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Impact of computed-tomography defined sarcopenia on outcomes of older adults undergoing transcatheter aortic valve implantation

Published:December 06, 2021DOI:https://doi.org/10.1016/j.jcct.2021.12.001

      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

      Keywords

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      References

        • Smith C.R.
        • Leon M.B.
        • Mack M.J.
        • et al.
        Transcatheter versus surgical aortic-valve replacement in high-risk patients.
        N Engl J Med. 2011; 364: 2187-2198https://doi.org/10.1056/NEJMoa1103510
        • Reardon M.J.
        • Van Mieghem N.M.
        • Popma J.J.
        • et al.
        Surgical or transcatheter aortic-valve replacement in intermediate-risk patients.
        N Engl J Med. 2017; 376: 1321-1331https://doi.org/10.1056/NEJMoa1700456
        • Mack M.J.
        • Leon M.B.
        • Thourani V.H.
        • et al.
        Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients.
        N Engl J Med. 2019; 380: 1695-1705https://doi.org/10.1056/NEJMoa1814052
        • Baumgartner H.
        • Falk V.
        • Bax J.
        • et al.
        2017 ESC/EACTS guidelines for the management of valvular heart disease the task force for the management of valvular heart disease of the European Society of Cardiology ( ESC ) and the European.
        Eur Heart J. 2017; 38: 2739-2791https://doi.org/10.1093/eurheartj/ehx391
        • Kappetein A.P.
        • Head S.J.
        • Généreux P.
        • et al.
        Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document.
        Eur Heart J. 2012; 33: 2403-2418https://doi.org/10.1093/eurheartj/ehs255
        • Holmes D.R.
        • Brennan J.M.
        • Rumsfeld J.S.
        • et al.
        Clinical outcomes at 1 year following transcatheter aortic valve replacement.
        JAMA, J Am Med Assoc. 2015; 313: 1019-1028https://doi.org/10.1001/jama.2015.1474
        • Debonnaire P.
        • Fusini L.
        • Wolterbeek R.
        • et al.
        Value of the “tAVI2-SCORe” versus surgical risk scores for prediction of one year mortality in 511 patients who underwent transcatheter aortic valve implantation.
        Am J Cardiol. 2015; 115: 234-242https://doi.org/10.1016/j.amjcard.2014.10.029
        • Nashef S.A.M.
        • Roques F.
        • Michel P.
        • Gauducheau E.
        • Lemeshow S.
        • Salamon R.
        European system for cardiac operative risk evaluation (EuroSCORE).
        Eur J Cardio-thoracic Surg. 1999; 1: 9-13https://doi.org/10.1016/S1010-7940(99)00134-7
        • Lindman B.R.
        • Alexander K.P.
        • O'Gara P.T.
        • Afilalo J.
        Futility, benefit, and transcatheter aortic valve replacement.
        JACC Cardiovasc Interv. 2014; 7: 707-716https://doi.org/10.1016/j.jcin.2014.01.167
        • D'Onofrio A.
        • Salizzoni S.
        • Agrifoglio M.
        • et al.
        When does transapical aortic valve replacement become a futile procedure? An analysis from a national registry.
        J Thorac Cardiovasc Surg. 2014; 148: 973-979https://doi.org/10.1016/j.jtcvs.2014.06.015
        • Iliadis C.
        • Schwabe L.
        • Müller D.
        • Stock S.
        • Baldus S.
        • Pfister R.
        Impact of frailty on periprocedural health care utilization in patients undergoing transcatheter edge-to-edge mitral valve repair.
        Clin Res Cardiol. 2020; https://doi.org/10.1007/s00392-020-01789-5
        • Volaklis K.A.
        • Halle M.
        • Koenig W.
        • et al.
        Association between muscular strength and inflammatory markers among elderly persons with cardiac disease: results from the KORA-Age study.
        Clin Res Cardiol. 2015; https://doi.org/10.1007/s00392-015-0867-7
        • Cruz-Jentoft A.J.
        • Bahat G.
        • Bauer J.
        • et al.
        Sarcopenia: revised European consensus on definition and diagnosis.
        Age Ageing. 2019; 1: 16-31https://doi.org/10.1093/ageing/afy169
        • Jones K.
        • Gordon-Weeks A.
        • Coleman C.
        • Silva M.
        Radiologically determined sarcopenia predicts morbidity and mortality following abdominal Surgery: a systematic review and meta-analysis.
        World J Surg. 2017; 9: 2266-2279https://doi.org/10.1007/s00268-017-3999-2
        • Chang S.F.
        • Lin P.L.
        Systematic literature review and meta-analysis of the association of sarcopenia with mortality.
        Worldviews Evidence-Based Nurs. 2016; 2: 153-162https://doi.org/10.1111/wvn.12147
        • Ter Maaten J.M.
        • Damman K.
        • Hillege H.L.
        • et al.
        Creatinine excretion rate, a marker of muscle mass, is related to clinical outcome in patients with chronic systolic heart failure.
        Clin Res Cardiol. 2014; https://doi.org/10.1007/s00392-014-0738-7
        • Heidari B.
        • Al-Hijji M.A.
        • Moynagh M.R.
        • et al.
        Transcatheter aortic valve replacement outcomes in patients with sarcopaenia.
        EuroIntervention. 2019; 8: 671-677https://doi.org/10.4244/eij-d-19-00110
        • Damluji A.A.
        • Rodriguez G.
        • Noel T.
        • et al.
        Sarcopenia and health-related quality of life in older adults after transcatheter aortic valve replacement.
        Am Heart J. 2020; 224: 171-181https://doi.org/10.1016/j.ahj.2020.03.021
        • Mamane S.
        • Mullie L.
        • Lok Ok
        • Choo W.
        • et al.
        Sarcopenia in older adults undergoing transcatheter aortic valve replacement.
        J Am Coll Cardiol. 2019; 25: 3178-3180https://doi.org/10.1016/j.jacc.2019.10.030
        • Mok M.
        • Allende R.
        • Leipsic J.
        • et al.
        Prognostic value of fat mass and skeletal muscle mass determined by computed tomography in patients who underwent transcatheter aortic valve implantation.
        Am J Cardiol. 2016; 117: 828-833https://doi.org/10.1016/j.amjcard.2015.12.015
        • Mamane S.
        • Mullie L.
        • Piazza N.
        • et al.
        Psoas muscle area and all-cause mortality after transcatheter aortic valve replacement: the Montreal-Munich study.
        Can J Cardiol. 2016; https://doi.org/10.1016/j.cjca.2015.12.002
        • Lang R.M.
        • Badano L.P.
        • Mor-Avi V.
        • et al.
        Recommendations for cardiac chamber quantification by echocardiography in adults (2015).
        Eur Heart J Cardiovasc Imag. 2015; 16: 233-270https://doi.org/10.1093/ehjci/jev014
        • O'Brien S.M.
        • Shahian D.M.
        • Filardo G.
        • et al.
        The society of thoracic surgeons 2008 cardiac Surgery risk models: Part 2-isolated valve Surgery.
        Ann Thorac Surg. 2009; 88: S23-S42https://doi.org/10.1016/j.athoracsur.2009.05.056
        • Charlson M.
        • Pompei P.
        • Ales L.
        • Mackenzie C.
        A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J Chron Dis. 1987; 40: 373-383https://doi.org/10.1016/0021-9681(87)90171-8
        • Hermiller J.B.
        • Yakubov S.J.
        • Reardon M.J.
        • et al.
        Predicting early and late mortality after transcatheter aortic valve replacement.
        J Am Coll Cardiol. 2016; 68: 343-352https://doi.org/10.1016/j.jacc.2016.04.057
        • Miller K.D.
        • Jones E.
        • Yanovski J.A.
        • Shankar R.
        • Feuerstein I.
        • Falloon J.
        Visceral abdominal-fat accumulation associated with use of indinavir.
        Lancet. 1998; 9106: 871-875https://doi.org/10.1016/S0140-6736(97)11518-5
        • Foldyna B.
        • Troschel F.M.
        • Addison D.
        • et al.
        Computed tomography-based fat and muscle characteristics are associated with mortality after transcatheter aortic valve replacement.
        J Cardiovasc Comput Tomogr. 2018; 12: 223-228https://doi.org/10.1016/j.jcct.2018.03.007
        • Paknikar R.
        • Friedman J.
        • Cron D.
        • et al.
        Psoas muscle size as a frailty measure for open and transcatheter aortic valve replacement.
        J Thorac Cardiovasc Surg. 2016; 151: 745-751https://doi.org/10.1016/j.jtcvs.2015.11.022
        • DeLong E.R.
        • DeLong D.M.
        • Clarke-Pearson D.L.
        Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach.
        Biometrics. 1988;
        • Nemec U.
        • Heidinger B.
        • Sokas C.
        • Chu L.
        • Eisenberg R.L.
        Diagnosing sarcopenia on thoracic computed tomography: quantitative assessment of skeletal muscle mass in patients undergoing transcatheter aortic valve replacement.
        Acad Radiol. 2017; 24: 1154-1161https://doi.org/10.1016/j.acra.2017.02.008
        • D'Ascenzo F.
        • Ballocca F.
        • Moretti C.
        • et al.
        Inaccuracy of available surgical risk scores to predict outcomes after transcatheter aortic valve replacement.
        J Cardiovasc Med. 2013; 14: 894-898https://doi.org/10.2459/JCM.0b013e3283638e26
        • Surkan M.J.
        • Gibson W.
        Interventions to mobilize elderly patients and reduce length of hospital stay.
        Can J Cardiol. 2018; https://doi.org/10.1016/j.cjca.2018.04.033
        • Eichler S.
        • Salzwedel A.
        • Harnath A.
        • et al.
        Nutrition and mobility predict all-cause mortality in patients 12 months after transcatheter aortic valve implantation.
        Clin Res Cardiol. 2018; https://doi.org/10.1007/s00392-017-1183-1
        • Katano S.
        • Yano T.
        • Kouzu H.
        • et al.
        Energy intake during hospital stay predicts all-cause mortality after discharge independently of nutritional status in elderly heart failure patients.
        Clin Res Cardiol. 2021; https://doi.org/10.1007/s00392-020-01774-y
        • Afilalo J.
        • Lauck S.
        • Kim D.H.
        • et al.
        Frailty in older adults undergoing aortic valve replacement: the FRAILTY-AVR study.
        J Am Coll Cardiol. 2017; 70: 689-700https://doi.org/10.1016/j.jacc.2017.06.024