Highlights
- •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.
Abstract
Background
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.
Methods
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.
Results
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.
Conclusions
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.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: December 06, 2021
Accepted:
December 4,
2021
Received in revised form:
November 29,
2021
Received:
July 13,
2021
Identification
Copyright
© 2021 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
