Computed tomography-based fat and muscle characteristics are associated with mortality after transcatheter aortic valve replacement

Foldyna, Borek; Troschel, Fabian M.; Fintelmann, Florian J.; Elmariah, Sammy; Furman, Deborah; Eslami, Parastou; Ghoshhajra, Brian B.; Lu, Michael T.; Murthy, Venkatesh L.; Hoffmann, Udo; Shah, Ravi

doi:10.1016/j.jcct.2018.03.007

Cited by 45 publications

(40 citation statements)

References 27 publications

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“… 14 Another study suggested the significant correlation of both small SAT and VAT areas with poor prognosis, and reported that the highest quartile of the CT density in SAT (but not in VAT) was an independent factor for increased mortality after TAVR. 15 Our data are in partial agreement with the results of previous studies. However, the CT area of AT differed between sexes and likely weakened the prognostic predictive value compared with CT density.…”

Section: Discussionsupporting

confidence: 92%

“…As we discussed, the volume and density of AT were different from those of younger patients and the western TAVR cohort. 13 , 15 , 25 Again, the age- and race-specific differences should be confirmed by further study. Third, several confounding factors were considered in the Cox regression model.…”

Section: Discussionmentioning

confidence: 84%

“…Some clinical articles have noted the correlation between AT and clinical outcome after TAVR. 13 , 14 , 15 These studies reported that the fat area alone was not related to clinical outcomes 13 and that a small SAT area alone (the VAT area was not mentioned) was associated with a poor outcome. 14 Another study suggested the significant correlation of both small SAT and VAT areas with poor prognosis, and reported that the highest quartile of the CT density in SAT (but not in VAT) was an independent factor for increased mortality after TAVR.…”

Section: Discussionmentioning

confidence: 99%

“…A few reports have evaluated the prognostic impact of AT characteristics assessed by CT in patients who underwent TAVR. 13 , 14 , 15 However, there remains a paucity of data due to the relatively small sample sizes and lack of CT density information. The current study therefore aimed to investigate the clinical impact of CT-derived AT area and density information on the prognosis of patients who underwent TAVR using large-scale Japanese multicentre registry data.…”

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confidence: 99%

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

et al. 2021

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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.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

et al. 2021

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“…In a series of 161 consecutive pneumonectomy patients, we have previously showed that sarcopenia (defined as sex-specific total psoas area [TPA] at the 3rd lumbar vertebra level below the 33rd percentile), was an independent negative prognostic factor of long-term survival [ 8 ]. Since that publication, there has been accumulating evidence that, in cancer patients (regardless from the kind of cancer and administered treatments), sarcopenia can be better assessed by taking into account the other abdominal muscles (Total Muscular Parietal Area, TMPA) at the same level (L3), thus calculating Total Muscular Area (TMA; TMA = TPA + TMPA); TMA would have better prognostic discrimination than TPA [ 10 , 11 , 12 ]. Furthermore, technological evolutions allow easy calculation by a computed tomography-scan (CT-scan) of muscular fat content, allowing to take into account only the muscular part of each muscle, in the idea that muscular fat infiltration (i.e., myosteatosis) could impact the outcome [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Total Psoas Area and Total Muscular Parietal Area Affect Long-Term Survival of Patients Undergoing Pneumonectomy for Non-Small Cell Lung Cancer

Daffré¹,

Prieto²,

Martini

et al. 2021

Cancers

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There is no standardization in methods to assess sarcopenia; in particular the prognostic significance of muscular fatty infiltration in lung cancer patients undergoing surgery has not been evaluated so far. We thus performed several computed tomography (CT)-based morphometric measurements of sarcopenia in 238 consecutive non-small cell lung-cancer patients undergoing pneumonectomy from 1 January 2007 to 31 December 2015. Sarcopenia was assessed by the following CT-based parameters: cross-sectional total psoas area (TPA), cross-sectional total muscle area (TMA), and total parietal muscle area (TPMA), defined as TMA without TPA. Measures were performed at the level of the third lumbar vertebra and were obtained for the entire muscle surface, as well as by excluding fatty infiltration based on CT attenuation. Findings were stratified for gender, and a threshold of the 33rd percentile was set to define sarcopenia. Furthermore, we assessed the possibility of being sarcopenic at both the TPA and TPMA level, or not, by taking into account of not fatty infiltration. Five-year survival was 39.1% for the whole population. Lower TPA, TMA, and TPA were associated with lower survival at univariate analysis; taking into account muscular fatty infiltration did not result in more powerful discrimination. Being sarcopenic at both psoas and parietal muscle level had the optimum discriminating power. At the multivariable analysis, being sarcopenic at both psoas and parietal muscles (considering the whole muscle areas, including muscular fat), male sex, increasing age, and tumor stage, as well as Charlson Comorbidity Index (CCI), were independently associated with worse long-term outcomes. We conclude that sarcopenia is a powerful negative prognostic factor in patients with lung cancer treated by pneumonectomy.

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Sarcopenia index as a predictor of clinical outcomes in older patients undergoing transcatheter aortic valve replacement

Romeo

Chiabrando

Seropián

et al. 2021

Cathet Cardio Intervent

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Background: Sarcopenia is a prevalent condition in elderly patients and has been associated with adverse outcomes following transcatheter aortic valve replacement (TAVR). The present study aimed to determine the predictive value of serum creatinine-cystatin C ratio, that is, "Sarcopenia Index" (SI) as a surrogate marker of sarcopenia, and investigate its association with clinical outcomes after TAVR. Methods:We conducted a retrospective observational study of patients undergoing TAVR between January, 2016 and December, 2018 at Hospital Italiano de Buenos Aires, Argentina. Patients were excluded if <65-years old, presented previous surgical aortic valve replacement, severe chronic kidney disease, or hemodialysis requirement.The SI was obtained at baseline before TAVR. All-cause mortality and/or readmissions for congestive heart failure (CHF) were defined as the primary endpoint.Results: In total 100 patients met inclusion criteria for the purpose of the study. Sarcopenia Index was significantly correlated with Timed Up and Go (r = À0.272, p = .010) and Gait Speed (r = À0.278, p = .005). During follow-up, 5/100 patients died within 30 days and a total of 10/100 patients died at 1-year follow-up. Moreover, survival curves were significantly worse (Log-rank test = p = .02) and CHF readmissions were more prevalent in the lowest SI tertile (Log-rank test = p = .01).In multivariate Cox regression analysis, we identified low SI (cutoff ≤66) as an independent predictor of long-term adverse outcomes (HR = 4.01, 95% CI = 1.31-12.27, p = .015) at 1-year follow-up.Conclusion: Sarcopenia Index, surrogate for the degree of skeletal muscle mass (SMM), could be used as a predictor of adverse outcomes in patients undergoing TAVR.

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Computed tomography-based fat and muscle characteristics are associated with mortality after transcatheter aortic valve replacement

Cited by 45 publications

References 27 publications

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

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

Total Psoas Area and Total Muscular Parietal Area Affect Long-Term Survival of Patients Undergoing Pneumonectomy for Non-Small Cell Lung Cancer

Sarcopenia index as a predictor of clinical outcomes in older patients undergoing transcatheter aortic valve replacement

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