TAVI Success Is More Than Just the Valve: CT-Derived Sarcopenia as a Major Determinant of Long-Term Survival

IF 9.1 1区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of Cachexia Sarcopenia and Muscle Pub Date : 2025-07-11 DOI:10.1002/jcsm.70012

Nikolaos Schörghofer, Christoph Knapitsch, Gretha Hecke, Nikolaus Clodi, Lucas Brandstetter, Crispiana Cozowicz, Matthias Hammerer, Klaus Hergan, Uta C. Hoppe, Bernhard Scharinger, Elke Boxhammer

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Abstract

Background

Sarcopenia, characterized by progressive skeletal muscle loss, is a silent yet powerful marker associated with survival, yet its impact on long-term outcomes in transcatheter aortic valve implantation (TAVI) remains underestimated. While frailty has been recognized as a main factor of resilience and recovery, the role of muscle integrity is frequently overlooked. This study explores whether computed tomography (CT)-derived psoas muscle area (PMA) and psoas muscle area index (PMI) are key predictors of post-TAVI survival.

Methods

A total of 539 patients (mean age 82.0 ± 5.1 years; 49.9% female) undergoing TAVI were analysed in this retrospective, single-centre study. Sarcopenia was analysed via sex-specific quartiles of PMA and PMI. Long-term survival was examined using Kaplan–Meier analysis, univariate and multivariate Cox regression analysis. Interaction terms were introduced to assess whether the association between sarcopenia and survival differed by age, sex, renal function and anaemia status.

Results

Sarcopenia emerged as a predictor of long-term mortality (HR = 1.52, p = 0.011 for PMA; HR = 1.55, p = 0.008 for PMI) after TAVI. Notably, younger patients (< 80 years) with sarcopenia faced double the mortality risk (HR = 2.48, p = 0.001 for PMA; HR = 2.55, p = 0.001 for PMI), whereas in older patients, the association was weaker. In women, who typically show a post-TAVI survival advantage, sarcopenia reduced this benefit (HR = 1.75, p = 0.020 for PMA; HR = 1.88, p = 0.008 for PMI). The most striking finding was the synergistic effect of sarcopenia and chronic kidney disease (CKD), resulting in a threefold increase in mortality risk (HR = 2.82, p = 0.027 for PMA; HR 3.14, p = 0.011). After multivariate adjustment, sarcopenia remained a strong, independent predictor of long-term mortality (HR = 1.58, p = 0.009 for PMA; HR = 1.49, p = 0.024 for PMI), reinforcing its clinical relevance in TAVI risk stratification.

Conclusion

Our study suggests that sarcopenia is not just a passive bystander, but may serve as a marker associated with long-term mortality in TAVI patients, especially in younger individuals, women and those with CKD or anaemia. Since muscle mass predicts survival and is potentially modifiable, assessing and intervening against sarcopenia before and after TAVI could represent a clinical priority in patients with aortic valve stenosis. This study underscores the importance of a more nuanced approach—not merely focusing on valve replacement, but on strengthening patient-centred care.

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TAVI的成功不仅仅是瓣膜：ct衍生的肌肉减少症是长期生存的主要决定因素

背景：骨骼肌减少症，以进行性骨骼肌丧失为特征，是一个与生存相关的沉默但强大的标志物，但其对经导管主动脉瓣植入术（TAVI）的长期预后的影响仍被低估。虽然脆弱已被认为是弹性和恢复的主要因素，但肌肉完整性的作用经常被忽视。本研究探讨了计算机断层扫描（CT）得出的腰肌面积（PMA）和腰肌面积指数（PMI）是否是tavi后生存的关键预测指标。方法539例患者(平均年龄82.0±5.1岁；49.9%（女性）接受TAVI的患者在本回顾性单中心研究中进行分析。通过PMA和PMI的性别特异性四分位数分析肌肉减少症。长期生存率采用Kaplan-Meier分析、单因素和多因素Cox回归分析。引入相互作用项来评估肌肉减少症与生存率之间的关联是否因年龄、性别、肾功能和贫血状况而异。结果肌少症是长期死亡率的预测因子（HR = 1.52, p = 0.011）；TAVI后PMI的HR = 1.55, p = 0.008。值得注意的是，年轻的肌肉减少症患者（80岁）面临两倍的死亡风险(HR = 2.48, p = 0.001；HR = 2.55, p = 0.001)，而在老年患者中，相关性较弱。在tavi后通常表现出生存优势的女性中，肌肉减少症降低了这种获益(HR = 1.75, p = 0.020；HR = 1.88, p = 0.008)。最引人注目的发现是肌肉减少症和慢性肾脏疾病（CKD）的协同作用，导致死亡风险增加三倍(HR = 2.82, p = 0.027；HR 3.14, p = 0.011)。多因素调整后，肌少症仍然是长期死亡率的一个强有力的独立预测因子(HR = 1.58, p = 0.009；PMI的HR = 1.49, p = 0.024)，加强了其在TAVI风险分层中的临床相关性。结论：我们的研究表明，肌肉减少症不仅仅是一个被动的旁观者，而且可能是TAVI患者长期死亡率的一个相关标志，特别是在年轻人、女性和CKD或贫血患者中。由于肌肉质量可以预测生存率，并且有可能改变，因此在TAVI前后评估和干预肌肉减少症可能是主动脉瓣狭窄患者的临床优先考虑。这项研究强调了一种更细致入微的方法的重要性——不仅仅关注瓣膜置换术，还要加强以病人为中心的护理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cachexia Sarcopenia and Muscle MEDICINE, GENERAL & INTERNAL-

CiteScore

13.30

自引率

12.40%

发文量

234

审稿时长

16 weeks

期刊介绍： The Journal of Cachexia, Sarcopenia and Muscle is a peer-reviewed international journal dedicated to publishing materials related to cachexia and sarcopenia, as well as body composition and its physiological and pathophysiological changes across the lifespan and in response to various illnesses from all fields of life sciences. The journal aims to provide a reliable resource for professionals interested in related research or involved in the clinical care of affected patients, such as those suffering from AIDS, cancer, chronic heart failure, chronic lung disease, liver cirrhosis, chronic kidney failure, rheumatoid arthritis, or sepsis.