Beyond the Obesity Paradox: Analysis of New Prognostic Factors in Transcatheter Aortic Valve Implantation Procedure

Figures

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  Figure 1. (a) Anterior SAT thickness, measured as the largest anterior distance on the axial slice between the rectus abdominis and the skin at the level of the umbilicus. (b) Posterior SAT thickness is measured as the distance between the left iliac crest and the posterior skin. (c) VAT thickness is obtained by calculating the retro-renal fat thickness as the distance from the left kidney to the nearest posterior inner abdominal wall on the axial slice passing through the left renal vein. (d,e) The VAT area, presented in orange, and the SAT area, presented in yellow, were segmented with 3D Slicer version 5.1.0 software using fat-specific thresholds.

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  Figure 2. (a) Right psoas muscle diameter measured on a single axial CT slice at the level of the L3 transverse process by considering the largest diameter perpendicular to the longest anteroposterior axis of the muscle. (b) Area of both psoas muscles segmented with 3D Slicer version 5.1.0. software using muscle-specific thresholds.

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  Figure 3. This graph shows the distributions of the psoas/height ratio (a), anterior SAT distance (b), posterior SAT distance (c), anterior + posterior SAT distance (d), VAT distance (e), and total fat area (f) in relation to the absence and presence of mortality within the 24-month follow-up period. As the diagrams show, the blue columns, which represent the pre-TAVI CT values for the psoas, VAT, and SAT measurements in patients who did not die in the 24-month follow-up period, show higher values than the green columns, which represent the same pre-TAVI CT measurements in patients who died during the 24-month follow-up period. These graphs confirm that overweight and obesity are good prognostic factors of TAVI outcomes, and sarcopenia is a poor prognostic factor.