Quality of Life after Transcatheter Aortic Valve Replacement in Sarcopenic Patients Using the Toronto Aortic Stenosis Quality of Life Questionnaire

Abstract

Background: Sarcopenia is the core component of frailty; however, its role in patients undergoing transcatheter aortic valve replacement (TAVR) is a matter of debate. The Toronto Aortic Stenosis Quality of Life Questionnaire (TASQ) is a validated instrument for assessing quality of life (QoL) in patients with severe aortic stenosis (AS). Aims: We aim to evaluate the QoL of sarcopenic and non-sarcopenic patients with severe AS undergoing TAVR. Methods: TASQ was prospectively administered to patients undergoing TAVR. All patients completed the TASQ before TAVR and at a 3-month follow-up. The study population was divided in two groups according to sarcopenic status. The primary endpoint was the TASQ score in the sarcopenic and non-sarcopenic cohorts. Results: In total, 99 patients were eligible for the analysis. In both sarcopenic (n = 56) and non-sarcopenic (n = 43) cohorts, significant changes were observed in the overall TASQ score and in all but one (i.e., health expectations) of the individual domains (p < 0.01). Sarcopenic and non-sarcopenic patients showed substantial improvements across TASQ subscores. The mean change in overall TASQ score at three months revealed a significant improvement in both cohorts (p < 0.01). Health expectations worsened in sarcopenic patients at the 3-month follow-up (p = 0.06). Conclusions: The TASQ questionnaire revealed changes in QoL after TAVR, regardless of patients’ sarcopenic status. Health status improved substantially in both sarcopenic and non-sarcopenic patients following TAVR. Lack of improvement in health expectations seems to depend on patients’ expectations regarding the procedure and specific aspects in the evaluation of the outcome.

Quality of life in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation: tools and evidence

“…Although it is a ‘new’ questionnaire, the TASQ is effective in assessing minimal changes in QoL among patients with severe aortic stenosis who undergo TAVI or AVR. Quality of life improved substantially after either intervention, as indicated by changes in the TASQ overall score, 36,59 even in frail, sarcopenic patients 60 …”

“…Quality of life improved substantially after either intervention, as indicated by changes in the TASQ overall score, 36,59 even in frail, sarcopenic patients. 60 As for QoL in minimally symptomatic patients, interesting data have come from the STS/ACC/TVT Registry, recently published by Huded et al 61 Two hundred and thirty-one thousand two hundred and eighty-five patients were included who underwent TAVI between 2015 and 2021. All patients included had preserved ejection fraction and 20% of them were minimally symptomatic prior to the intervention.…”

Living in disadvantaged neighborhoods linked to less intervention for severe aortic stenosis

“…Theoretically any patient younger than this age could be eligible for intervention and hence the age 95 was chosen as an upper limit. In a recent study by Pesarini and associates 23 , TAVR was associated with improved quality of life in both patients with and without sarcopenia, a marker of frailty, which implies that it is reasonable to offer intervention to the elderly population. Yet, the overall percentage of patients undergoing intervention in this study is low (47%) and the nadir was in the most disadvantaged groups which are relatively younger and could experience increase life expectancy after AVR.…”

Advanced Cardiac Imaging in the Assessment of Aortic Stenosis

“…The highly specialized leaflets that form the valve and must be compliant enough to open without resistance to blood flow become stiff and lose compliance. This results in an increase in the intraventricular pressure required to maintain the flow across the valve, which ultimately leads to myocardial decompensation and triggers patient symptoms [1,2]. Despite the high disease prevalence, there are no medical therapies to halt or delay disease progression, and the only available treatment is aortic valve replacement or implantation.…”