Hogeschool van Amsterdam

Urban Vitality

CT determined psoas muscle area predicts mortality in women undergoing transcatheter aortic valve implantation

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<p>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.</p>

Reference 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, 93(4), E248-E254. https://doi.org/10.1002/ccd.27823
Published by  Urban Vitality 1 March 2019

Publication date

Mar 2019

Author(s)

Martijn S. van Mourik
Yvonne C. Janmaat
Floortje van Kesteren
Jeroen Vendrik
R. Nils Planken
Marieke J. Henstra
Juliëtte F. Velu
Wieneke Vlastra
Aeilko H. Zwinderman
Karel T. Koch
Robbert J. de Winter
Joanna J. Wykrzykowska
Jan J. Piek
José P.S. Henriques
Vincent R. Lanting
Jan Baan
Robert Lindeboom
M. Marije Vis

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