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Importance of combined assessment of skeletal muscle mass and density by computed tomography in predicting clinical outcomes after transcatheter aortic valve replacement

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Abstract

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

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Acknowledgements

The authors thank the investigators and institutions that have participated in the OCEAN-TAVI registry.

Funding

The OCEAN-TAVI registry is supported by Edwards Lifesciences and Daiichi-Sankyo company.

Author information

Authors and Affiliations

  1. Department of Cardiovascular Medicine, Nagoya Heart Center, Nagoya, Aichi, Japan

    Takahiro Tokuda, Ai Kagase & Yutaka Koyama

  2. Department of Cardiovascular Medicine, Department of Cardiology, Toyohashi Heart Center, 21-1 Gobutori, Oyama-Cho, Toyohashi, Aichi, 441-8530, Japan

    Masanori Yamamoto

  3. Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan

    Toshiaki Otsuka

  4. Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan

    Toshiaki Otsuka

  5. Department of Cardiology, Sendai Kosei Hospital, Miyagi, Japan

    Norio Tada

  6. Department of Cardiology, New Tokyo Hospital, Chiba, Japan

    Toru Naganuma

  7. Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Kanagawa, Japan

    Motoharu Araki

  8. Department of Cardiology, Shonan Kamakura General Hospital, Kanagawa, Japan

    Futoshi Yamanaka

  9. Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan

    Shinichi Shirai

  10. Department of Cardiology, Osaka City General Hospital, Osaka, Japan

    Kazuki Mizutani

  11. Department of Cardiovascular, Surgery Tokyo Bay Urayasu-Ichikawa Medical Center, Chiba, Japan

    Minoru Tabata

  12. Department of Cardiology, Toyama University Hospital, Toyama, Japan

    Hiroshi Ueno

  13. Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan

    Kensuke Takagi

  14. Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan

    Akihiro Higashimori

  15. Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan

    Yusuke Watanabe

  16. Department of Cardiology, Keio University School of Medicine, Tokyo, Japan

    Kentaro Hayashida

Authors
  1. Takahiro Tokuda
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  2. Masanori Yamamoto
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  3. Ai Kagase
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  4. Yutaka Koyama
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  5. Toshiaki Otsuka
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  6. Norio Tada
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  7. Toru Naganuma
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  8. Motoharu Araki
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  9. Futoshi Yamanaka
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  10. Shinichi Shirai
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  11. Kazuki Mizutani
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  12. Minoru Tabata
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  13. Hiroshi Ueno
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  14. Kensuke Takagi
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  15. Akihiro Higashimori
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  16. Yusuke Watanabe
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  17. Kentaro Hayashida
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the OCEAN-TAVI Investigators

Corresponding author

Correspondence to Masanori Yamamoto.

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Conflict of interest

Dr. Yamamoto, Dr. Tada, Dr. Naganuma, Dr. Shirai, Dr. Mizutani, and Dr. Watanabe are clinical proctors for Edwards Lifesciences and Medtronic. Dr. Araki, Dr. Tabata, Dr. Takagi, Dr. Higashimori, and Dr. Hayashida are clinical proctors of Edwards Lifesciences. Dr. Ueno is a clinical proctor for Medtronic. The remaining authors have nothing to disclose.

Informed consent

This study was approved by all institutional review boards that participated in the OCEAN-TAVI registry. The OCEAN-TAVI investigations was registered with the University Hospital Medical Information Network (no.: UMIN000020423). The medical ethics committees at all hospitals approved this study protocol, and written informed consent was obtained from all patients before TAVI.

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Tokuda, T., Yamamoto, M., Kagase, A. et al. Importance of combined assessment of skeletal muscle mass and density by computed tomography in predicting clinical outcomes after transcatheter aortic valve replacement. Int J Cardiovasc Imaging 36, 929–938 (2020). https://doi.org/10.1007/s10554-020-01776-x

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