Computed tomography measured psoas muscle attenuation predicts mortality after transcatheter aortic valve implantation

Abstract

Aims The aim of this study was to determine if computed tomography (CT) psoas muscular attenuation measurements may predict all-cause mortality in patients undergoing TAVI.Methods Ninety-four consecutive patients undergoing TAVI were analysed. The CT axial slice at the level of the fourth lumbar vertebra was selected. The psoas muscle areas were manually contoured. The circumferential surface area (CSA) of both psoas muscles was determined by selecting the voxels with attenuation values, ranging from 0 to 100 Hounsfield Units (HU). The mean CT attenuation coefficient of the psoas muscle (Psoas mean HU) was measured. The muscle was subdivided into a low-density muscle (LDM) (0-29 HU) and high-density muscle (HDM) (30-100 HU) portion. The HDM/LDM ratio was calculated. We searched for a correlation between HDM/LDM, CSA LDM (%), Psoas mean HU and all-cause mortality. ResultsThe mean age was 81.2 W 7.5 years. Thirty patients had adverse outcome (all-cause mortality). Compared with patients with the lowest CSA LDM (%), patients in the third and second tertiles had an increased hazard ratio for mortality (2.871; 95% confidence interval 0.880-9.371 and 5.044; 95% confidence interval 1. 641-15.795, respectively) in a multivariable model with EuroSCORE II, Barthel frailty index and CSA LDM (%) (P U 0.231, 0.097 and 0.019, respectively). HDM/LDM and Psoas mean HU (as continuous variable) were also independent predictors of all-cause mortality (P U 0.019, P U 0.013, respectively) Conclusion CSA LDM (%), Psoas mean HU and HDM/LDM are independent and incremental predictors of all-cause mortality in patients undergoing TAVI.

Adiponectin serum level is an independent and incremental predictor of all‐cause mortality after transcatheter aortic valve replacement

“…The CT scanning protocol has been previously described. 14 Combined prospective ECG‐triggered cardiac CT, chest, abdominal, and intrapelvic CT imaging acquisition to select the appropriate bioprosthetic size and assess the vascular access is part of the routine workup before TAVR.…”

“…The acquisition protocol of the psoas muscle variables has been described previously. 14 In summary, the psoas muscle area (PMA) was measured by contouring the psoas muscle border on a CT axial slice at the fourth lumbar vertebra. A filter, selecting the voxels with attenuation values between 0 HU and 100 Hounsfield Units (HU), determined the area attributed to the psoas muscle.…”

“…A triphasic intravenous radiology contrast (Iomeron 350) injection protocol was used: 80 ml contrast agent at 4 ml/s, followed by | 3 60 ml contrast agent at 4 ml/s plus 60 ml 0.9%NaCl solution at 2 ml/s, followed by 28 ml 0.9% NaCl solution at 2 ml/s). 14…”

Impact of psoas muscle evaluation on clinical outcomes in patients undergoing left ventricular assist device implantation

“…(8) Disturbance of wound healing. (9) Gastrointestinal complications are defined as gastrointestinal bleeding, mesenteric ischemia, peritonitis, ileus or gallbladder removal. (10) Postoperative renal failure, defined as the need for renal replacement therapy.…”

Sarcopenia detected by computed tomography: a simple tool for screening transcatheter aortic valve implantation candidates

“…However, evidence regarding its prognostic impact diverges. 14,15 In the current issue, Walpot et al 16 sought to retrospectively evaluate the role of psoas muscle attenuation (PMA) assessed by CT in predicting long-term all-cause mortality after TAVI. They analysed 94 consecutive TAVI patients with a median age of 81 years and at intermediate surgical risk (median STS score 4.7%).…”