The prognostic value of small psoas muscle area in patients undergoing mitral transcatheter edge-to-edge repair.

Abstract

Sarcopenia may be more advanced in high-surgical-risk patients undergoing mitral transcatheter edge-to-edge repair (M-TEER). However, the clinical significance of psoas muscle area (PMA), measured by computed tomography (CT) as an index of sarcopenia, remains uncertain in this population. To determine the association between PMA and clinical outcomes following M-TEER in high-risk patients. Of 238 patients who underwent M-TEER at our facility between January 2019 and July 2023, 214 patients with available preoperative CT were enrolled. Bilateral cross-sectional PMA was measured at the L4 vertebra level and indexed to body surface area. Patients in the lowest sex-specific tertile of index PMA were classified as the smaller PMA group, and the remainder as the larger PMA group. The composite outcome comprised heart failure hospitalization or all-cause death. The mean age and median Society of Thoracic Surgeons score was 80.6 ± 9.0 years and 11.6% (interquartile range 7.3%-17.1%). Seventy-one patients were assigned to the smaller PMA group, and 143 to the larger PMA group. At 1 year, the smaller PMA group had higher rates of the composite outcome and heart failure hospitalization than the larger PMA group (composite outcome: 46.5% versus 26.6%, P = 0.003; heart failure hospitalization: 35.1% versus 17.3%, P = 0.006). The rate of all-cause death was numerically higher in the smaller PMA group, though the difference was not statistically significant (25.4% versus 16.1%, P = 0.10). Decreased PMA measured by preprocedural CT in patients undergoing M-TEER was associated with adverse clinical outcomes.