Hirofumi Hioki1, Yusuke Watanabe1, Ken Kozuma1, Masanori Yamamoto2, Toru Naganuma3, Motoharu Araki4, Norio Tada5, Shinichi Shirai6, Futoshi Yamanaka7, Akihiro Higashimori8, Kazuki Mizutani9, Minoru Tabata10, Kensuke Takagi11, Hiroshi Ueno12, Kentaro Hayashida13. 1. Division of Cardiology, Department of Internal Medicine, Teikyo University Hospital, Tokyo, Japan. 2. Division of Cardiovascular Medicine, Toyohashi Heart Center, Aichi, Japan. 3. Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan. 4. Department of Cardiovascular Medicine, Yokohama City Eastern Hospital, Kanagawa, Japan. 5. Department of Cardiovascular Center, Sendai Kosei Hospital, Miyagi, Japan. 6. Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan. 7. Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan. 8. Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada, Japan. 9. Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan. 10. Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan. 11. Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan. 12. Department of the Second Department of Internal Medicine, University of Toyama, Toyama, Japan. 13. Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
Abstract
BACKGROUND: The prognostic impact of skeletal muscle mass, assessed using lean body mass (LBM), remain unclear in patients who underwent transcatheter aortic valve replacement (TAVR). The aim of this study to assess prognostic impact of LBM on mortality after TAVR. METHODS: We assessed 1,613 patients (median age 85 years, 70% female) who underwent TAVI from October 2013 to April 2016 using OCEAN (Optimized transCathEter vAlvular interveNtion)-TAVI registry data. LBM was calculated using the James formula. The primary endpoint was all-cause death after TAVR. RESULTS: Median follow-up period was 287 days (interquartile range 110-462). The Kaplan-Meier analysis demonstrated that patients with low LBM had significantly higher incidence of all-cause death than those with high LBM in male (32.3% vs. 9.9%, log rank P < 0.001) and female (15.8% vs. 9.2%, log-rank P = 0.011). On contrary, the risk stratification using body mass index (BMI) could not validate into female patients who underwent TAVR. The multivariate analysis showed that the LBM was an independent predictor of all-cause death in male (Hazard ratio [HR] 0.93; 95% confidence interval [CI] 0.89-0.98) and female (HR 0.94; 95% CI 0.89-0.99). Inversely, the assessment using BMI could not identify the high-risk population in a female. CONCLUSIONS: The patients with low LBM had the higher incidence of all-cause death after TAVR than those with high LBM, regardless of gender. Thus, the risk stratification using LBM might provide further insight to identify the high-risk TAVR population, compared to conventional risk stratification using BMI.
BACKGROUND: The prognostic impact of skeletal muscle mass, assessed using lean body mass (LBM), remain unclear in patients who underwent transcatheter aortic valve replacement (TAVR). The aim of this study to assess prognostic impact of LBM on mortality after TAVR. METHODS: We assessed 1,613 patients (median age 85 years, 70% female) who underwent TAVI from October 2013 to April 2016 using OCEAN (Optimized transCathEter vAlvular interveNtion)-TAVI registry data. LBM was calculated using the James formula. The primary endpoint was all-cause death after TAVR. RESULTS: Median follow-up period was 287 days (interquartile range 110-462). The Kaplan-Meier analysis demonstrated that patients with low LBM had significantly higher incidence of all-cause death than those with high LBM in male (32.3% vs. 9.9%, log rank P < 0.001) and female (15.8% vs. 9.2%, log-rank P = 0.011). On contrary, the risk stratification using body mass index (BMI) could not validate into female patients who underwent TAVR. The multivariate analysis showed that the LBM was an independent predictor of all-cause death in male (Hazard ratio [HR] 0.93; 95% confidence interval [CI] 0.89-0.98) and female (HR 0.94; 95% CI 0.89-0.99). Inversely, the assessment using BMI could not identify the high-risk population in a female. CONCLUSIONS: The patients with low LBM had the higher incidence of all-cause death after TAVR than those with high LBM, regardless of gender. Thus, the risk stratification using LBM might provide further insight to identify the high-risk TAVR population, compared to conventional risk stratification using BMI.
Authors: M S van Mourik; J F Velu; V R Lanting; J Limpens; B J Bouma; J J Piek; J Baan; J P S Henriques; M M Vis Journal: Neth Heart J Date: 2020-05 Impact factor: 2.380