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The Clinical Impact of Psoas Muscle Cross-Sectional Area on Medium-Term Mortality After Transcatheter Aortic Valve Implantation.
Heart Lung Circ. 2020 Jun; 29(6):904-913.HL

Abstract

AIM

Psoas muscle cross-sectional area (CSA) is a proposed marker of frailty associated with mortality after transcatheter aortic valve implantation (TAVI). We assessed the impact of psoas CSA on medium-term mortality over 5 years in a large cohort, adjusted for pre-procedural variables.

METHOD

This single-centre registry-derived analysis assessed 1,731 consecutive TAVI patients between 2007 and 31 April 2015 with available abdominal computed tomography scans. Sex-stratified, height-adjusted psoas CSA was measured mid-body of the fourth lumbar vertebra. Kaplan-Meier survival distributions across psoas CSA quartiles were compared. Cox and logistic regression models were used to assess baseline variables associated with the primary outcome, which was mortality within 5 years.

RESULTS

Median age was 81 years (interquartile range, 77 - 85); 52.5% were women. The primary endpoint occurred in 555 patients over a mean follow-up of 775 days. Lower psoas CSA quartile patients were older, had a lower body mass index, lower creatinine clearance, and lower rates of previous cardiac surgery, with higher rates of diabetes, coronary artery disease, pacemaker, anaemia, hypoalbuminaemia, and higher European System for Cardiac Operative Risk Evaluation (EuroSCORE). Unadjusted survival by psoas CSA quartile was significantly different in men (log rank p=0.041) but not women (p=0.099). In Bonferroni-adjusted multivariate analysis, psoas CSA quartiles were not significantly associated with mortality. Hypoalbuminaemia (hazard ratio [HR], 2.10; 95% confidence interval [CI], 1.53 - 2.87 [p<0.001]) and increasing age (HR, 1.03 per year; 95% CI, 1.01 - 1.05 [p=0.002]) were associated with increased risk; female sex (HR, 0.63; 95% CI 0.51 - 0.78 [p<0.001]), and hypercholesterolaemia (HR, 0.67; 95%, CI 0.54 0.83 [p<0.001]) with reduced risk.

CONCLUSIONS

Psoas CSA was not significantly associated with mortality after adjusting for pre-procedural variables. Hypoalbuminaemia, sex, hypercholesterolaemia, and age were significantly associated with mortality after TAVI.

Authors+Show Affiliations

Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; St. George's Hospital, University of London, London, UK.Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.St. George's Hospital, University of London, London, UK.Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.St.-Johannes-Hospital, Dortmund, Germany.Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany; Department of Cardiology, Medizinische Universität Wien, Vienna, Austria. Electronic address: christian.hengstenberg@meduniwien.ac.at.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31182269

Citation

Michel, Jonathan, et al. "The Clinical Impact of Psoas Muscle Cross-Sectional Area On Medium-Term Mortality After Transcatheter Aortic Valve Implantation." Heart, Lung & Circulation, vol. 29, no. 6, 2020, pp. 904-913.
Michel J, Pellegrini C, Rheude T, et al. The Clinical Impact of Psoas Muscle Cross-Sectional Area on Medium-Term Mortality After Transcatheter Aortic Valve Implantation. Heart Lung Circ. 2020;29(6):904-913.
Michel, J., Pellegrini, C., Rheude, T., von Scheidt, M., Trenkwalder, T., Elhmidi, Y., Mayr, N. P., Brecker, S., Kasel, A. M., Kastrati, A., Schunkert, H., Husser, O., Bleiziffer, S., & Hengstenberg, C. (2020). The Clinical Impact of Psoas Muscle Cross-Sectional Area on Medium-Term Mortality After Transcatheter Aortic Valve Implantation. Heart, Lung & Circulation, 29(6), 904-913. https://doi.org/10.1016/j.hlc.2019.05.095
Michel J, et al. The Clinical Impact of Psoas Muscle Cross-Sectional Area On Medium-Term Mortality After Transcatheter Aortic Valve Implantation. Heart Lung Circ. 2020;29(6):904-913. PubMed PMID: 31182269.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Clinical Impact of Psoas Muscle Cross-Sectional Area on Medium-Term Mortality After Transcatheter Aortic Valve Implantation. AU - Michel,Jonathan, AU - Pellegrini,Costanza, AU - Rheude,Tobias, AU - von Scheidt,Moritz, AU - Trenkwalder,Teresa, AU - Elhmidi,Yacine, AU - Mayr,N Patrick, AU - Brecker,Stephen, AU - Kasel,A Markus, AU - Kastrati,Adnan, AU - Schunkert,Heribert, AU - Husser,Oliver, AU - Bleiziffer,Sabine, AU - Hengstenberg,Christian, Y1 - 2019/05/23/ PY - 2018/10/24/received PY - 2019/04/02/revised PY - 2019/05/01/accepted PY - 2019/6/12/pubmed PY - 2021/1/21/medline PY - 2019/6/12/entrez KW - Frailty KW - Psoas KW - Sarcopaenia KW - TAVI SP - 904 EP - 913 JF - Heart, lung & circulation JO - Heart Lung Circ VL - 29 IS - 6 N2 - AIM: Psoas muscle cross-sectional area (CSA) is a proposed marker of frailty associated with mortality after transcatheter aortic valve implantation (TAVI). We assessed the impact of psoas CSA on medium-term mortality over 5 years in a large cohort, adjusted for pre-procedural variables. METHOD: This single-centre registry-derived analysis assessed 1,731 consecutive TAVI patients between 2007 and 31 April 2015 with available abdominal computed tomography scans. Sex-stratified, height-adjusted psoas CSA was measured mid-body of the fourth lumbar vertebra. Kaplan-Meier survival distributions across psoas CSA quartiles were compared. Cox and logistic regression models were used to assess baseline variables associated with the primary outcome, which was mortality within 5 years. RESULTS: Median age was 81 years (interquartile range, 77 - 85); 52.5% were women. The primary endpoint occurred in 555 patients over a mean follow-up of 775 days. Lower psoas CSA quartile patients were older, had a lower body mass index, lower creatinine clearance, and lower rates of previous cardiac surgery, with higher rates of diabetes, coronary artery disease, pacemaker, anaemia, hypoalbuminaemia, and higher European System for Cardiac Operative Risk Evaluation (EuroSCORE). Unadjusted survival by psoas CSA quartile was significantly different in men (log rank p=0.041) but not women (p=0.099). In Bonferroni-adjusted multivariate analysis, psoas CSA quartiles were not significantly associated with mortality. Hypoalbuminaemia (hazard ratio [HR], 2.10; 95% confidence interval [CI], 1.53 - 2.87 [p<0.001]) and increasing age (HR, 1.03 per year; 95% CI, 1.01 - 1.05 [p=0.002]) were associated with increased risk; female sex (HR, 0.63; 95% CI 0.51 - 0.78 [p<0.001]), and hypercholesterolaemia (HR, 0.67; 95%, CI 0.54 0.83 [p<0.001]) with reduced risk. CONCLUSIONS: Psoas CSA was not significantly associated with mortality after adjusting for pre-procedural variables. Hypoalbuminaemia, sex, hypercholesterolaemia, and age were significantly associated with mortality after TAVI. SN - 1444-2892 UR - https://www.unboundmedicine.com/medline/citation/31182269/The_Clinical_Impact_of_Psoas_Muscle_Cross_Sectional_Area_on_Medium_Term_Mortality_After_Transcatheter_Aortic_Valve_Implantation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1443-9506(19)30474-3 DB - PRIME DP - Unbound Medicine ER -