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Psoas muscle size as a frailty measure for open and transcatheter aortic valve replacement.
J Thorac Cardiovasc Surg. 2016 Mar; 151(3):745-751.JT

Abstract

OBJECTIVE

To evaluate the use of sarcopenia as a frailty assessment tool for patients with aortic stenosis undergoing surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR).

METHODS

The study cohort comprised 295 patients who underwent either SAVR (n = 156) or TAVR (n = 139). The mean preoperative Society of Thoracic Surgeons mortality risk score was 4.7%. Preoperative computed tomography (CT) scans were used to calculate gender-standardized total psoas area (TPA), as a validated measure of sarcopenia.

RESULTS

For the entire cohort, independent predictors of a composite measure of 30-day death, stroke, renal failure, prolonged ventilation, and deep wound infection included preoperative STS major morbidity and mortality risk score (odds ratio [OR], 91.1; P = .02) and TPA (OR, 0.5; P = .024). Two-year survival was 85.7% in patients with sarcopenia, compared with 93.8% in patients without sarcopenia (P = .02). Independent predictors of late survival included TPA (hazard ratio, 0.47; P = .02). Male sex (OR, 0.52; P = .04) and TPA (OR, 0.6; P = .001) were predictive of high resource utilization. A separate analysis by treatment group found that TPA predicted high resource utilization after SAVR (OR, 0.4; P < .001), but not after TAVR (P = .66).

CONCLUSIONS

CT scan-derived measurement of TPA as an objective frailty assessment tool predicts early morbidity and mortality, high resource utilization, and late survival after treatment for aortic stenosis. The correlation observed between sarcopenia and resource utilization after SAVR versus TAVR suggests that this simple and reproducible risk assessment tool also may help identify those patients who will derive optimal benefit from catheter-based therapy.

Authors+Show Affiliations

Department of Cardiac Surgery, University of Michigan Medical Center, Ann Arbor, Mich; Morphomic Analysis Group, University of Michigan Medical Center, Ann Arbor, Mich.Morphomic Analysis Group, University of Michigan Medical Center, Ann Arbor, Mich.Morphomic Analysis Group, University of Michigan Medical Center, Ann Arbor, Mich.Department of Cardiac Surgery, University of Michigan Medical Center, Ann Arbor, Mich.Department of Medicine, University of Michigan Medical Center, Ann Arbor, Mich.Department of Medicine, University of Michigan Medical Center, Ann Arbor, Mich.Department of Surgery, University of Michigan Medical Center, Ann Arbor, Mich; Morphomic Analysis Group, University of Michigan Medical Center, Ann Arbor, Mich.Department of Surgery, University of Michigan Medical Center, Ann Arbor, Mich; Morphomic Analysis Group, University of Michigan Medical Center, Ann Arbor, Mich.Department of Cardiac Surgery, University of Michigan Medical Center, Ann Arbor, Mich; Morphomic Analysis Group, University of Michigan Medical Center, Ann Arbor, Mich. Electronic address: hjpatel@med.umich.edu.

Pub Type(s)

Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26896357

Citation

Paknikar, Raghavendra, et al. "Psoas Muscle Size as a Frailty Measure for Open and Transcatheter Aortic Valve Replacement." The Journal of Thoracic and Cardiovascular Surgery, vol. 151, no. 3, 2016, pp. 745-751.
Paknikar R, Friedman J, Cron D, et al. Psoas muscle size as a frailty measure for open and transcatheter aortic valve replacement. J Thorac Cardiovasc Surg. 2016;151(3):745-751.
Paknikar, R., Friedman, J., Cron, D., Deeb, G. M., Chetcuti, S., Grossman, P. M., Wang, S., Englesbe, M., & Patel, H. J. (2016). Psoas muscle size as a frailty measure for open and transcatheter aortic valve replacement. The Journal of Thoracic and Cardiovascular Surgery, 151(3), 745-751. https://doi.org/10.1016/j.jtcvs.2015.11.022
Paknikar R, et al. Psoas Muscle Size as a Frailty Measure for Open and Transcatheter Aortic Valve Replacement. J Thorac Cardiovasc Surg. 2016;151(3):745-751. PubMed PMID: 26896357.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Psoas muscle size as a frailty measure for open and transcatheter aortic valve replacement. AU - Paknikar,Raghavendra, AU - Friedman,Jeffrey, AU - Cron,David, AU - Deeb,G Michael, AU - Chetcuti,Stanley, AU - Grossman,P Michael, AU - Wang,Stewart, AU - Englesbe,Michael, AU - Patel,Himanshu J, Y1 - 2015/11/21/ PY - 2015/05/10/received PY - 2015/10/20/revised PY - 2015/11/02/accepted PY - 2016/2/21/entrez PY - 2016/2/21/pubmed PY - 2016/7/12/medline KW - aortic valve replacement KW - outcomes KW - transcatheter valve replacement SP - 745 EP - 751 JF - The Journal of thoracic and cardiovascular surgery JO - J Thorac Cardiovasc Surg VL - 151 IS - 3 N2 - OBJECTIVE: To evaluate the use of sarcopenia as a frailty assessment tool for patients with aortic stenosis undergoing surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). METHODS: The study cohort comprised 295 patients who underwent either SAVR (n = 156) or TAVR (n = 139). The mean preoperative Society of Thoracic Surgeons mortality risk score was 4.7%. Preoperative computed tomography (CT) scans were used to calculate gender-standardized total psoas area (TPA), as a validated measure of sarcopenia. RESULTS: For the entire cohort, independent predictors of a composite measure of 30-day death, stroke, renal failure, prolonged ventilation, and deep wound infection included preoperative STS major morbidity and mortality risk score (odds ratio [OR], 91.1; P = .02) and TPA (OR, 0.5; P = .024). Two-year survival was 85.7% in patients with sarcopenia, compared with 93.8% in patients without sarcopenia (P = .02). Independent predictors of late survival included TPA (hazard ratio, 0.47; P = .02). Male sex (OR, 0.52; P = .04) and TPA (OR, 0.6; P = .001) were predictive of high resource utilization. A separate analysis by treatment group found that TPA predicted high resource utilization after SAVR (OR, 0.4; P < .001), but not after TAVR (P = .66). CONCLUSIONS: CT scan-derived measurement of TPA as an objective frailty assessment tool predicts early morbidity and mortality, high resource utilization, and late survival after treatment for aortic stenosis. The correlation observed between sarcopenia and resource utilization after SAVR versus TAVR suggests that this simple and reproducible risk assessment tool also may help identify those patients who will derive optimal benefit from catheter-based therapy. SN - 1097-685X UR - https://www.unboundmedicine.com/medline/citation/26896357/Psoas_muscle_size_as_a_frailty_measure_for_open_and_transcatheter_aortic_valve_replacement_ DB - PRIME DP - Unbound Medicine ER -