Borek Foldyna1, Fabian M Troschel2, Daniel Addison3, Florian J Fintelmann2, Sammy Elmariah4, Deborah Furman4, Parastou Eslami3, Brian Ghoshhajra3, Michael T Lu3, Venkatesh L Murthy5, Udo Hoffmann3, Ravi Shah3. 1. Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA; Department of Diagnostic and Interventional Radiology, University of Leipzig, Heart Center, Leipzig, Germany. Electronic address: bfoldyna@mgh.harvard.edu. 2. Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, Boston, USA. 3. Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA. 4. Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA. 5. Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, USA.
Abstract
BACKGROUND: Computed tomography (CT)-based fat and muscle measures are associated with outcome in large populations. We tested if muscle and fat characteristics are associated with long-term outcomes after TAVR. METHODS: We included 403 clinical CTs performed prior to TAVR at our center between 2008 and 2016, measuring area (cm2) and density (Hounsfield units, HU) of both psoas muscles (PM), subcutaneous adipose (SAT), and visceral adipose tissue (VAT). Area measures were indexed to height, log-transformed and both area and density were standardized for analysis. We assessed the association of each measure with all-cause mortality (adjusted for age, sex, body mass index (BMI), and the Society of Thoracic Surgeons (STS) risk score. RESULTS: Of the 403 individuals (83 ± 8 years; 52% female), 167 (41.4%) died during a median follow-up of 458 days (interquartile range IQR 297-840). Fat measures were feasible and rapid. Fat area was available in 242 (60%) patients with an adequate field of view. Individuals with the lowest PM area, SAT area or VAT area exhibited the highest hazard of mortality. In addition, greater SAT density was associated with a higher mortality hazard (adjusted HR per standard deviation increase in density = 1.35, 95%CI 1.10-1.67, P = 0.005). CONCLUSION: Rapid CT-based tissue characterization is feasible in patients referred for TAVR. Decreased PM area and increased SAT density are associated with long-term mortality after TAVR, even after accounting for age, sex, BMI, and STS score. Further studies are necessary to interrogate sex-specific relationships between CT tissue metrics and mortality and whether CT measures are incremental to well-established frailty metrics.
BACKGROUND: Computed tomography (CT)-based fat and muscle measures are associated with outcome in large populations. We tested if muscle and fat characteristics are associated with long-term outcomes after TAVR. METHODS: We included 403 clinical CTs performed prior to TAVR at our center between 2008 and 2016, measuring area (cm2) and density (Hounsfield units, HU) of both psoas muscles (PM), subcutaneous adipose (SAT), and visceral adipose tissue (VAT). Area measures were indexed to height, log-transformed and both area and density were standardized for analysis. We assessed the association of each measure with all-cause mortality (adjusted for age, sex, body mass index (BMI), and the Society of Thoracic Surgeons (STS) risk score. RESULTS: Of the 403 individuals (83 ± 8 years; 52% female), 167 (41.4%) died during a median follow-up of 458 days (interquartile range IQR 297-840). Fat measures were feasible and rapid. Fat area was available in 242 (60%) patients with an adequate field of view. Individuals with the lowest PM area, SAT area or VAT area exhibited the highest hazard of mortality. In addition, greater SAT density was associated with a higher mortality hazard (adjusted HR per standard deviation increase in density = 1.35, 95%CI 1.10-1.67, P = 0.005). CONCLUSION: Rapid CT-based tissue characterization is feasible in patients referred for TAVR. Decreased PM area and increased SAT density are associated with long-term mortality after TAVR, even after accounting for age, sex, BMI, and STS score. Further studies are necessary to interrogate sex-specific relationships between CT tissue metrics and mortality and whether CT measures are incremental to well-established frailty metrics.
Authors: Robin F Gohmann; Batuhan Temiz; Patrick Seitz; Sebastian Gottschling; Christian Lücke; Christian Krieghoff; Christian Blume; Matthias Horn; Matthias Gutberlet Journal: Quant Imaging Med Surg Date: 2021-10
Authors: Robin F Gohmann; Sebastian Gottschling; Patrick Seitz; Batuhan Temiz; Christian Krieghoff; Christian Lücke; Matthias Horn; Matthias Gutberlet Journal: Quant Imaging Med Surg Date: 2021-02
Authors: Andreas Kammerlander; Asya Lyass; Taylor F Mahoney; Jana Taron; Parastou Eslami; Michael T Lu; Michelle T Long; Ramachandran S Vasan; Joseph M Massaro; Udo Hoffmann Journal: Eur Radiol Date: 2022-07-02 Impact factor: 7.034
Authors: Jeroen Walpot; Paul van Herck; Valerie Collas; Liene Bossaerts; Caroline M Van de Heyning; Tom Vandendriessche; Hein Heidbuchel; Inez Rodrigus; Christophe De Block; Gary R Small; Johan Bosmans Journal: Clin Cardiol Date: 2022-08-06 Impact factor: 3.287