Author + information
- Vishal Dahya1,
- Carla Prado2,
- Aline C. Silva3,
- Penny Burroughs4,
- Julian Hurt5,
- Shafi Mohamed6,
- Thomas Noel7 and
- Wayne Batchelor8
- 1Florida State University College of Medicine, Tallahassee, Florida, United States
- 2Miyazaki medical association hospital, Miyazaki, Miyazaki, Japan
- 3Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
- 4Tallahassee memorial hospital, Tallahassee, Florida, United States
- 5Florida State University College of Medicine, Tallahassee, FL, USA
- 6Hofstra Northwell School of Medicine - North Shore University Hospital
- 7Interventional Cardiologist, Tallahassee, Florida, United States
- 8Southern Medical Group, Tallahassee, Florida, United States
We determined the prevalence of sarcopenia in patients undergoing transcatheter aortic valve replacement (TAVR) and whether skeletal muscle mass measured from preoperative computed tomography (CT) images provides value in predicting post-operative length of stay. There is limited data on the use of body composition as a frailty measure in TAVR patients and no studies have determined if this measure predicts length of stay.
We studied 104 consecutive patients who underwent TAVR at Tallahassee Memorial Hospital from 2012 to 2016. Patient demographics, standard frailty measures (hand grip, albumin, and 5m walk test), clinical comorbidities, echocardiographic data and VARC II major complications were recorded. Skeletal muscle index (SMI) [skeletal muscle mass cross-sectional area/height2] was measured from CT images using Slice-O-Matic software (Tomovision, Montreal, Quebec, Canada) (Figure 1). Clinical outcomes were assessed and multivariate methods used to determine predictors of LOS.
Sarcopenia was prevalent in men (83%) and women (56%). Patients who suffered a major complication had significantly longer length of stay (13 vs. 4.6 days, p< 0.0001). SMI was correlated with age, gender, BMI, handgrip strength, and previous CABG, but not major complication. A multivariate model including all univariate predictors of LOS showed SMI, major complication, transapical access, atrial fibrillation, and chronic obstructive lung disease as independent predictors of LOS. For every 7.3 cm2/m2 increase in SMI, there was a 1 day reduction in LOS. None of the standard measures of frailty predicted LOS.
SMI, a measure of sarcopenia readily determined from pre-TAVR CT scans, independently predicts TAVR LOS better than standard frailty testing. Further evaluation of SMI as a frailty measure after TAVR is warranted.
STRUCTURAL: Valvular Disease: Aortic