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CT determined psoas muscle area predicts mortality in women undergoing transcatheter aortic valve implantation.
Catheter Cardiovasc Interv. 2019 03 01; 93(4):E248-E254.CC

Abstract

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.

Authors+Show Affiliations

Amsterdam UMC, University of Amsterdam, AMC Heartcenter, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.ACHIEVE - Centre of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.Amsterdam UMC, University of Amsterdam, AMC Heartcenter, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands. Amsterdam UMC, University of Amsterdam, Department of Radiology, Amsterdam, The Netherlands.Amsterdam UMC, University of Amsterdam, AMC Heartcenter, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.Amsterdam UMC, University of Amsterdam, Department of Radiology, Amsterdam, The Netherlands.Amsterdam UMC, University of Amsterdam, Department of Geriatrics, Amsterdam, The Netherlands.Amsterdam UMC, University of Amsterdam, AMC Heartcenter, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.Amsterdam UMC, University of Amsterdam, AMC Heartcenter, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.Department of Clinical Epidemiology, Biostatistics and Bioinformatics, University of Amsterdam, Amsterdam, The Netherlands.Amsterdam UMC, University of Amsterdam, AMC Heartcenter, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.Amsterdam UMC, University of Amsterdam, AMC Heartcenter, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.Amsterdam UMC, University of Amsterdam, AMC Heartcenter, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.Amsterdam UMC, University of Amsterdam, AMC Heartcenter, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.Amsterdam UMC, University of Amsterdam, AMC Heartcenter, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.Amsterdam UMC, University of Amsterdam, AMC Heartcenter, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.Amsterdam UMC, University of Amsterdam, AMC Heartcenter, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.ACHIEVE - Centre of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.Department of Clinical Epidemiology, Biostatistics and Bioinformatics, University of Amsterdam, Amsterdam, The Netherlands.Amsterdam UMC, University of Amsterdam, AMC Heartcenter, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

30208263

Citation

van Mourik, Martijn S., et al. "CT Determined Psoas Muscle Area Predicts Mortality in Women Undergoing Transcatheter Aortic Valve Implantation." Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions, vol. 93, no. 4, 2019, pp. E248-E254.
van Mourik MS, Janmaat YC, van Kesteren F, et al. CT determined psoas muscle area predicts mortality in women undergoing transcatheter aortic valve implantation. Catheter Cardiovasc Interv. 2019;93(4):E248-E254.
van Mourik, M. S., Janmaat, Y. C., van Kesteren, F., Vendrik, J., Planken, R. N., Henstra, M. J., Velu, J. F., Vlastra, W., Zwinderman, A. H., Koch, K. T., de Winter, R. J., Wykrzykowska, J. J., Piek, J. J., Henriques, J. P. S., Lanting, V. R., Baan, J., Latour, C., Lindeboom, R., & Vis, M. M. (2019). CT determined psoas muscle area predicts mortality in women undergoing transcatheter aortic valve implantation. Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions, 93(4), E248-E254. https://doi.org/10.1002/ccd.27823
van Mourik MS, et al. CT Determined Psoas Muscle Area Predicts Mortality in Women Undergoing Transcatheter Aortic Valve Implantation. Catheter Cardiovasc Interv. 2019 03 1;93(4):E248-E254. PubMed PMID: 30208263.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - CT determined psoas muscle area predicts mortality in women undergoing transcatheter aortic valve implantation. AU - van Mourik,Martijn S, AU - Janmaat,Yvonne C, AU - van Kesteren,Floortje, AU - Vendrik,Jeroen, AU - Planken,R Nils, AU - Henstra,Marieke J, AU - Velu,Juliëtte F, AU - Vlastra,Wieneke, AU - Zwinderman,Aeilko H, AU - Koch,Karel T, AU - de Winter,Robbert J, AU - Wykrzykowska,Joanna J, AU - Piek,Jan J, AU - Henriques,José P S, AU - Lanting,Vincent R, AU - Baan,Jan,Jr AU - Latour,Corine, AU - Lindeboom,Robert, AU - Vis,M Marije, Y1 - 2018/09/12/ PY - 2018/05/18/received PY - 2018/06/15/revised PY - 2018/07/14/accepted PY - 2018/9/13/pubmed PY - 2020/4/15/medline PY - 2018/9/13/entrez KW - computed tomography KW - psoas muscle mass KW - sarcopenia KW - transcatheter aortic valve replacement SP - E248 EP - E254 JF - Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions JO - Catheter Cardiovasc Interv VL - 93 IS - 4 N2 - 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. SN - 1522-726X UR - https://www.unboundmedicine.com/medline/citation/30208263/CT_determined_psoas_muscle_area_predicts_mortality_in_women_undergoing_transcatheter_aortic_valve_implantation_ L2 - https://doi.org/10.1002/ccd.27823 DB - PRIME DP - Unbound Medicine ER -