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

Abstract

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.

Prognostic Value of Sarcopenia in Older Adults with Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis

“…Table 1 summarizes the characteristics of all studies included in this meta-analysis. The 13 studies [14][15][16][17][18][19][20][21][22][23][24][25][26] enrolled 5248 individuals who were included in the qualitative analysis. All the included studies were published after 2016.…”

“…All the included studies were published after 2016. Of these, 5 reported retrospective data [16,17,20,23,26], and 8 were prospective cohort studies [14,15,18,19,21,22,24,25]. The sample size of the included studies ranged from 81 to 1375.…”

“…And the mean age of patients ranged from 78.1 to 84.9 years. In addition, the included patients were sampled from a diversity of populations, involving 3 studies conducted in Asia [20,25,26], 7 in America [15,16,19,[21][22][23][24], and 3 in Europe [14,17,18] Prevalence Of Sarcopenia Table 1 summarized the commonly used diagnostic criteria of sarcopenia. According to European Working Group on Sarcopenia in Older People(EWGSOP) [11], eleven studies de ned sarcopenia by low muscle mass measured on CT-scan regardless of low skeletal muscle mass index (SMI) [14-17, 19, 21, 23-26], psoas muscle area (PMA) [17,22] or psoas muscle area index (PMI) [21].…”

“…Many studies regarding the predictive value of sarcopenia in patients post TAVI have been conducted [14][15][16][17][18][19][20][21][22][23][24][25][26]. However, the results of these studies remain inconsistent and even controversial.…”

“…However, the results of these studies remain inconsistent and even controversial. For example, Brouessard et al [14] reported that sarcopenia was not correlated with rehospitalization and mortality at one year after TAVI. On the other hand, Heidari et al [19] found that sarcopenia was an independent risk factor for mortality in patients following TAVI.…”