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

Abstract

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.

Poorer Muscle Quality and Quantity With ART Initiation Is Associated With Greater Inflammation and Immune Activation

“…Among older adults without HIV, lower psoas quality and/or quantity have been associated with frailty and falls. [49][50][51] We have previously shown greater odds of lower functional status associated with the immune activation biomarker CD8 + CD38/HLA-DR and increased levels of IL-6 in PWH. 46 In addition, we have found that higher density (less fat) psoas and paraspinal muscle were associated with better physical function.…”

Predictability of Radiologically Measured Psoas Muscle Area for Intraoperative Hypotension in Older Adult Patients Undergoing Femur Fracture Surgery

“…Several previous studies have shown that radiologically assessed PMA, as a surrogate of sarcopenia, was related to surgical mortality in various surgical settings, such as transcatheter aortic valve implantation [ 6 ], abdominal [ 7 ], and femur fracture surgery [ 5 , 22 ]. Based on these results, we considered the underlying relationship between surgical mortality and low PMA.…”

“…PMA normalization is necessary to consider its clinical use because it differs according to race, sex, and age. Several PMA normalization methods have been used, such as the psoas: L4 vertebrae index [ 5 , 6 ], which is normalized by BMI, BSA [ 12 ], and height [ 7 ]. Some studies using CT-measured PMA used height 2 for adjustment; the present study utilized BSA, according to Canales et al [ 14 ].…”

“…Therefore, identifying the predisposing risk factors preoperatively is important to improve surgical outcomes. Preoperative assessment of frailty and sarcopenia, as a surrogate of frailty, have emerged as useful predictors of surgical mortality and morbidity in various surgical conditions in older adults [ 5 , 6 , 7 , 8 ].…”

Impairments identified by comprehensive geriatric assessment in potential candidates for left ventricular assist device and heart transplantation

“…In addition, we used the Edmonton Frail Scale (EFS) as a second and multi-domain instrument to assess frailty ( Supplementary Table S4 ) [31] . Rolfson et al demonstrated that the EFS is a valid tool for determining frailty when compared to the CGA and the EFS is used in several cardiac populations, including heart failure patients, in literature [32] , [33] , [34] , [35] .…”