Clinical Outcomes of Subcutaneous and Visceral Adipose Tissue Characteristics Assessed in Patients Underwent Transcatheter Aortic Valve Replacement

Abstract

Background Adipose tissue (AT) characteristics are considered to be a marker for predicting clinical outcomes. This study aimed to investigate the prognostic value of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) computed tomography (CT) assessment in patients who underwent transcatheter aortic valve replacement (TAVR). Methods We used the Japanese multicentre registry data of 1372 patients (age: 84.5 ± 5.0 years, women: 70.6%) who underwent TAVR. The SAT and VAT were assessed according to the preprocedural CT area and density. Baseline characteristics and clinical outcomes were compared based on the differences in AT characteristics. The independent associations with all-cause mortality after TAVR were evaluated according to the CT area and density of AT. Results Low-volume area of SAT and VAT was associated with worse clinical outcomes compared with high-volume area of SAT and VAT in patients who underwent TAVR (log-rank test P = 0.016 and P = 0.014). High CT density of SAT and VAT was associated with increasing mortality in comparison with low CT density of SAT and VAT (log-rank test P < 0.001 and P = 0.007). The Cox regression multivariate analysis demonstrated the independent association of increased all-cause mortality in the high SAT and VAT density (hazard ratio [HR]: 1.41, 95% confidence interval [CI]: 1.06-1.88, P = 0.019, and HR: 1.34, 95% CI: 1.03-1.76, P = 0.031, respectively), but not in the low SAT and VAT area (HR: 0.85, 95% CI: 0.74-1.29, P = 0.85, and HR: 0.78, 95% CI: 0.60-1.03, P = 0.085, respectively). Conclusions CT-derived AT characteristics, particularly the qualitative assessments, were useful for predicting the prognosis in patients after TAVR.

Sarcopenia and adipose tissue evaluation by artificial intelligence predicts the overall survival after TAVI

“…Similarly to the previous study 8 , men presented with a higher VAT index than women, and women presented with a higher SAT index than men also in our study. Nevertheless, the amount of fat indexed for body height did not affect all-cause mortality in our study, similar to the study by Shibata et al 10 . On the other hand, lower VAT and SAT area (not indexed to height) in the study by Foldyna predicted worse outcomes after TAVI 30 .…”

“…Indeed, sarcopenia is very common in the elderly population (11 to 50% of patients over 80 years based on the methodology used) 2 , 3 , and the presence of sarcopenia was repeatedly associated with prolonged hospitalization and increased mortality in TAVI patients 4 – 6 . On the other hand, the presence of obesity, another widespread condition in the elderly population, was shown to be protective in this patient group if defined using body mass index (BMI) 7 —this fact is described as the “obesity paradox.” Nevertheless, recent studies implementing data derived from preprocedural CT-scan are not so conclusive as some of them showed no effect of fat area on mortality 8 , 9 , while others indicated that alterations not in the adipose tissue area but in the adipose tissue density may be of prognostic significance 10 .…”

Methodology, clinical applications, and future directions of body composition analysis using computed tomography (CT) images: A review

“…[119], [120], [121], [122] Preoperative low VAT and SAT (umbilical level) is associated with increased mortality. [174] Metabolic diseases Decreased skeletal muscle mass (L3, L4-5)…”

X-ray attenuation of bone, soft and adipose tissue in CT from 70 to 140 kV and comparison with 3D printable additive manufacturing materials

“…By some authors it is reported as − 90 to slightly less than − 100 HU 46 , 47 in patients in the abdominal region. Other authors report average adipose tissue values between − 63 to − 88 with an average of − 79 HU for visceral fat, and − 64 to − 104 (average − 89) for subcutaneous adipose tissue 48 using standard scan protocols applying a tube potential of 120 kV. CT numbers of adipose tissues in this work were higher, with the lowest values seen in the visceral fat segmented in the bovine rib sample.…”