Prognostic value of psoas muscle area and pleural effusion in patients undergoing TAVI

Background: Radiographic markers such as psoas muscle area (PMA) and pleural effusion have been linked to mortality after transcatheter aortic valve implantation (TAVI). We examined their relationship with cause-specific mortality and their incremental prognostic value beyond EuroSCORE II. Methods: This retrospective study included 1090 consecutive TAVI patients treated at Heart Hospital, Tampere University Hospital between 2008 and 2020. Preoperative CT scans were reviewed for L3-level PMA and pleural effusion (>10 mm thickness). Subdistribution hazard models adjusted for age, sex, BMI, and BSA were used to analyze cause-specific mortality. Incremental prognostic value beyond EuroSCORE II was assessed using time-dependent discrimination indexes (AUC and IDI) and net-reclassification index (NRI) at 3 years. Results: During a median follow-up of 4.3 years (IQR 3.1-6.0), 54% (n = 590) of patients died: 64% (n = 376) from cardiovascular, 30% (n = 177) from non-cardiovascular, and 6% (n = 37) from unnatural causes. PMA and pleural effusion were associated with cardiovascular mortality (PMA: SDH/1SD 0.88, 95% CI 0.78-0.99, p = 0.037; pleural effusion: SDH 1.73, 95% CI 1.37-2.19, p < 0.001). Combined inclusion of PMA and pleural effusion improved NRI = 0.13 (p = 0.004) and IDI = 0.015 (p = 0.004) of overall mortality prediction compared to EuroSCORE II alone. Conclusions: Psoas muscle area (PMA) and pleural effusion were independently associated with cardiovascular mortality after TAVI, whereas no significant associations were observed with non-cardiovascular deaths. Combined inclusion of these parameters led to a modest but not clinically meaningful improvement in the EuroSCORE II-based prediction of mortality.