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CT determined psoas muscle area predicts mortality in women undergoing transcatheter aortic valve implantation
Author(s) -
van Mourik Martijn S.,
Janmaat Yvonne C.,
van Kesteren Floortje,
Vendrik Jeroen,
Planken R. Nils,
Henstra Marieke J.,
Velu Juliëtte F.,
Vlastra Wieneke,
Zwinderman Aeilko H.,
Koch Karel T.,
de Winter Robbert J.,
Wykrzykowska Joanna J.,
Piek Jan J.,
Henriques José P. S.,
Lanting Vincent R.,
Baan Jan,
Latour Corine,
Lindeboom Robert,
Vis M. Marije
Publication year - 2019
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27823
Subject(s) - medicine , hazard ratio , cardiology , confidence interval , euroscore , population , risk stratification , aortic valve , cardiac surgery , environmental health
Objectives The aim of this study was to assess the predictive value of PMA measurement for mortality. Background Current surgical risk stratification have limited predictive value in the transcatheter aortic valve implantation (TAVI) population. In TAVI workup, a CT scan is routinely performed but body composition is not analyzed. Psoas muscle area (PMA) reflects a patient's global muscle mass and accordingly PMA might serve as a quantifiable frailty measure. Methods Multi‐slice computed tomography scans (between 2010 and 2016) of 583 consecutive TAVI patients were reviewed. Patients were divided into equal sex‐specific tertiles (low, mid, and high) according to an indexed PMA. Hazard ratios (HR) and their confidence intervals (CI) were determined for cardiac and all‐cause mortality after TAVI. Results Low iPMA was associated with cardiac and all‐cause mortality in females. One‐year adjusted cardiac mortality HR in females for mid‐iPMA and high‐iPMA were 0.14 [95%CI, 0.05–0.45] and 0.40 [95%CI, 0.15–0.97], respectively. Similar effects were observed for 30‐day and 2‐years cardiac and all‐cause mortality. In females, adding iPMA to surgical risk scores improved the predictive value for 1‐year mortality. C‐statistics changed from 0.63 [CI = 0.54–0.73] to 0.67 [CI: 0.58–0.75] for EuroSCORE II and from 0.67 [CI: 0.59–0.77] to 0.72 [CI: 0.63–0.80] for STS‐PROM. Conclusions Particularly in females, low iPMA is independently associated with an higher all‐cause and cardiac mortality. Prospective studies should confirm whether PMA or other body composition parameters should be extracted automatically from CT‐scans to include in clinical decision making and outcome prediction for TAVI.