Key result
Higher muscle area linked to ~7% lower 5-year mortality after TAVR.
Why the study?
Few data are available on frailty parameters such as total muscle area and visceral adipose tissue measured by pre-TAVR CT for risk assessment in TAVR patients.
Do CT-derived total muscle area and visceral adipose tissue predict 5-year all-cause mortality in patients undergoing TAVR?
Cohort (n=500)
Do CT-derived total muscle area and visceral adipose tissue predict 5-year all-cause mortality in patients undergoing TAVR?
Higher normalized total muscle area derived from routine pre-TAVR CT is associated with lower 5-year all-cause mortality, particularly in men, and can complement frailty assessment.
Answers are grounded in this paper and cite their sources.
May complement frailty assessment in TAVR; hypothesis-generating for muscle-targeted interventions.
Background: A careful work-up before Transcatheter aortic valve replacement (TAVR) consists not only of measuring anatomical conditions but also assessment of frailty. Previous studies have evaluated body composition parameters, primarily fat and muscle mass. Few data are available on other frailty parameters, which, however, can be easily determined by pre-TAVR computed tomography (CT). Objectives: The primary objective was to investigate the impact of total muscle area (TMA) and visceral adipose tissue (VAT), as frailty parameters, on 5-year all-cause mortality in patients undergoing TAVR. Methods: Between 01/2017 and 12/2018, consecutive TAVR patients undergoing CT-angiography scan enabling TMA and VAT measurement were included. A single axial image was acquired at the level of the middle third lumbar vertebra to perform TMA and VAT measurements using dedicated slicing software (Sliceomatic, TomoVision). Results: A total of 500 patients qualified for TMA analysis. Age was not associated with a higher risk of 5-year mortality HR 1.02 (95% CI: 0.998 - 1.049; p=0.069). Body surface area normalized TMA (nTMA) was significantly associated with 5-year all-cause mortality (HR 0.927, 95% CI: 0.927-0.997; p= 0.033), while VAT had no effect (HR 1.002, 95% CI: 0.99-1.015; p= 0.7). The effect of nTMA on 5- year all-cause mortality was gender-dependent: the protective effect of higher nTMA was found in male patients (pinteraction: sex * nTMA = 0.007). The combination of normalized TMA and VAT was not associated with higher mortality rates. Conclusion: Normalized TMA derived from routine CT before TAVR complements frailty assessment in patients undergoing TAVR.
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Demirel et al. (2024) conducted a cohort in TAVR patients (n=500). Total muscle area (TMA) and visceral adipose tissue (VAT) was evaluated on 5-year all-cause mortality (HR 0.927, 95% CI 0.927-0.997, p=0.033). Higher body surface area normalized total muscle area (nTMA) was significantly associated with reduced 5-year all-cause mortality in TAVR patients (HR 0.927; 95% CI 0.927-0.997; p=0.033).
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