title: Psoas Muscle Area and All-Cause Mortality After Transcatheter Aortic Valve Replacement: The Montreal-Munich Study.
abstract: BACKGROUND
  Psoas muscle area (PMA) is a novel measure of frailty that can be efficiently measured from computed tomography images to help predict risk in older adults referred for transcatheter aortic valve replacement (TAVR). The objective of this study was to determine if PMA would be incrementally predictive of mortality and morbidity after TAVR.
  
  
  METHODS
  The pre-TAVR computed tomography scans of 208 consecutive patients at 2 hospitals in Montreal and Munich were analyzed to measure the cross-sectional area of the left and right psoas muscles on a single axial slice at the level of L4. The primary outcome was all-cause mortality assessed according to sex-stratified Cox regression models adjusted for the Society of Thoracic Surgeons predicted risk of mortality.
  
  
  RESULTS
  The mean age was 80.7 ± 6.8 years with 55% women and a total of 57 deaths over a mean follow-up of 504 days. PMA was lower in nonsurvivors compared with survivors among women (12.9 vs 14.5 cm(2); P = 0.047) but not men (21.7 vs 22.4 cm(2); P = 0.50). The association between PMA and all-cause mortality in women persisted after adjustment for Society of Thoracic Surgeons risk (hazard ratio, 0.88 per cm(2); 95% confidence interval, 0.78-0.99). An association between PMA and bleeding complications was seen in men (odds ratio, 0.78; 95% confidence interval, 0.62-0.97). Sensitivity analyses with PMA normalized to body mass index yielded similar results.
  
  
  CONCLUSIONS
  This study has shown that PMA is a marker of frailty associated with midterm survival in women who undergo TAVR. Further research is warranted to pursue PMA as a prognostic marker and therapeutic target in this vulnerable population.
authors.affiliation: Department of Medicine, McGill University, Montreal, Quebec, Canada.
authors.forename: Samuel
authors.initials: S
authors.lastname: Mamane
authors.affiliation: Department of Medicine, McGill University, Montreal, Quebec, Canada.
authors.forename: Louis
authors.initials: L
authors.lastname: Mullie
authors.affiliation: Department of Medicine, McGill University, Montreal, Quebec, Canada; Division of Cardiology, McGill University, Montreal, Quebec, Canada.
authors.forename: Nicolo
authors.initials: N
authors.lastname: Piazza
authors.affiliation: Department of Medicine, McGill University, Montreal, Quebec, Canada; Division of Cardiology, McGill University, Montreal, Quebec, Canada.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Martucci
authors.affiliation: Department of Medicine, McGill University, Montreal, Quebec, Canada; Division of Geriatric Medicine, McGill University, Montreal, Quebec, Canada.
authors.forename: José
authors.initials: J
authors.lastname: Morais
authors.affiliation: Department of Anesthesia, McGill University, Montreal, Quebec, Canada.
authors.forename: Antonio
authors.initials: A
authors.lastname: Vigano
authors.affiliation: Department of Radiology, McGill University, Montreal, Quebec, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Levental
authors.affiliation: Department of Medicine, McGill University, Montreal, Quebec, Canada.
authors.forename: Kristoff
authors.initials: K
authors.lastname: Nelson
authors.affiliation: Division of Cardiac Surgery, German Heart Center, Munich, Germany.
authors.forename: Ruediger
authors.initials: R
authors.lastname: Lange
authors.affiliation: Department of Medicine, McGill University, Montreal, Quebec, Canada; Division of Cardiology, McGill University, Montreal, Quebec, Canada; Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, Quebec, Canada. Electronic address: jonathan.afilalo@mcgill.ca.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Afilalo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006328:Cardiac Catheterization / Q000009:adverse effects*; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D016017:Odds Ratio; D011379:Prognosis; D016658:Psoas Muscles / Q000000981:diagnostic imaging*; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome