Preoperative osteosarcopenia predicts adverse outcomes in patients undergoing transcatheter aortic valve implantation

[Purpose] Transcatheter aortic valve implantation (TAVI) has become a standard treatment for severe aortic stenosis; however, reliable predictors of post-TAVI outcomes remain unclear. Osteosarcopenia, defined as the coexistence of low muscle mass and low bone density, has been associated with poor outcomes in older adults, but its prognostic significance in TAVI patients has not yet been established. This study aimed to investigate the prognostic significance of preoperative osteosarcopenia in patients undergoing TAVI. [Participants and Methods] This retrospective study included 93 consecutive patients who underwent TAVI at Sapporo City General Hospital between 2019 and 2023. Sarcopenia and osteopenia were evaluated using computed tomography-derived psoas muscle index (PMI) and vertebral bone mineral density (BMD), respectively. Osteosarcopenia was defined as values in the lowest sex-specific tertile for both PMI and BMD. The primary outcome was a composite of all-cause mortality and unplanned hospitalization within 1 year after discharge. [Results] Among the 93 patients (mean age, 84.9 ± 5.9 year; 38.7% male), 14 (15.1%) were diagnosed with osteosarcopenia. During follow-up, 28.0% of participants experienced the composite endpoint. Patients with osteosarcopenia demonstrated significantly lower event-free survival rates. Multivariate Cox regression analysis identified osteosarcopenia as an independent predictor of adverse outcomes. [Conclusion] Preoperative osteosarcopenia independently predicts poor clinical outcomes after TAVI in ambulatory patients and may serve as a useful marker for early risk stratification.