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Usefulness of skeletal muscle area detected by computed tomography to predict mortality in patients undergoing transcatheter aortic valve replacement: a meta-analysis study

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Abstract

Measures of sarcopenia, such as low muscle mass measured from the readily available preoperative computed tomography (CT) images, have been recently suggested as a predictor of outcomes in patients undergoing transcatheter aortic valve replacement (TAVR). However, results of these studies are variable and, therefore, we performed a systematic review of current literature to evaluate sarcopenia as a predictor of outcome post TAVR. The search was carried out in electronic databases between 2008 and 2018. We identified studies that reported CT-derived skeletal muscle area (SMA) and survival outcomes post TAVR. Studies were evaluated for the incidence of early (≤ 30 days) and late all-cause mortality (> 30 days) post TAVR. Eight studies with 1881 patients were included (mean age of 81.8 years ± 12, 55.9% men). Mean body mass index was (28.2 kg/m2 ± 1.1), mean Society of Thoracic Surgeons risk score (7.0 ± 0.6), and mean albumin level was (3.8 g/dL ± 0.1). Higher SMA was associated with lower long-term mortality [odds ratio (OR) 0.49, 95% confidence interval (CI) 0.28–0.83, p = 0.049], compared with low SMA. Also, higher SMA was associated with lower early mortality but was not statistically significant (OR 0.72; 95% CI 0.44–1.18; p = 0.285). CT-derived SMA provides value in predicting post-TAVR long-term outcomes for patients undergoing TAVR. This is a simple risk assessment tool that may help in making treatment decisions and help identifying and targeting high-risk patients with interventions to improve muscle mass prior to and following the procedures.

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Acknowledgements

The authors thank Mr. Fred King, MSLS (the medical librarian at MedStar Washington Hospital Center) for his great help in the literature search.

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Authors and Affiliations

  1. Section of Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving St NW, Washington, DC, 20010, USA

    Mohamad Soud, Gavin Ho, Kayode O. Kuku, Marco Cejudo-Tejeda, Alexandre Hideo-Kajita, Ron Waksman & Hector M. Garcia-Garcia

  2. Mayo Clinic Evidence-based Practice Center, Mayo Clinic, Rochester, MN, USA

    Fares Alahdab

  3. Hospital da Luz, Luz-Saude. Av. Lusiada 100, 1500-650, Lisbon, Portugal

    Pedro de Araujo Gonçalves

  4. Hospital de Santa Cruz — Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal

    Pedro de Araujo Gonçalves & Rui Campante Teles

  5. Chronic Diseases Research Center — Nova Medical School, Lisbon, Portugal

    Pedro de Araujo Gonçalves

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  1. Mohamad Soud
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Correspondence to Hector M. Garcia-Garcia.

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Conflict of interest

Ron Waksman: Advisory Board: Abbott Vascular, Amgen, Boston Scientific, Cardioset, Cardiovascular Systems Inc., Medtronic, Philips Volcano, Pi-Cardia Ltd.; Consultant: Abbott Vascular, Amgen, Biosensors, Biotronik, Boston Scientific, Cardioset, Cardiovascular Systems Inc., Medtronic, Philips Volcano, Pi-Cardia Ltd.; Grant Support: Abbott Vascular, AstraZeneca, Biosensors, Biotronik, Boston Scientific, Chiesi; Speakers Bureau: AstraZeneca, Chiesi; Investor: MedAlliance. All other authors declared that they have no conflict of interest.

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Soud, M., Alahdab, F., Ho, G. et al. Usefulness of skeletal muscle area detected by computed tomography to predict mortality in patients undergoing transcatheter aortic valve replacement: a meta-analysis study. Int J Cardiovasc Imaging 35, 1141–1147 (2019). https://doi.org/10.1007/s10554-019-01582-0

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