Importance of combined assessment of skeletal muscle mass and density by computed tomography in predicting clinical outcomes after transcatheter aortic valve replacement

• DOI: 10.1007/s10554-020-01776-x
• Publication Date: 2020-02-10T09:03:01Z
• Authors: Takahiro Tokuda; Masanori Yamamoto; Ai Kagase; Yutaka Koyama; Toshiaki Otsuka; Norio Tada; Toru Naganuma; Motoharu Araki; Futoshi Yamanaka; Shinichi Shirai; Kazuki Mizutani; Minoru Tabata; Hiroshi Ueno; Kensuke Takagi; Akihiro Higashimori; Yusuke Watanabe; Kentaro Hayashida
• Keywords: Aged, 80 and over; Male; Sarcopenia; Time Factors; Aortic Valve Stenosis; Risk Assessment; 3. Good health; Transcatheter Aortic Valve Replacement; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Japan; Predictive Value of Tests; Risk Factors; Multidetector Computed Tomography; Body Composition; Humans; Female; Registries; Muscle, Skeletal; Geriatric Assessment; Aged; Retrospective Studies

Skeletal muscle mass (SMM) as calculated by computed tomography (CT) is a predictor of all-cause mortality after transcatheter aortic valve replacement (TAVR), but it remains unclear whether using CT-determined density of skeletal muscle has additive prognostic value. We utilized the Japanese multicenter registry data of 1375 patients who underwent CT prior to TAVR. Sarcopenia status was defined by the CT-derived SMM index (threshold: men, 55.4 cm2/m2; women, 38.9 cm2/m2). The threshold for high and low CT density was based on the median value of the entire cohort (men: 33.4 HU; women: 29.5 HU). Sarcopenia was observed in 802 patients (58.3%) overall. Patients were categorized into non-sarcopenia and high-CT density (n = 298), non-sarcopenia and low-CT density (n = 275), sarcopenia and high-CT density (n = 399), and sarcopenia and low-CT density (n = 403) groups, and procedural outcomes and mortality compared. The cumulative 3-year mortality rates in these groups were 18%, 27%, 24%, and 32%, respectively. Cox-regression multivariate analysis revealed that low-CT density (compared with high-CT density) and sarcopenia and low-CT density (compared with non-sarcopenia and high-CT density as reference) increased mortality after TAVR (hazard ratios [HR]: 1.35 and 1.43, 95% confidence intervals [Cis]: 1.06-1.72 and 1.00-2.08, p = 0.01, and 0.049, respectively). However, sarcopenia alone was not related to an increased risk of mortality (HR 1.30, 95% CI 0.99-1.69, p = 0.52). In conclusion, CT density-based skeletal muscle quality assessment combined with the SMM index improves prediction of adverse outcomes after TAVR.