Meta-Analysis of the Prognostic Value of Psoas-Muscle Area on Mortality in Patients Undergoing Transcatheter Aortic Valve Implantation
Section snippets
Methods
All studies investigating prognostic value of PMA on mortality after TAVI for severe AS were identified using a 2-level search strategy. First, databases including MEDLINE and EMBASE were searched through May 2018 using Web-based search engines (PubMed, OVID). Search terms included psoas and aortic valve. Second, relevant studies were identified through a manual search of secondary sources including references of initially identified studies and a search of reviews and commentaries. All
Results
Of 31 potentially relevant studies screened initially, 6 eligible studies12, 13, 14, 15, 16, 17 enrolling a total of 1,237 TAVI patients with 1-year to 2-year (considered to be “midterm”) follow-up were identified and included (Table 3). According to PMA, 4 studies14, 15, 16, 17 divided patients into tertiles, one13 into 50th-percentiles, and one12 into quartiles. Mean age (78.96 to 83.3 years), body mass index (26.3 to 29.58 kg/m2), and Society of Thoracic Surgeons predicted risk of mortality
Discussion
The results of the present study suggest that low PMA, especially “lowest-tertile/quartile” PMA, is a predictor of high all-cause mortality at midterm (1-year to 2-year) follow-up after TAVI for patients (both men and women) with severe AS. However, PMA categorization into 50th percentiles may be invalid to predict mortality.
Low PMA as a continuous variable, not as a categorical variable (quantiles), may not be associated with high mortality at midterm follow-up after TAVI. In the study by Garg
Disclosures
The authors have no conflicts of interest to disclose.
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2023, Journal of Clinical AnesthesiaCitation Excerpt :The psoas muscle index (PMI) was calculated by adding the right and left psoas area and standardising to the patient's height (bilateral psoas area/height2). Patients were grouped into sex-stratified PMI tertiles and those in the lowest tertile were defined as sarcopenic [33]. Measurements were performed by a single investigator who received training in psoas measurements from an experienced consultant radiologist.
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2021, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :Although psoas muscle quantity and quality have been shown to be associated with outcomes in surgical and trauma patients, the applicability of these metrics in TAVR patients is unclear.24-27 A meta-analysis, including six papers and sample size of 1,237 by Takagi et al., demonstrated that small psoas muscle cross-sectional area was associated with increased all-cause mortality at one-to-two years after TAVR.11 PD was not investigated.
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2020, American Journal of CardiologyCitation Excerpt :Survival status and date of death were obtained from both the National Registry of Population and the valve policlinic. Sarcopenia was the lowest gender-specific tertile of psoas muscle area indexed to body surface area (calculated with DuBois and DuBois formula) measured on preprocedural computer tomography.2 High-risk EuroSCORE II threshold was ≥4%.
The Clinical Impact of Psoas Muscle Cross-Sectional Area on Medium-Term Mortality After Transcatheter Aortic Valve Implantation
2020, Heart Lung and CirculationCitation Excerpt :In TAVI patients, low psoas CSA has been found to correlate with early poor outcomes and high resource utilisation [9,10], with 6-month mortality [11], 12-month mortality [12], and, in women, with longer-term mortality [13,14]. Recent meta-analysis data has also suggested that patients in the lowest tertile/quartile of psoas CSA are at increased risk of mid-term mortality [15]. Available retrospective studies investigating psoas CSA as a predictor of mortality in TAVI patients have been of relatively small sample size with the inherent limitation of confounding due to unmeasured baseline variables.
Computed Tomography-Determined Muscle Quality Rather Than Muscle Quantity Is a Better Determinant of Prolonged Hospital Length of Stay in Patients Undergoing Transcatheter Aortic Valve Implantation
2020, Academic RadiologyCitation Excerpt :Garg et al. reported that low PMA could predict poor early outcome and higher resource utilization after TAVI, but did not predict 1-year mortality (28). A meta-analysis of the prognostic value of PMA on mortality after TAVI concluded that although the lowest tertile/quartile PMA may be a predictor of higher all-cause mortality at midterm follow-up after TAVI, PMA categorization into 50th percentiles or PMA as a continuous variable was unable to predict post-TAVI mortality (38). In a recent larger study including 1076 patients reported by Kofler et al., the lowest tertile PMA was shown to be independently associated with 30-day and mid-term mortality, but the association between PMA and LOS was not mentioned (39).
Associations of Sarcopenia and Body Composition Measures with Mortality after Transcatheter Aortic Valve Replacement
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