- •Computed tomography-defined sarcopenia predicts all-cause mortality among older adults undergoing TAVI.
- •PMA-sarcopenia is associated with short- and long-term cardiovascular mortality and long-term all-cause mortality.
- •PMA-sarcopenia provides prognostic information independent of current tools adopted to predict postTAVI mortality.
The adoption of Computed tomography (CT)-defined sarcopenia to risk stratify transcatheter aortic valve implantation (TAVI) candidates remains limited by a lack of both standardized definition and evidence of independent value over currently adopted mortality prediction tools.
391 consecutive TAVI patients with pre-procedural CT scan were included (81 ± 6 years, 57.5% male, STS-PROM score 4.4 ± 3.6%) and abdominal muscle retrospectively quantified. The two definitions of radiologic sarcopenia previously adopted in TAVI studies were compared (psoas muscle area [PMA] at the L4 vertebra level: “PMA-sarcopenia”; indexed skeletal muscle area at the L3 vertebra level: “SMI-sarcopenia”). The primary endpoint was longer available-term all-cause mortality. Secondary endpoints were Valve Academic Research Consortium-2-defined in-hospital and 30-day outcomes.
SMI- and PMA-sarcopenia were present in 192 (49.1%) and 117 (29.9%) patients, respectively.
After a median of 24 (12–30) months follow-up, 83 (21.2%) patients died. PMA-(adj-HR 1.81, 95%CI 1.12–2.93, p = 0.015), but not SMI-sarcopenia (adj-HR 1.23, 95%CI 0.76–2.00, p = 0.391), was associated with all-cause mortality independently of age, sex and in-study outcome predictors (atrial fibrillation, hemoglobin, history of peripheral artery disease, cancer and subcutaneous adipose tissue). PMA-defined sarcopenia provided additive prognostic value over current post-TAVI mortality risk estimators including STS-PROM (p = 0.001), Euroscore II (p = 0.025), Charlson index (p = 0.025) and TAVI2-score (p = 0.020). Device success, early safety, clinical efficacy and 30-day all-cause death were unaffected by sarcopenia status regardless of definition.
PMA-sarcopenia (but not SMI-sarcopenia) is predictive of 2 year mortality among TAVI patients. The prognostic information provided by PMA-sarcopenia is independent of the tools currently adopted to predict post-TAVI mortality in clinical practice.
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Published online: December 06, 2021
Accepted: December 4, 2021
Received in revised form: November 29, 2021
Received: July 13, 2021
© 2021 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.