Skeletal Muscle Characteristics May Inform Preprocedural Risk Stratification in Transcatheter Aortic Valve Replacement Patients

• Published in: Journal of cardiothoracic and vascular anesthesia Vol. 35; no. 9; pp. 2618 - 2625
• Main Authors: Furzan, Alberto, Quraishi, Sadeq A., Brovman, Ethan, Weintraub, Andrew, Connors, Ann, Allen, David, Patel, Prakash A., Cobey, Frederick C.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2021
• Subjects: aortic stenosis; Aortic Valve - surgery; Aortic Valve Stenosis - surgery; frailty; Heart Valve Prosthesis Implantation; Humans; outcomes measure; Psoas Muscles - anatomy & histology; Retrospective Studies; Risk Assessment; Risk Factors; sarcopenia; Survival Rate; transcatheter aortic valve replacement; Transcatheter Aortic Valve Replacement - adverse effects; Treatment Outcome; transcatheter aortic valve replacement; frailty; aortic stenosis; outcomes measure; sarcopenia
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2020.12.024

Low psoas muscle mass previously has been associated with mortality after transcatheter aortic valve replacement (TAVR). Evidence from other clinical disciplines suggests that psoas density (PD) may be a better predictor than psoas muscle cross-sectional area indexed to body surface area (PI). The authors hypothesized that PD would be more strongly correlated with patient discharge disposition and survival after TAVR than PI.
The authors performed a single-center, retrospective study of TAVR patients from 2013 to 2016. PI and PD were assessed at the third lumbar spine level using computed tomography imaging. Propensity-score matching was used to investigate the association of PI and PD with discharge disposition and mortality.
Tertiary university hospital
Cohort of 245 TAVR patients.
None
A total of 245 patients met inclusion criteria. Following propensity score matching, patients with PI <4 cm2/m2 and PD <25 Hounsfield units (HU) were less likely to survive and to be discharged home compared with patients with PI ≥4 cm2/m2 or PD >25 HU. After repeating the propensity score matching with PI as a covariable, PD remained associated with mortality (90 days: odds ratio [OR] 4.59; 95% confidence interval [CI] 2.96-10.31, p < 0.001, 1 year: OR 6.14; 95% CI 3.45-28.57, p = 0.01, 3 years: OR 4.55; 95% CI 2.41-40.00, p = 0.03).
PD may be more relevant than PI in risk stratification for TAVR patients.