Defining optimal muscle surface area thresholds for sarcopenia-related mortality after cardiovascular interventions

Area of Science:

• Cardiovascular Medicine
• Geriatrics
• Sarcopenia Research

Background:

• Psoas muscle area (PMA) is a known predictor of sarcopenia-related mortality.
• The precise nature of the association between PMA and long-term mortality, and whether a specific threshold exists, requires further investigation.

Purpose of the Study:

• To determine if the association between PMA and long-term mortality is linear or non-linear.
• To identify a potential threshold for defining patients at high risk of mortality based on PMA.

Main Methods:

• A meta-analysis of individual participant data from four cohorts (3893 patients) undergoing cardiovascular interventions (AAA, TAVI, TA, PAD).
• Pooled spline curves visualized the PMA-mortality association.
• Cox models and inverse-variance meta-analysis were used to combine hazard ratios.
• Results were validated in a separate cohort (561 patients) assessing sarcopenia via masseter muscle area.

Main Results:

• PMA showed a significant inverse and linear association with long-term mortality (p < 0.001).
• Patients with low muscle mass (PMA Z-values ≤ -1.5) had a 1.6-fold increased adjusted mortality risk (HR 1.6, 95% CI 1.3-2.0).
• This finding was consistent in the replication cohort (HR 1.7, 95% CI 1.0-2.82).

Conclusions:

• Long-term mortality risk increases linearly with decreasing PMA after cardiovascular interventions.
• A PMA Z-value below -1.5 identifies patients with consistently elevated mortality risk, irrespective of other factors.