Preoperative osteosarcopenia predicts adverse outcomes in patients undergoing transcatheter aortic valve implantation

Q: What are the key findings of this study?

Preoperative osteosarcopenia significantly predicted an increased risk of all-cause mortality and unplanned hospitalization at 1 year after transcatheter aortic valve implantation (HR 3.98).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Severe aortic stenosis undergoing TAVI (n=93). Intervention: Preoperative osteosarcopenia vs. Absence of osteosarcopenia. Primary outcome: Composite of all-cause mortality and unplanned hospitalization within 1 year after discharge (HR 3.98, 95% CI 1.72-9.25, p=<0.001).

Q: What does this research mean for the field?

Preoperative osteosarcopenia is an independent predictor of all-cause mortality and unplanned hospitalization within 1 year after transcatheter aortic valve implantation. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To investigate the prognostic significance of preoperative osteosarcopenia in patients undergoing transcatheter aortic valve implantation.

Hirokazu Sugiura; Masahiro Takahashi; Yuki Sugawara; Naoya Asakawa

doi:10.1589/jpts.38.197

January 1, 2026Journal of Physical Therapy ScienceOpen Access

Preoperative osteosarcopenia predicts adverse outcomes in patients undergoing transcatheter aortic valve implantation

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Key result

Preoperative osteosarcopenia linked to ~4-fold higher risk of 1-year mortality and rehospitalization post-TAVI.

HR 3.98
95% CI 1.72-9.25
P<0.001
n=93

Why the study?

Reliable predictors of post-TAVI outcomes remain unclear, and the prognostic significance of preoperative osteosarcopenia in TAVI patients has not yet been established.

Does preoperative osteosarcopenia predict the composite of all-cause mortality and unplanned hospitalization within 1 year in older adults undergoing transcatheter aortic valve implantation?

Key Points

To investigate the prognostic significance of preoperative osteosarcopenia in patients undergoing transcatheter aortic valve implantation.
Retrospective single-center study analyzed 93 consecutive patients (mean age 84.9 ± 5.9 years; 38.7% male) who underwent TAVI between 2019 and 2023 at Sapporo City General Hospital.
Preoperative CT scans quantified the psoas muscle index (PMI) and vertebral bone mineral density (BMD), defining osteosarcopenia as falling in the lowest sex-specific tertile for both measures.
The primary endpoint was a composite of all-cause mortality and unplanned hospitalization within 1 year after hospital discharge.
Osteosarcopenia was identified in 14 of 93 patients (15.1%), and 26 of 93 patients (28.0%) experienced the primary composite endpoint during 1-year follow-up.
Patients with osteosarcopenia had significantly lower event-free survival than those without osteosarcopenia (log-rank p<0.001; univariate HR 3.98, 95% CI: 1.72–9.25), with an absolute risk difference of 34.4% and a number needed to harm of 2.9.
Median event-free survival was 126 days in the osteosarcopenia group versus not reached in the non-osteosarcopenia group, with osteosarcopenia conferring worse outcomes than sarcopenia alone (p=0.024) or osteopenia alone (p=0.048).

Study Design

Type

Cohort (n=93)

Multicenter

No

Structured PICO

Does preoperative osteosarcopenia predict the composite of all-cause mortality and unplanned hospitalization within 1 year in older adults undergoing transcatheter aortic valve implantation?

P

Population

93 older adults (mean age 84.9 years, 61.3% female) with severe aortic stenosis undergoing transcatheter aortic valve implantation, free of baseline immobility, followed for 1 year.

E

Exposure

Presence of preoperative osteosarcopenia, defined as values in the lowest sex-specific tertile for both computed tomography-derived psoas muscle index (PMI) and vertebral bone mineral density (BMD)

C

Comparator

Absence of preoperative osteosarcopenia (non-osteosarcopenia, or sarcopenia alone/osteopenia alone)

O

Outcome

Composite of all-cause mortality and unplanned hospitalization within one year after dischargecomposite

Main Result

Hazard Ratio: 3.98 (95% CI 1.72–9.25)

p-value: p=<0.001

Preoperative osteosarcopenia assessed via routine CT imaging serves as an independent, robust predictor of adverse clinical outcomes at 1 year in patients undergoing TAVI, potentially guiding early risk stratification and targeted rehabilitation.

Limitations

Single-center study with a relatively small sample size limiting statistical power and generalizability.
Standardized diagnostic criteria for osteosarcopenia are not yet established, and sex-specific tertile cutoffs used were population-specific.
Retrospective and observational design cannot establish causal relationships.
Baseline nutritional data (e.g., daily protein intake, serum vitamin D levels) were not evaluated.
Exclusion of patients unable to ambulate independently introduced a selection bias.
Single-center study with a relatively small sample size, limiting statistical power
Standardized diagnostic criteria for osteosarcopenia have not yet been established, and population-specific tertiles were used
Retrospective and observational design precludes establishing causality
Lack of baseline nutritional data such as daily protein intake or serum vitamin D levels
Exclusion of patients unable to ambulate independently introduced selection bias

Implication

May support CT-based osteosarcopenia screening for TAVI risk stratification; hypothesis-generating and requires prospective validation.

Abstract

[Purpose] Transcatheter aortic valve implantation (TAVI) has become a standard treatment for severe aortic stenosis; however, reliable predictors of post-TAVI outcomes remain unclear. Osteosarcopenia, defined as the coexistence of low muscle mass and low bone density, has been associated with poor outcomes in older adults, but its prognostic significance in TAVI patients has not yet been established. This study aimed to investigate the prognostic significance of preoperative osteosarcopenia in patients undergoing TAVI. [Participants and Methods] This retrospective study included 93 consecutive patients who underwent TAVI at Sapporo City General Hospital between 2019 and 2023. Sarcopenia and osteopenia were evaluated using computed tomography-derived psoas muscle index (PMI) and vertebral bone mineral density (BMD), respectively. Osteosarcopenia was defined as values in the lowest sex-specific tertile for both PMI and BMD. The primary outcome was a composite of all-cause mortality and unplanned hospitalization within 1 year after discharge. [Results] Among the 93 patients (mean age, 84.9 ± 5.9 year; 38.7% male), 14 (15.1%) were diagnosed with osteosarcopenia. During follow-up, 28.0% of participants experienced the composite endpoint. Patients with osteosarcopenia demonstrated significantly lower event-free survival rates. Multivariate Cox regression analysis identified osteosarcopenia as an independent predictor of adverse outcomes. [Conclusion] Preoperative osteosarcopenia independently predicts poor clinical outcomes after TAVI in ambulatory patients and may serve as a useful marker for early risk stratification.

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Published by Journal of Physical Therapy Science · CC BY-NC-ND

Cite This Study

Sugiura et al. (2026) conducted a cohort in Severe aortic stenosis undergoing TAVI (n=93). Preoperative osteosarcopenia vs. Absence of osteosarcopenia was evaluated on Composite of all-cause mortality and unplanned hospitalization within 1 year after discharge (HR 3.98, 95% CI 1.72-9.25, p=<0.001). Preoperative osteosarcopenia significantly predicted an increased risk of all-cause mortality and unplanned hospitalization at 1 year after transcatheter aortic valve implantation (HR 3.98).

synapsesocial.com/papers/69fada7f03f892aec9b1e4ee https://doi.org/10.1589/jpts.38.197

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Preoperative osteosarcopenia predicts adverse outcomes in patients undergoing transcatheter aortic valve implantation

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

Preoperative osteosarcopenia predicts adverse outcomes in patients undergoing transcatheter aortic valve implantation

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

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