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Published on: June 3, 2018
Prognostic value of CT body composition analysis for 1-year mortality after transcatheter aortic valve replacement
Sarah Soh1, Young Joo Suh2, Suji Lee2
1Anesthesia and Pain Research Institute, Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Insights
Body composition indices from pre-procedural CT scans, specifically sarcopenia and adipopenia at the T12 level, can predict 1-year mortality in patients undergoing transcatheter aortic valve replacement (TAVR). These findings aid in risk stratification for improved patient outcomes.
Area of Science:
- Cardiology
- Radiology
- Gerontology
Background:
- Transcatheter aortic valve replacement (TAVR) is a crucial procedure for aortic stenosis.
- Predicting long-term outcomes post-TAVR is essential for patient management.
- Body composition analysis using computed tomography (CT) offers insights into patient health.
Purpose of the Study:
- To evaluate the predictive value of body composition indices from pre-procedural CT scans for 1-year mortality in TAVR patients.
- To identify specific body composition metrics that correlate with mortality risk.
Main Methods:
- A cohort of 408 patients undergoing TAVR was analyzed.
- Skeletal muscle and subcutaneous fat areas were measured at T4, T12, and L3 levels on pre-procedural CT scans.
- Cox proportional hazard regression was used to assess the association between body composition and 1-year mortality.
Main Results:
- 1-year mortality was significantly higher in patients with sarcopenia and/or adipopenia.
- Patients with both sarcopenia and adipopenia had a 26% mortality rate.
- Body composition at the T12 level, including sarcopenia and adipopenia, was an independent predictor of 1-year mortality (HR: 4.09).
Conclusions:
- Sarcopenia and adipopenia, assessed via CT at the T12 level, are valuable for stratifying 1-year all-cause mortality risk in TAVR patients.
- Pre-procedural CT-based body composition analysis can guide clinical decision-making and patient counseling.
Objectives:
To investigate the value of body composition indices derived from pre-procedural computed tomography (CT) in predicting 1-year mortality among patients who underwent transcatheter aortic valve replacement (TAVR).
Materials And Methods:
We assessed consecutive patients who underwent TAVR between June 2016 and December 2021 at a single academic medical center. Skeletal muscle and subcutaneous fat area at the T4, T12, and L3 levels on pre-procedural CT were measured. The association between body composition and 1-year mortality was evaluated using Cox proportional hazard regression analysis.
Results:
Finally, 408 patients were included (185 men and 223 women; mean age, 81.7 ± 5.1 years; range, 62-98 years). Post-procedural death occurred in 13.2% of patients. The muscle-height index and fat-height index at the L3 level were more strongly correlated with those at the T12 level (r = 0.765, p < 0.001 and r = 0.932, p < 0.001, respectively) than with those at the T4 level (r = 0.535, p < 0.001 and r = 0.895, p < 0.001, respectively). The cumulative 1-year mortality rate was highest for patients with both sarcopenia and adipopenia (26%), followed by those with adipopenia only (17%), those with sarcopenia only (12%), and those with neither sarcopenia nor adipopenia (8%, p = 0.002). Multivariable analysis revealed that body composition at the T12 level was an independent risk factor for 1-year mortality (hazard ratio: 4.09, 95% confidence interval: 2.01-8.35) in patients with both sarcopenia and adipopenia (p < 0.001).
Conclusion:
Sarcopenia or adipopenia assessed with CT at the thoracic level may be valuable for stratifying 1-year all-cause mortality in patients who undergo TAVR.
Clinical Relevance Statement:
Skeletal muscle and subcutaneous fat mass indices at the level of T12, measured on pre-procedural CT, have value for risk stratification of 1-year all-cause mortality in patients who undergo transcatheter aortic valve replacement.
Key Points:
Sarcopenia and adipopenia are associated with the prognosis of patients undergoing transcatheter aortic valve replacement. Body composition at the T12 level was an independent risk factor for 1-year all-cause mortality. Sarcopenia or adipopenia assessed at T12 with pre-procedural CT is valuable for risk stratification.
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