Effects of computed tomography-defined sarcopenia on patients undergoing transcatheter aortic valve implantation.

Abstract

Objectives: Stratifying patients with aortic stenosis is crucial for improving their lifetime management. Several studies analysed computed tomography (CT)-defined sarcopenia in patients undergoing transcatheter aortic valve implantation (TAVI). However, the criteria for CT-defined sarcopenia are heterogeneous among these studies. Mostly, they primarily evaluated short-term outcomes; research focusing on long-term outcomes, related to lifetime management in patients with aortic stenosis, is rare. We assessed the effects of CT-defined sarcopenia on the short- and long-term outcomes in patients undergoing TAVI using three different sarcopenia criteria, including two traditional criteria and a novel criterion.

Methods: In this retrospective study, we enrolled 360 patients. Three different sarcopenia criteria (skeletal muscle index [SMI], psoas muscle area [PMA], and psoas muscle volume index [PVI]) were applied to assess safety and early and long-term clinical outcomes.

Results: SMI-, PMA-, and PVI-sarcopenia were diagnosed in 244 (67.7%), 246 (68.3%), and 161 (44.7%) patients, respectively. However, PMA-sarcopenia was associated with poor long-term survival after TAVI. Furthermore, PVI-sarcopenia was associated with lower safety at 30 days and poor long-term survival. Using Cox regression hazard models, PVI-sarcopenia tended to be a risk factor of overall survival (hazards ratio: 1.49, p = 0.052).

Conclusions: In patients undergoing TAVI, CT-defined sarcopenia using PVI-based criteria was a reliable predictor of poor outcomes. This finding might facilitate stratification of patients undergoing TAVI.