Association between psoas muscle area and outcomes after transcatheter tricuspid valve repair

Transcatheter tricuspid valve repair (TTVR) might be an alternative option to reduce tricuspid regurgitation (TR) in patients with sarcopenia. Psoas muscle area (PMA) measured using computed tomography (CT) is known as a marker of sarcopenia. We investigated the association of PMA with procedural and clinical outcomes following TTVR. We retrospectively measured left and right PMA using pre-procedural CT in patients undergoing TTVR. Low PMA was defined as the total PMA < 20.3 cm² for men and < 11.8 cm² for women. The primary outcome was a composite of all-cause mortality and heart failure hospitalization within one year after TTVR. Of 163 patients, 47 (29%) were considered as having low PMA. Procedural success, defined as residual TR of ≤ 2 + at discharge, and in-hospital mortality were comparable between patients with low and high PMA. Patients with low PMA had a higher incidence of the composite outcome than those with high PMA (49% vs. 21%; p = 0.001) This association was consistent after adjusting for baseline characteristics (adjusted hazard ratio 0.43; 95% confidence interval: 0.23-0.80; p = 0.008). In contrast, the New York Heart Association functional class improved from baseline to three-month follow-up, regardless of PMA. Approximately 30% of patients undergoing TTVR were found to have low PMA. Although TTVR may be a safe therapeutic option to reduce TR and improve heart failure symptoms in patients with sarcopenia, the prognosis after TTVR remains poor in this population. Pre-procedural CT-based assessment of PMA may enhance risk stratification and support better clinical decision-making for TTVR.