Total Muscle Area and Visceral Adipose Tissue Measurements for Frailty Assessment in TAVR Patients

Abstract

Background: Transcatheter aortic valve replacement (TAVR) is a treatment option for severe aortic valve stenosis. Pre-TAVR assessments, extending beyond anatomy, include evaluating frailty. Potential frailty parameters in pre-TAVR computed tomography (CT) scans are not fully explored but could contribute to a comprehensive frailty assessment. The primary objective was to investigate the impact of total muscle area (TMA) and visceral adipose tissue (VAT) as frailty parameters on 5-year all-cause mortality in patients undergoing TAVR. Methods: Between 01/2017 and 12/2018, consecutive TAVR patients undergoing CT scans enabling TMA and VAT measurements were included. Results: A total of 500 patients qualified for combined TMA and VAT analysis. Age was not associated with a higher risk of 5-year mortality (HR 1.02, 95% CI: 0.998–1.049; p = 0.069). Body surface area normalized TMA (nTMA) was significantly associated with 5-year, all-cause mortality (HR 0.927, 95% CI: 0.927–0.997; p = 0.033), while VAT had no effect (HR 1.002, 95% CI: 0.99–1.015; p = 0.7). The effect of nTMA on 5-year, all-cause mortality was gender dependent: the protective effect of higher nTMA was found in male patients (pinteraction: sex × nTMA = 0.007). Conclusions: Normalized total muscle area derived from a routine CT scan before transcatheter aortic valve replacement complements frailty assessment in patients undergoing TAVR.

Low Bone Mineral Density on Computed Tomography: Association with Poor Survival after Transcatheter Aortic Valve Replacement

“…In contrast, neither appendicular muscle area (PMA) nor VAT demonstrated a significant correlation with escalated 5-year mortality rates. Moreover, the amalgamation of TMA and VAT did not augment the prognostic potency for predicting diminished survival rates [7].…”

“…Conversely, appendicular muscle area (PMA) and VAT were not correlated with increased 5-year mortality. Furthermore, the combination of TMA and VAT did not exhibit enhanced predictive power for lower survival rates [7].…”

“…Over the past two decades, TAVR has undergone remarkable evolution, marked by substantial enhancements in safety, efficacy, and procedural outcomes. These advancements led to a notable rise in the utilization of TAVR procedures, encompassing a broader spectrum of patients, including those deemed to be at intermediate or low surgical risk [1][2][3][4][5][6][7].…”