Impact of Severe Sarcopenia on Rehospitalization and Survival One Year After a TAVR Procedure in Patients Aged 75 and Older

Figures & data

Figure 1 Patients flow diagram.

Abbreviations: TAVR, transcatheter aortic valve replacement; GP, general practitioner.

Table 1 Baseline Characteristics of Patients (N=182) and With or Without Rehospitalization

Characteristics	All Participants	Rehospitalization
	182	Yes=64	No=118	p-value
Age ^a	84 (81–86)	84 (82–86)	84 (80–85)	0.19
Male ^b	91 (50)	35 (54.7)	54 (45.7)	0.50
Baseline Characteristics
CIRS-G score ^a	9.0 (7.0–11.0)	9 (8–11)	9 (7–11)	0.16
Euroscore I ^a	9.4 (7.0–13.9)	10.6 (7.2–18.6)	8.8 (6.7–13)	0.02
Euroscore II	2.9 (1.8–4.6)	3.4 (1.9–5.1)	2.8 (1.8–4.2)	0.14
Cockcroft Renal clearance ^a	55.9 (44.4–70.0)	53 (42–70)	59 (45–70)	0.28
NYHA ≥ 3, n (%)	46 (25.2)	17 (26.5)	29 (24.6)	1
LVEF ^a	60 (54–65)	60 (55–65)	61 (55–65)	0.20
Reduced LVEF ^b	24 (13.2)	10 (15.6)	13 (11.0)	0.59
Pulmonary hypertension ^b	42 (23.1)	18 (28.1)	24 (20.3)	0.41
Atrial fibrillation ^b	63 (34.6)	24 (37.5)	36 (30.5)	0.58
Peripheral artery disease ^b	17 (9.3)	7 (10.9)	8 (6.7)	0.55
Diabetes ^b	30 (16.5)	16 (25.0)	14 (11.8)	0.02
Coronary artery disease ^b	96 (52.7)	35 (54.7)	58 (49.1)	0.83
Body mass index ^a	26.4 (23.8–29.6)	26.6 (24.1–29.9)	26.3 (24.1–30.3)	0.56
Mini Nutritional Assessment ^a	25 (24–26)	25 (24–26)	25 (24–26)	0.38
Malnutrition* ^b	9 (4.9)	2 (3.1)	6 (5.1)	0.71
Mini Mental Status score ^a	25 (24–28)	26 (24–27)	26 (24–28)	0.78
ADL ^a	6 (6–6)	6 (6–6)	6 (6–6)	0.55
IADL ^a	4 (3–4)	4 (3–4)	4 (3–4)	0.59
Sarcopenia data
Gait speed ^a	0.90 ± 0.23	0.85 ± 0.25	0.92 ± 0.22	0.10
Total SMI**, cm^2/m^2 a	52.5 ± 8.3	53.1 ± 8.1	52.6 ± 8.5	0.64
Total SMRA**, UH ^a	25.1 ± 14.5	24.7 ± 13.8	25.3 ± 12.1	0.79
Severe Sarcopenia ^b	9 (4.9)	3 (4.7)	6 (5.0)	0.58
TAVR procedure
Femoral approach ^b	167 (91.7)	58 (90.6)	104 (88.1)	0.81
Length of stay ^a	6 (5–8)	7 (5–8)	5 (4–7)	0.04
Rehabilitation	37 (20)	15 (23)	22 (18)	0.56

Notes: Significant p-value (ie, p < 0.05) indicated in bold. *Malnutrition, BMI ≤ 21 kg/m² or MNA < 17; **total: psoas, paraspinal and abdominal wall muscles; ^amedian (Interquartile Range), or mean ± SD depending on normality; ^bn(%).

Abbreviations: CIRS-G, Cumulative Illness Rating Scale-Geriatric (range 0 to 56); NYHA, New York Heart Association; LVEF, left ventricular ejection fraction; ADL, activity of daily living. IADL, instrumental activities of daily living; SMI, skeletal muscle index; SMRA, skeletal muscle mean attenuation.

Table 2 Association of Preprocedural Factors with Rehospitalization One Year After Transcatheter Aortic Valve Implantation, in Multivariable Cox Regression

Preprocedural Factors	Rehospitalization
	HR (95% CI)	p-value
Age	1.04 (0.96–1.12)	0.29
Male	1.05 (0.61–1.83)	0.85
EuroSCORE I	1.03 (0.99–1.06)	0.06
Left Ventricular Ejection Fraction	0.99 (0.96–1.02)	0.41
Diabetes	2.06 (1.11–3.84)	0.02
Severe Sarcopenia	0.98 (0.71–2.13)	0.34

Note: p-value and hazard ratio (HR) significant (ie, p < 0.05): indicated in bold.

Table 3 Prevalence of Loss of Skeletal Muscle Mass on CT-Scan and Severe Sarcopenia According to Previously Published Threshold

Study (Year)	CT-Scan Cut-Off for Loss of Skeletal Muscle Mass for Men and Women	Prevalence
		Loss of Skeletal Muscle Mass on CT-Scan	Severe Sarcopenia (Loss of Skeletal Muscle Mass on CT-Scan + Gait Speed < 0.8m/sec)
Dahya (2016)^Citation15 Damluji (2021)^Citation21	Total SMI < 55.0 cm^2/m^2 in men < 39.0 cm^2/m^2 in women	55 (30.2%)	9 (4.9%)
Mok (2016)^Citation19 Nemec (2017)^Citation18 Heidari (2019)^Citation16 Tokuda(2020)^Citation20	Total SMI < 55.4 cm^2/m^2 in men < 38.9 cm^2/m^2 in women	56 (30.7%)	9 (4.9%)
Krishnan (2019)^Citation17	Total SMI < 50.0 cm^2/m^2 in men < 35.0 cm^2/m^2 in women	26 (14.3%)	4 (2.2%)
Mamane (2019)^Citation13	Psoas SMA < 20.3 cm^2 in men < 11.8 cm^2 in women	117 (64.3%)	36 (19.7%)

Dahya V, Xiao J, Prado CM, et al. Computed tomography-derived skeletal muscle index: a novel predictor of frailty and hospital length of stay after transcatheter aortic valve replacement. Am Heart J. 2016;182:21–27. doi:10.1016/j.ahj.2016.08.01627914496

 PubMed Web of Science ®Google Scholar

Damluji AA, Rodriguez G, Noel T, et al. Sarcopenia and health-related quality of life in older adults after transcatheter aortic valve replacement. Am Heart J. 2020;224:171–181. doi:10.1016/j.ahj.2020.03.02132416332

 PubMed Web of Science ®Google Scholar

Mok M, Allende R, Leipsic J, et al. Prognostic value of fat mass and skeletal muscle mass determined by computed tomography in patients who underwent transcatheter aortic valve implantation. Am J Cardiol. 2016;117(5):828–833. doi:10.1016/j.amjcard.2015.12.01526754122

 PubMed Web of Science ®Google Scholar

Nemec U, Heidinger B, Sokas C, Chu L, Eisenberg RL. Diagnosing sarcopenia on thoracic computed tomography: quantitative assessment of skeletal muscle mass in patients undergoing transcatheter aortic valve replacement. Acad Radiol. 2017;24(9):1154–1161. doi:10.1016/j.acra.2017.02.00828365235

 PubMed Web of Science ®Google Scholar

Heidari B, Al-Hijji MA, Moynagh MR, et al. Transcatheter aortic valve replacement outcomes in patients with sarcopenia. EuroIntervention. 2019;15(8):671–677. doi:10.4244/EIJ-D-19-0011031062696

 PubMed Web of Science ®Google Scholar

Tokuda T, Yamamoto M, Kagase A, et al. Importance of combined assessment of skeletal muscle mass and density by computed tomography in predicting clinical outcomes after transcatheter aortic valve replacement. Int J Cardiovasc Imaging. 2020;36(5):929–938. doi:10.1007/s10554-020-01776-x32040683

 PubMed Web of Science ®Google Scholar

Krishnan A, Suarez-Pierre A, Zhou X, et al. Comparing frailty markers in predicting poor outcomes after transcatheter aortic valve replacement. Innovations. 2019;14(1):43–54. doi:10.1177/155698451982769830848712

 PubMedGoogle Scholar

Mamane S, Mullie L, Lok Ok Choo W. Sarcopenia in Older Adults Undergoing Transcatheter Aortic Valve Replacement. J Am Coll Cardiol. 2019;74(25):3178–3180. doi:10.1016/j.jacc.2019.10.03031856975

 PubMed Web of Science ®Google Scholar