What is the clinical evidence from this study?

Study design: Cohort. Population: Surgical Aortic Valve Replacement (n=228). Intervention: Pectoralis muscle area as a measure of frailty vs. Non-sarcopenic status. Primary outcome: One-year mortality (OR 0.997, 95% CI 0.995-1.000, p=0.025).

What does this research mean for the field?

Lower pectoralis index is associated with worse risk-adjusted outcomes after surgical aortic valve replacement. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

The study aims to determine if pectoralis muscle area can predict morbidity and mortality in patients undergoing surgical aortic valve replacement.

February 2, 2026Open Access

Pectoralis Muscle Area Predicts Frailty and Risk-Adjusted Mortality After Surgical Aortic Valve Replacement

Key Result

Lower pectoralis index is associated with worse risk-adjusted outcomes after surgical aortic valve replacement.

Key Points

The study aims to determine if pectoralis muscle area can predict morbidity and mortality in patients undergoing surgical aortic valve replacement.
Identified patients undergoing surgical aortic valve replacement from 2009 to 2016 at a single center
Measured pectoralis muscle area on preoperative CT and indexed it to body surface area
Defined sarcopenia as pectoralis index below the sex-specific 25th percentile
Performed regression analysis using Society of Thoracic Surgeons risk scores
Sarcopenic patients were significantly older (median age 82 vs 80 years)
Sarcopenic patients had a higher mean STS predicted risk of mortality (7.0% vs 5.7%)
No differences in operative mortality or major morbidity by sarcopenic status were found
Lower pectoralis index correlated with greater major morbidity and likelihood of discharge to a facility
Lower pectoralis index was associated with one-year mortality

Study Design

Type

Cohort (n=228)

Multicenter

Structured PICO

Does lower pectoralis index (sarcopenia) predict worse risk-adjusted mortality and morbidity in moderate to high-risk patients undergoing surgical aortic valve replacement?

Population

228 moderate to high-risk patients (STS PROM >3%) with severe aortic stenosis undergoing first-time surgical aortic valve replacement (SAVR), median age 80-82, 40.4% female, US-based (single center). Excluded: lack of preoperative chest CT, endocarditis.

Intervention

Sarcopenia, defined as pectoralis index (pectoralis muscle cross-sectional area indexed to body surface area) below the sex-specific 25th percentile on preoperative chest CT

Comparator

Non-sarcopenic patients (pectoralis index at or above the sex-specific 25th percentile)

Outcome

Risk-adjusted 1-year mortality, STS major morbidity, and likelihood of discharge to a facilityhard clinical

Pectoralis muscle area measured on routine preoperative chest CT serves as an objective marker of frailty that independently predicts 1-year mortality and major morbidity after surgical aortic valve replacement.

Main Result

Effect estimate: OR 0.997 (95% CI 0.995-1.000)

Absolute Event Rate: 31% vs 17.4%

p-value: p=0.025

Limitations

Single center study
Retrospective design
Limited generalizability to all patients undergoing SA VR
Modest sample size may limit statistical power

Abstract

Background: Psoas muscle cross-sectional area predicts morbidity and mortality as a surrogate for frailty in cardiac surgery patients, but routine preoperative abdominal imaging is uncommon. We hypothesized that pectoralis and psoas muscle cross-sectional area correlate, and pectoralis area may predict morbidity and mortality for patients undergoing surgical aortic valve replacement (SAVR). Methods: A psoas muscle area validation cohort of moderate to high-risk patients undergoing SAVR (1/2009–12/2016) were identified from the University of Virginia. Pectoralis muscle area identified on preoperative computed tomography (CT) was indexed to body surface area to define pectoralis index. Sarcopenia was defined as pectoralis index below sex-specific 25th percentile. Patients were stratified by sarcopenic status, and regression analysis identified risk-adjusted associations utilizing Society of Thoracic Surgeons (STS) predicted risk scores. Results: Preoperative chest imaging was available for 228 patients. Sarcopenic patients were significantly older (median 82 vs 80 years, p = 0.041) and had greater mean society of thoracic surgeons predicted risk of mortality (STS PROM) (7.0% vs 5.7%, p = 0.047). There was no difference by sarcopenic status for operative mortality (8.8% vs 4.1%, p = 0.171) or major morbidity (21.1% vs 19.9%, p = 0.849). Risk-adjusted pectoralis index was associated with greater STS major morbidity (OR 0.998, p = 0.021), likelihood of discharge to a facility (OR 0.998, p = 0.014), and one-year mortality (OR 0.997, p = 0.025). Conclusion: Lower pectoralis index may be associated with worse risk-adjusted outcomes after SAVR. Pectoralis defined sarcopenia may serve as a useful measure of frailty in cardiac surgery patients.

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