Importance of Combined Assessment of Skeletal Muscle Mass and Density by CT in Predicting Clinical Outcomes After TAVR

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Abstract number: Tokyo20A-OP019 Abstract type: Oral Presentation Reference: This abstract was presented at PCR Tokyo Valves 2020, 14-16 February 2020, Tokyo Link: https://abstractbook.pcronline.com/export/pdf/id/160017 Published on: 10 February 2020

Importance of combined assessment of skeletal muscle mass and density by CT in predicting clinical outcomes after TAVR

TOKUDA T. (1), YAMAMOTO M. (2), OTSUKA T. (3), TADA N. (4), NAGANUMA T. (5), YAMANAKA F. (6), SHIRAI S. (7), MIZUTANI K. (8), TABATA M. (9), UENO H. (10), HIGASHIMORI A. (11), ARAKI M. (12), WATANABE Y. (13), HAYASHIDA K. (14) (1) Nagoya heart center, Aichi JAPAN(2) Toyohashi heart center, Aichi JAPAN(3) Nippon Medical School Hospital, Tokyo JAPAN(4) Sendai Kousei Hospital, Miyagi JAPAN(5) New Tokyo Hospital, Chiba JAPAN(6) Shonan Kamakura General Hospital, Kanagawa JAPAN(7) Kokura Memorial Hospital, Fukuoka JAPAN(8) Osaka City General Hospital, Osaka JAPAN(9) Tokyo Bay Urayasu Ichikawa Medical Center, Chiba JAPAN(10) toyama university hospital, Toyama JAPAN(11) Kishiwada Tokushukai Hospital, Osaka JAPAN(12) Saiseikai Yokohamashi Tobu Hospital, Kanagawa JAPAN(13) Teikyo University, Tokyo JAPAN(14) Keio University, Tokyo JAPAN

THEME: Interventions for Valvular Disease TOPIC(S): TAVI

AIMS Skeletal muscle mass (SMM) as calculated by computed tomography (CT) is a predictor of all-cause mortality after transcatheter aortic valve replacement (TAVR), but it remains unclear whether using CT-determined density of skeletal muscle has additive prognostic value.

METHODS AND RESULTS We utilized the Japanese multicenter registry data of 1375 patients who underwent CT prior to TAVR. Sarcopenia status was defined by the CT-derived SMM index (threshold: men, 55.4 cm2/m2; women, 38.9 cm2/m2). The threshold for high and low CT density was based on the median value of the entire cohort (men: 33.4 HU; women: 29.5 HU). Sarcopenia was observed in 802 patients (58.3%) overall. Patients were categorized into non-sarcopenia and high-CT density (n = 298), non-sarcopenia and low-CT density (n = 275), sarcopenia and high-CT density (n = 399), and sarcopenia and low-CT density (n = 403) groups, and procedural outcomes and mortality compared. The cumulative 3-year mortality rates in these groups were 18%, 27%, 24%, and 32%, respectively. Cox-regression multivariate analysis revealed that low-CT density (compared with high-CT density) and sarcopenia and low-CT density (compared with non-sarcopenia and high-CT density as reference) increased mortality after TAVR (hazard ratios [HR]: 1.35 and 1.43, 95% confidence intervals [Cis]: 1.06-1.72 and 1.00-2.08, p = 0.01, and 0.049, respectively). However, sarcopenia alone was not related to an increased risk of mortality (HR: 1.30, 95% CI: 0.99-1.69, p = 0.52).

CONCLUSIONS In conclusion, CT density-based skeletal muscle quality assessment combined with the SMM index improves prediction of adverse outcomes after TAVR.