Association of CT-Based Sarcopenia, Clinical Frailty, and Nutritional Status With Mortality After Aortic Valve Replacement for Severe Aortic Stenosis

Q: What are the key findings of this study?

CT-defined sarcopenia was independently associated with a significantly increased risk of 1-year all-cause mortality (HR 2.63) after aortic valve replacement for severe aortic stenosis.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Severe aortic stenosis (n=407). Intervention: CT-defined sarcopenia vs. Absence of sarcopenia. Primary outcome: All-cause mortality within 1 year (HR 2.63, 95% CI 1.22-5.67, p=0.014).

Q: What does this research mean for the field?

CT-defined sarcopenia and higher Clinical Frailty Scale scores are independently associated with a significantly increased risk of 1-year all-cause mortality after aortic valve replacement for severe aortic stenosis. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Jin Ha Park; Hyun‐Soo Zhang; Suji Lee; Sarah Soh; Young Joo Suh

doi:10.3348/kjr.2026.0589

January 1, 2026Korean Journal of RadiologyOpen Access

Association of CT-Based Sarcopenia, Clinical Frailty, and Nutritional Status With Mortality After Aortic Valve Replacement for Severe Aortic Stenosis

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Key result

CT-defined sarcopenia linked to ~163% higher one-year mortality after AVR for severe aortic stenosis.

HR 2.63
95% CI 1.22-5.67
P=0.014
n=407

Why the study?

Do frailty-related markers (Clinical Frailty Scale, CONUT score, and CT-based sarcopenia) predict mortality in patients with severe aortic stenosis undergoing aortic valve replacement?

Key Points

To evaluate the association of the Clinical Frailty Scale, Controlling Nutritional Status score, and CT-defined sarcopenia with 1-year all-cause mortality following aortic valve replacement for severe aortic stenosis.
Retrospectively analyzed 407 patients with severe aortic stenosis who underwent surgical or transcatheter aortic valve replacement at a tertiary center between November 2020 and December 2022.
Evaluated functional frailty with the Clinical Frailty Scale (CFS), nutritional status with the Controlling Nutritional Status (CONUT) score, and structural sarcopenia via sex-specific tertiles of the paravertebral muscle index at the T12 vertebral level on CT.
Conducted multivariable Cox proportional hazards regression to determine independent predictors of 1-year mortality, adjusting for the Society of Thoracic Surgeons (STS) score.
Within 1 year after aortic valve replacement, 32 patients (7.9%) died; mortality was 15.4% (21/136) in patients with sarcopenia compared to 4.1% (11/271) in those without sarcopenia.
In overall multivariable analysis, higher CFS scores (HR 1.82, 95% CI 1.40–2.38; P < 0.001) and CT-defined sarcopenia (HR 2.63, 95% CI 1.22–5.67; P = 0.014) independently predicted mortality, whereas the STS score (HR 1.00, 95% CI 0.95–1.06; P = 0.883) and CONUT score (HR 1.05, 95% CI 0.90–1.22; P = 0.563) did not.
A significant interaction occurred between sarcopenia and nutritional status: higher CONUT scores predicted mortality only in patients without sarcopenia (HR 1.57, 95% CI 1.16–2.13; P = 0.004) and not in those with sarcopenia (HR 0.91, 95% CI 0.76–1.09; P = 0.313).

Study Design

Type

Cohort (n=407)

Multicenter

No

Structured PICO

Do frailty-related markers (Clinical Frailty Scale, CONUT score, and CT-based sarcopenia) predict mortality in patients with severe aortic stenosis undergoing aortic valve replacement?

P

Population

407 patients (mean age 78.0 years, 54.3% female) with severe aortic stenosis who underwent surgical or transcatheter aortic valve replacement, followed for 1 year.

E

Exposure

Assessment of frailty-related markers (Clinical Frailty Scale, CONUT score, and CT-based sarcopenia) prior to surgical or transcatheter aortic valve replacement (AVR)

O

Outcome

All-cause mortality within 1 year after AVRhard clinical

Main Result

Hazard Ratio: 2.63 (95% CI 1.22–5.67)

Absolute Event Rate: 15.4% vs 4.1%

p-value: p=0.014

Limitations

Single-center observational study with inherent limitations of retrospective analyses
Inter-rater reliability of the Clinical Frailty Scale was not assessed
Sarcopenia cutoffs were derived from cohort tertiles rather than established external standards
Limited number of deaths (32 total) introduces a risk of overfitting and instability in the models
Potential residual confounding related to treatment selection between SAVR and TAVR
Single-center observational study with retrospective design
PMI at T12 cutoff values for sarcopenia were derived from lower tertiles within the cohort rather than established external standards
Limited number of deaths, leading to an inherent risk of overfitting and instability in interaction and stratified models
Residual confounding related to treatment selection between SAVR and TAVR could not be completely excluded

Implication

Higher Clinical Frailty Scale scores and CT-based sarcopenia are independently associated with 1-year mortality after aortic valve replacement for severe aortic stenosis, providing complementary prognostic value.

Abstract

Objective: This study investigated the association between multiple frailty-related markers-Clinical Frailty Scale (CFS), Controlling Nutritional Status (CONUT) score, and computed tomography (CT)-based sarcopenia-and overall survival after aortic valve replacement (AVR) for severe aortic stenosis (AS), with particular emphasis on the first year after AVR. Materials and Methods: A total of 407 patients with severe AS who underwent surgical or transcatheter AVR at a tertiary center between November 2020 and December 2022 were retrospectively included.Three frailty-related markers were analyzed: CFS score for functional frailty, CONUT score for nutritional status, and CT-defined sarcopenia for structural muscle depletion.The CONUT score was calculated using serum markers, and sarcopenia was defined according to cohort-specific tertiles of the paravertebral muscle index quantified at the 12th thoracic vertebra (T12) vertebral level using CT.Multivariable Cox proportional hazards analysis was performed to assess the prognostic associations of the Society of Thoracic Surgeons (STS) score and the three frailty-related markers with all-cause mortality after AVR.Results: Within 1 year after AVR, 32 patients (7.9%) died.In the overall multivariable analysis, higher CFS scores and CTdefined sarcopenia were independently associated with mortality, with hazard ratios (HRs) of 1.82 (95% confidence interval [CI], 1.40-2.38;P < 0.001) and 2.63 (95% CI, 1.22-5.67;P = 0.014), respectively.The STS score and CONUT scores were not associated with survival, with HRs of 1.00 (95% CI, 0.95-1.06;P = 0.883) and 1.05 (95% CI, 0.90-1.22;P = 0.563), respectively.A significant interaction was observed between the CONUT score and sarcopenia.Conclusion: Among patients with severe AS undergoing AVR, higher CFS scores and CT-based sarcopenia were independently associated with survival after adjustment for the STS score.The prognostic association of the CONUT score differed according to sarcopenia status.These findings support the incorporation of functional and structural vulnerabilities into risk assessment for patients undergoing AVR for AS; however, the role of nutritional status requires further investigation.

Discussion

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Cite This Study

Park et al. (2026) conducted a cohort in Severe aortic stenosis (n=407). CT-defined sarcopenia vs. Absence of sarcopenia was evaluated on All-cause mortality within 1 year (HR 2.63, 95% CI 1.22-5.67, p=0.014). CT-defined sarcopenia was independently associated with a significantly increased risk of 1-year all-cause mortality (HR 2.63) after aortic valve replacement for severe aortic stenosis.

synapsesocial.com/papers/6aa9016aeed42882c1fc17f7 https://doi.org/10.3348/kjr.2026.0589

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Association of CT-Based Sarcopenia, Clinical Frailty, and Nutritional Status With Mortality After Aortic Valve Replacement for Severe Aortic Stenosis

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Association of CT-Based Sarcopenia, Clinical Frailty, and Nutritional Status With Mortality After Aortic Valve Replacement for Severe Aortic Stenosis

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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