Prognostic value of CT body composition analysis for 1-year mortality after transcatheter aortic valve replacement

Objectives

To investigate the value of body composition indices derived from pre-procedural computed tomography (CT) in predicting 1-year mortality among patients who underwent transcatheter aortic valve replacement (TAVR).

Materials and methods

We assessed consecutive patients who underwent TAVR between June 2016 and December 2021 at a single academic medical center. Skeletal muscle and subcutaneous fat area at the T4, T12, and L3 levels on pre-procedural CT were measured. The association between body composition and 1-year mortality was evaluated using Cox proportional hazard regression analysis.

Results

Finally, 408 patients were included (185 men and 223 women; mean age, 81.7 ± 5.1 years; range, 62–98 years). Post-procedural death occurred in 13.2% of patients. The muscle-height index and fat-height index at the L3 level were more strongly correlated with those at the T12 level (r = 0.765, p < 0.001 and r = 0.932, p < 0.001, respectively) than with those at the T4 level (r = 0.535, p < 0.001 and r = 0.895, p < 0.001, respectively). The cumulative 1-year mortality rate was highest for patients with both sarcopenia and adipopenia (26%), followed by those with adipopenia only (17%), those with sarcopenia only (12%), and those with neither sarcopenia nor adipopenia (8%, p = 0.002). Multivariable analysis revealed that body composition at the T12 level was an independent risk factor for 1-year mortality (hazard ratio: 4.09, 95% confidence interval: 2.01–8.35) in patients with both sarcopenia and adipopenia (p < 0.001).

Conclusion

Sarcopenia or adipopenia assessed with CT at the thoracic level may be valuable for stratifying 1-year all-cause mortality in patients who undergo TAVR.

Clinical relevance statement

Skeletal muscle and subcutaneous fat mass indices at the level of T12, measured on pre-procedural CT, have value for risk stratification of 1-year all-cause mortality in patients who undergo transcatheter aortic valve replacement.

Key Points

Sarcopenia and adipopenia are associated with the prognosis of patients undergoing transcatheter aortic valve replacement.

Body composition at the T12 level was an independent risk factor for 1-year all-cause mortality.

Sarcopenia or adipopenia assessed at T12 with pre-procedural CT is valuable for risk stratification.

Graphical Abstract