Key result
Total psoas muscle area did not predict post-TAVI outcomes, whereas the Clinical Frailty Score was associated with all-cause mortality (adjusted coefficient 1.26; 95% CI 1.05-1.50; P=0.013).
Why the study?
Frailty is common among patients undergoing TAVI, but the prognostic relevance of newer objective versus traditional measures of frailty needed evaluation.
Does objective frailty assessment using total psoas muscle area predict post-TAVI morbidity and mortality better than traditional clinical frailty scores?
Cohort (n=420)
No
Does objective frailty assessment using total psoas muscle area predict post-TAVI morbidity and mortality better than traditional clinical frailty scores?
Effect estimate: adjusted regression coefficient 1.26 (95% CI 1.05-1.50)
p-value: p=0.013
Traditional clinical frailty scores outperform CT-derived psoas muscle area in predicting post-TAVI outcomes, highlighting the continued importance of clinical assessment.
Supports prioritizing Clinical Frailty Score for post-TAVI mortality risk; leaves open whether psoas area adds value in observational data.
OBJECTIVES: Frailty is common amongst patients undergoing transcatheter aortic valve implantation (TAVI). The aim of this study was to determine the prognostic relevance of newer objective and traditional measures of frailty after TAVI. METHODS: Consecutive patients were identified from the Leeds Teaching Hospitals Trust TAVI database. Frailty was quantified objectively by measuring the total psoas muscle area (TPMA) on routine computer tomography scans and compared against Canadian Study of Health and Aging Clinical Frailty Score, Katz Index of independence in activities of daily living and Clinician Estimated Poor Mobility. Postintervention morbidity and mortality were examined between these scoring systems. RESULTS: The current study included 420 patients who had undergone TAVI between January 2013 and December 2015. Median clinical follow-up was 4.0 years (interquartile range 2.9-5.0). Standardized measurements of the TPMA were not associated with either postintervention morbidity or mortality. Only the Canadian Study of Health and Aging Clinical Frailty Score was associated with hospital stay (adjusted regression coefficient 0.70, 95% confidence interval 0.04-1.36, P = 0.038) and overall all-cause mortality (adjusted regression coefficient 1.26, 95% confidence interval 1.05-1.50, P = 0.013). There were no significant correlations between TPMA and any of the traditional frailty tools. CONCLUSION: We demonstrate TPMA to be a poor measure of patient frailty when compared with traditional methods of assessment which failed to predict postintervention outcomes. Furthermore, morphometric sarcopaenia correlated poorly with established measures of frailty.
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Waduud et al. (2020) conducted a cohort in Transcatheter aortic valve implantation (TAVI) (n=420). Total psoas muscle area (TPMA) vs. Traditional frailty measures (e.g., Clinical Frailty Score) was evaluated on Postintervention morbidity and mortality (adjusted regression coefficient 1.26, 95% CI 1.05-1.50, p=0.013). Total psoas muscle area did not predict post-TAVI outcomes, whereas the Clinical Frailty Score was associated with all-cause mortality (adjusted coefficient 1.26; 95% CI 1.05-1.50; P=0.013).
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