title: Psoas Muscle Area as a Predictor of Outcomes in Transcatheter Aortic Valve Implantation.
abstract: Frailty is a powerful predictor of outcomes after transcatheter aortic valve implantation (TAVI). Sarcopenia as assessed by psoas muscle area (PMA) is a validated tool to assess frailty before surgical procedures. We evaluated PMA as a predictor of outcomes after TAVI in 152 consecutive patients who underwent this procedure at our institution from 2011 to 2014. Preoperative computed tomography scans were used to measure PMA, which then was indexed to body surface area. Outcomes evaluated included (1) early poor outcome (30 days mortality, stroke, dialysis, and prolonged ventilation), (2) 1-year mortality, and (3) high-resource utilization (length of stay >7 days, discharge to rehabilitation, or readmission within 30 days). Indexed PMA (odds ratio [OR] 3.19, confidence interval [CI] 1.30 to 7.83; p = 0.012) and age (OR 1.92, CI 1.87 to 1.98; p = 0.012) predicted early poor outcome. Society of Thoracic Surgeons score predicted 1-year mortality (hazard ratio 3.07, CI 1.93 to 6.23; p = 0.011). High-resource utilization was observed more frequently in patients with PMA less than the median (73% vs 51%, OR 2.65, CI 1.32 to 5.36; p = 0.006). In conclusion, indexed PMA predicts early poor outcome and high-resource utilization after TAVI.
authors.affiliation: Department of Cardiovascular Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania.
authors.forename: Lohit
authors.initials: L
authors.lastname: Garg
authors.affiliation: Department of Cardiovascular Medicine, St. Luke's University Health Network, Bethlehem, Pennsylvania.
authors.forename: Sahil
authors.initials: S
authors.lastname: Agrawal
authors.affiliation: Oakland University William Beaumont School of Medicine, Rochester, Michigan.
authors.forename: Timothy
authors.initials: T
authors.lastname: Pew
authors.affiliation: Department of Cardiovascular Medicine, Beaumont Health System, Royal Oak, Michigan.
authors.forename: George S
authors.initials: GS
authors.lastname: Hanzel
authors.affiliation: Department of Cardiovascular Medicine, Beaumont Health System, Royal Oak, Michigan.
authors.forename: Amr E
authors.initials: AE
authors.lastname: Abbas
authors.affiliation: Department of Cardiovascular Medicine, Beaumont Health System, Royal Oak, Michigan.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Gallagher
authors.affiliation: Department of Cardiovascular Medicine, Beaumont Health System, Royal Oak, Michigan.
authors.forename: Francis L
authors.initials: FL
authors.lastname: Shannon
authors.affiliation: Department of Cardiovascular Medicine, Beaumont Health System, Royal Oak, Michigan. Electronic address: Ivan.Hanson@beaumont.edu.
authors.forename: Ivan D
authors.initials: ID
authors.lastname: Hanson
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000453:epidemiology / Q000601:surgery*; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D016330:Frail Elderly; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009026:Mortality; D016017:Odds Ratio; D009929:Organ Size; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data; D011379:Prognosis; D016016:Proportional Hazards Models; D016658:Psoas Muscles / Q000000981:diagnostic imaging* / Q000473:pathology; D012047:Rehabilitation Centers; D006435:Renal Dialysis / Q000706:statistics & numerical data; D051437:Renal Insufficiency / Q000453:epidemiology* / Q000628:therapy; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D055948:Sarcopenia / Q000000981:diagnostic imaging* / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology*; D014057:Tomography, X-Ray Computed; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome