Combined Assessment of Skeletal Muscle Area Using Computed Tomography in Elderly Patients with Aortic Valve Stenosis Undergoing Transcatheter Aortic Valve Replacement

Abstract

The psoas muscle area (PMA) and rectus femoris muscle area (RFMA) have been used to estimate whole-body muscle mass in elderly patients. However, it is unclear whether combining these measurements can improve the predictive ability of traditional risk factors for adverse clinical events in elderly patients with aortic valve stenosis (AVS). We analyzed data from 153 patients with AVS who underwent transcatheter aortic valve replacement (TAVR), and measured PMA and RFMA using computed tomography (CT) before the procedure. This study assessed a composite of adverse clinical events including all-cause death and heart failure (HF) requiring hospitalization for up to 3 years after TAVR. During the follow-up period, 31 patients experienced adverse clinical events (19 died, and 12 had HF). The multivariate Cox hazards analysis demonstrated that patients exhibiting lower PMA (males with < 3.36 cm²/m² and females with < 2.52 cm²) and lower RFMA (males with < 3.26 cm²/m² and females with < 3.15 cm²/m²) had a higher probability of experiencing adverse clinical events compared to those with higher PMA and RFMA values, whether in combination or alone (P < 0.05). Additionally, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) analyses showed that the combination of lower PMA and RFMA had a greater incremental effect on the predictive value of clinical risk factors for adverse clinical events. Therefore, the combined measurement of skeletal muscles using CT scans may be a valuable tool for assessing the risk of AVS in elderly patients undergoing TAVR.