Comparing Frailty Markers in Predicting Poor Outcomes after Transcatheter Aortic Valve Replacement

Krishnan, Aravind; Suarez‐Pierre, Alejandro; Zhou, Xun; Lin, Cheng Ting; Fraser, Charles D.; Crawford, Todd C.; Hsu, Joshua; Hasan, Rani K.; Resar, Jon R.; Chacko, Matthews; Baumgartner, William A.; Conte, John V.; Mandal, Kaushik

doi:10.1177/1556984519827698

Cited by 13 publications

(14 citation statements)

References 43 publications

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“…Although several studies have now described the relationship between psoas sarcopenia and poor outcomes following TAVR, this association between psoas muscle and the outcome after TAVR is not straightforward [ 38 – 40 ]. Mamane et al identified a correlation between the psoas muscle area and 6-month mortality in female patients only [ 33 ] in a relatively small cohort, and another study by van Mourik et al showed similar findings [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

“…Its routine use, particularly, in research studies, is, in part, secondary to convenience and simplicity of acquiring measurements, but it is suggested in the literature that the total lumbar muscle area may be more closely related to the overall muscle mass, and given that psoas comprises only 10% of the total trunk musculature, this may not be accurate [ 45 , 46 ]. Indeed, Krishnan et al reported that sarcopenia was underestimated by 10% using psoas muscles only compared with paravertebral muscles on CT imaging in a cohort of patients who underwent TAVR [ 40 ]. The prospect of muscle segmentation on volumetric CT imaging using deep learning algorithms provides an exciting opportunity for work in this area and may streamline the collection of important quantitative measures to improve reproducibility [ 47 , 48 ].…”

Section: Discussionmentioning

confidence: 99%

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The Utility of Psoas Muscle Assessment in Predicting Frailty in Patients Undergoing Transcatheter Aortic Valve Replacement

Koizia

Naik

Peck

et al. 2020

Current Gerontology and Geriatrics Research

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Background. The rise in an ageing population has resulted in an increase in the prevalence of aortic stenosis. With the advent and rapid expansion in the use of transcatheter aortic valve replacements (TAVRs), patients with severe aortic stenosis, traditionally thought too high risk for surgical intervention, are now being treated with generally favourable results. Frailty is an important factor in determining outcome after a TAVR, and an assessment of frailty is fundamental in the identification of appropriate patients to treat. Objective. The objective of the study was to identify if the psoas muscle area is associated with frailty in TAVR patients and outcome after intervention. Method. In this prospective study, we measured outcomes of 62 patients who underwent TAVR procedures against the psoas muscle area and the Reported Edmonton Frail Scale (REFS). Our aim was to assess if psoas muscle assessment can be used as a simple method to predict frailty in our population group. Results. A total of 60 patients met the study criteria. Mean psoas-lumbar vertebral index was 0.61, with a lower value in the frail group. There was not a statistically significant correlation between the psoas measures, REFS score (indicative of frailty), and mortality. However, there was a statistically significant relationship between the psoas size and REFS score (p=0.043). Conclusion. Psoas assessment can be useful in providing additional information when planning for patients to undergo a TAVR and can be used as a screening tool to help identify frail patients within this high-risk group.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Utility of Psoas Muscle Assessment in Predicting Frailty in Patients Undergoing Transcatheter Aortic Valve Replacement

Koizia

Naik

Peck

et al. 2020

Current Gerontology and Geriatrics Research

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“…16,[18][19][20] To discuss the results, prevalence of severe sarcopenia was assessed using the other previous total skeletal muscle index thresholds. [13][14][15][16][17][18][19][20][21]…”

Section: Baseline Datamentioning

confidence: 99%

“…In the literature, some studies highlighted the impact of sarcopenia on the increase in mortality, rehospitalization or high resource utilization after TAVR, while others found diverging results. [13][14][15][16][17][18][19][20][21] But none of these studies included a complete geriatric assessment with physical performance and complete nutritional assessment. The main purpose of our study was to evaluate the impact of severe sarcopenia on rehospitalization and survival one year after a TAVR procedure in patients aged 75 years and older.…”

Section: Introductionmentioning

confidence: 99%

Impact of Severe Sarcopenia on Rehospitalization and Survival One Year After a TAVR Procedure in Patients Aged 75 and Older

Brouessard¹,

Bobet²,

Mathieu³

et al. 2021

CIA

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Background: Transcatheter aortic-valve replacement (TAVR) reduces mortality and improves quality of life in patients with severe aortic valve stenosis. One third of patients have no benefit one year after TAVR. Sarcopenia, an age-related loss of skeletal muscle mass, is associated with increased physical disability and mortality. The main purpose was to evaluate the impact of severe sarcopenia on rehospitalization one year after TAVR in older patients. Methods: All patients aged ≥75 referred for a TAVR in 2018 were included. Severe sarcopenia was defined by a loss of skeletal muscle mass defined on CT-scan measurement associated with a gait speed ≤0.8m/s. The main outcome was rehospitalization one year after TAVR. Results: Median age of the 182 included patients was 84, and 35% had an unplanned hospitalization at one year. Severe sarcopenia was diagnosed in 9 patients (4.9%). Univariable analysis showed that gait speed was a factor associated with readmission [HR=0.32, 95% CI (0.10-0.97), p=0.04] but not severe sarcopenia. In multivariable analysis, only diabetes was significantly associated with rehospitalization [HR=2.06, 95% CI (1.11-3.84), p=0.02]. Prevalence of severe sarcopenia varied according to different thresholds of skeletal muscle mass on CT-scan. Conclusion: Even though severe sarcopenia was not correlated with rehospitalization and mortality at one year after TAVR, our results emphasize the changes in the prevalence according to cutoff used. It highlights the need to define standardized methods and international threshold for sarcopenia diagnosis by CT-scan measurements, in general population and for patients with valvular heart disease.

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“…The difficulty of doing so in transplantation lies in the unpredictability to the transplant procedure itself. It may be possible to enroll patients who are listed for heart transplantation in longitudinal “pre‐habilitation” programs, designed to optimize physical and nutritional status for major cardiac interventions 20,29‐32 . These programs rely on multi‐disciplinary nutritional and physical therapy support tailored to optimizing pre‐procedural fitness 29,30,33 .…”

Section: Commentmentioning

confidence: 99%

Decreased Nutritional Risk Index is associated with mortality after heart transplantation

Krishnan

Bigelow

Hsu

et al. 2021

Clinical Transplantation

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Introduction Validated scoring tools, such as the Nutritional Risk Index (NRI), can aid clinicians in quantifying the degree of malnourishment in patients prior to an operation. We evaluated the association between NRI and outcomes after heart transplantation. Methods The United Network for Organ Sharing (UNOS) database was used to identify adult patients (age > 18) undergoing heart transplantation between 1987 and 2016. NRI was calculated and categorized into previously established groupings representing severity of malnutrition. Multivariate Cox proportional hazards modeling were used to assess the primary outcome of all‐cause mortality. Results A total of 25,236 patients were included in the analysis. Most patients (75.4%) were male. Malnourishment was absent (NRI ≥ 100) in 11,022 (44%) patients, while 2,898 (12%) were mildly malnourished (97.5 ≤ NRI < 100), 8,685 (34%) were moderately malnourished (83.5 ≤ NRI < 97.5), and 2,631 (10%) were severely malnourished (NRI < 83.5). Moderate‐to‐severe malnutrition was associated with increased mortality (HR = 1.18, p < .001, 95%CI: 1.13‐1.24), and post‐transplant renal failure requiring dialysis (OR: 1.13, p < .001, 95%CI: 1.03‐1.23). Conclusion Malnourishment determined by NRI is independently associated with mortality and post‐transplant dialysis after heart transplant. This is the largest study of NRI in heart transplant recipients.

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Comparing Frailty Markers in Predicting Poor Outcomes after Transcatheter Aortic Valve Replacement

Cited by 13 publications

References 43 publications

The Utility of Psoas Muscle Assessment in Predicting Frailty in Patients Undergoing Transcatheter Aortic Valve Replacement

The Utility of Psoas Muscle Assessment in Predicting Frailty in Patients Undergoing Transcatheter Aortic Valve Replacement

Impact of Severe Sarcopenia on Rehospitalization and Survival One Year After a TAVR Procedure in Patients Aged 75 and Older

Decreased Nutritional Risk Index is associated with mortality after heart transplantation

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