CT-CSA) as an early and objective screening method for swallowing dysfunction in older hospitalized patients with AHF. Methods This is a single-center, prospective, observational study. Patients aged 65 years or older, who were admitted for AHF, were included in this study. The CT-CSA of the geniohyoid muscle was measured in the coronal plane after identifying the midpoint between the mandible and the hyoid bone in the midsagittal plane. In addition, functional oral intake scale (FOIS) and maximum tongue pressure (MTP) as indices of swallowing function were assessed, respectively. Swallowing dysfunction was defined as FOIS <6 or MTP <20 kPa at discharge. To verify the relationship between the new screening item CT-CSA and swallowing dysfunction, multiple logistic regression analysis was performed using age, sex, and height as covariates. In addition, receiver operating characteristic (ROC) curve analysis was performed to determine the cut-off values of CT-CSA for FOIS <6 or MTP <20 kPa. Results A total of 46 people were included in the analysis (mean age: 87 ± 6 years, male: 37%, left ventricular ejection fraction: 50 ± 13%). At discharge, the number of patients with swallowing dysfunction was 5 defined by FOIS <6, and 12 patients defined by MTP <20 kPa. Results of multivariate analysis showed that the CT-CSA at admission was an independent predictor of swallowing dysfunction (FOIS, odds ratio: 0.962, 95%CI: 0.928–0.997, P = 0.036; MTP, odds ratio: 0.961, 95%CI: 0.935–0.987, P = 0.038). The cut-off values of CT-CSA calculated by ROC curve analysis were 158.60 mm² for FOIS <6 (area under the curve: 0.855, sensitivity: 1.000, specificity: 0.675, P = 0.022) and 154.50 mm² for MTP <20 kPa (area under the curve: 0.852, sensitivity: 0.750, specificity: 0.574, P = 0.002). Conclusion CT-CSA at admission is a reliable predictor of swallowing dysfunction in older patients with AHF. This imaging-based approach provides an objective assessment, unaffected by symptoms such as dyspnea and altered states of consciousness, enabling early detection or intervention for swallowing dysfunction.