Risk stratification using lean body mass in patients undergoing transcatheter aortic valve replacement

Area of Science:

• Cardiology
• Geriatrics
• Internal Medicine

Background:

• Prognostic implications of skeletal muscle mass, measured as lean body mass (LBM), are not well-defined in patients undergoing transcatheter aortic valve replacement (TAVR).
• Current risk stratification methods like body mass index (BMI) may not adequately identify all high-risk patients post-TAVR.

Purpose of the Study:

• To evaluate the prognostic impact of LBM on all-cause mortality in patients after TAVR.
• To compare the predictive value of LBM against BMI for risk stratification in the TAVR population.

Main Methods:

• Analysis of 1,613 patients from the OCEAN-TAVI registry who underwent TAVR between October 2013 and April 2016.
• Lean body mass (LBM) calculated using the James formula; primary endpoint was all-cause death.
• Kaplan-Meier analysis and multivariate regression used to assess the association between LBM, BMI, and mortality.

Main Results:

• Patients with low LBM exhibited a significantly higher incidence of all-cause death compared to those with high LBM in both males (32.3% vs. 9.9%) and females (15.8% vs. 9.2%).
• Multivariate analysis confirmed LBM as an independent predictor of all-cause death in both genders (HR 0.93 for males, HR 0.94 for females).
• Body mass index (BMI) failed to identify high-risk populations, particularly in female patients.

Conclusions:

• Low LBM is associated with increased all-cause mortality following TAVR, irrespective of gender.
• Risk stratification using LBM offers a potentially more insightful approach to identify high-risk TAVR patients compared to traditional BMI assessment.