Temporalis muscle (TM) atrophy has emerged as a potential biomarker for muscle wasting. However, its diagnostic utility as a monitoring tool in intensive care remains uncertain. Hence, the objective of this study was to evaluate the diagnostic value of sequential ultrasound- and computed tomography (CT)-based measurements of TM thickness (TMT). With a prospective observational design, we included 40 patients without preexisting sarcopenia admitted to a neurointensive care unit. TMT measurements, performed upon admission and serially every 3–4 days, were correlated with rectus femoris muscle thickness (RFT) ultrasound measurements. Interrater reliability was assessed by Bland Altmann plots and intraclass correlation coefficient (ICC). Analysis of variance was performed in subgroups to evaluate differences in the standard error of measurement (SEM). RFT decline was paralleled by ultrasound- as well as CT-based TMT measurements (TMT to RFT: r = 0.746, p < 0.001; CT-based TMT to ultrasound-based RFT: r = 0.609, p < 0.001). ICC was 0.80 [95% CI 0.74, 0.84] for ultrasound-based assessment and 0.90 [95% CI 0.88, 0.92] for CT-based TMT measurements. Analysis of variance for BMI, Heckmatt score, fluid balance, and agitation showed no evidence of measurement errors in these subgroups. This study demonstrates the clinical feasibility and utility of ultrasound- and CT-based TMT measurements for the assessment of muscle wasting.

Donation after circulatory death (DCD) heart transplantation expands the donor pool. Primary graft dysfunction (PGD) is more frequent after DCD than after donation after brain death (DBD), yet early survival is often similar, suggesting donor-type heterogeneity in PGD prognosis. UNOS STAR files were used to study adults undergoing isolated heart transplantation (September 14, 2023-October 1, 2025) with BI/LV PGD recorded at both 24 and 72 hours. PGD course was none, transient (24h only), or persistent (24/72h). Survival was left-truncated at postoperative day 3. Cox models estimated mortality hazard with center-clustered robust standard errors. Within persistent PGD, DCD vs DBD was evaluated with multivariable adjustment and 1:1 propensity-score matching, with pair-stratified Cox models used in the matched cohort. Among 6,629 recipients, 5,713 (86.2%) had no BI/LV PGD, 333 (5.0%) transient, and 583 (8.8%) persistent; DCD donors were overrepresented in transient and persistent courses. Persistent PGD tracked with higher stroke, dialysis, and mechanical circulatory support use, and survival separated stepwise by course. After adjustment including 72-hour severity, persistent PGD was associated with higher mortality hazard versus no PGD (aHR 2.25, 95% CI 1.63-3.10), whereas transient PGD was not. Within persistent PGD, DCD was associated with lower mortality hazard than DBD (aHR 0.59, 95% CI 0.38-0.92), with similar findings after matching. BI/LV PGD course over 72 hours stratified early risk after transplantation. Among recipients with persistent BI/LV PGD, early survival was more favorable after DCD than DBD, supporting donor-type-specific PGD presentations, while persistent PGD remained high risk regardless of donor type.