Romeo Francisco José, Chiabrando Juan Guido, Seropian Ignacio Miguel, Raleigh Juan Valle, de Chazal Horacio Medina, Garmendia Cristian Maximiliano, Smietniansky Maximiliano, Cal Mariela, Agatiello Carla Romina, Berrocal Daniel Horacio
Department of Interventional Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Catheter Cardiovasc Interv. 2021 Nov 15;98(6):E889-E896. doi: 10.1002/ccd.29799. Epub 2021 May 27.
Sarcopenia is a prevalent condition in elderly patients and has been associated with adverse outcomes following transcatheter aortic valve replacement (TAVR). The present study aimed to determine the predictive value of serum creatinine-cystatin C ratio, that is, "Sarcopenia Index" (SI) as a surrogate marker of sarcopenia, and investigate its association with clinical outcomes after TAVR.
We conducted a retrospective observational study of patients undergoing TAVR between January, 2016 and December, 2018 at Hospital Italiano de Buenos Aires, Argentina. Patients were excluded if <65-years old, presented previous surgical aortic valve replacement, severe chronic kidney disease, or hemodialysis requirement. The SI was obtained at baseline before TAVR. All-cause mortality and/or readmissions for congestive heart failure (CHF) were defined as the primary endpoint.
In total 100 patients met inclusion criteria for the purpose of the study. Sarcopenia Index was significantly correlated with Timed Up and Go (r = -0.272, p = .010) and Gait Speed (r = -0.278, p = .005). During follow-up, 5/100 patients died within 30 days and a total of 10/100 patients died at 1-year follow-up. Moreover, survival curves were significantly worse (Log-rank test = p = .02) and CHF readmissions were more prevalent in the lowest SI tertile (Log-rank test = p = .01). In multivariate Cox regression analysis, we identified low SI (cutoff ≤66) as an independent predictor of long-term adverse outcomes (HR = 4.01, 95% CI = 1.31-12.27, p = .015) at 1-year follow-up.
Sarcopenia Index, surrogate for the degree of skeletal muscle mass (SMM), could be used as a predictor of adverse outcomes in patients undergoing TAVR.
肌肉减少症在老年患者中普遍存在，并且与经导管主动脉瓣置换术（TAVR）后的不良结局相关。本研究旨在确定血清肌酐-胱抑素C比值，即“肌肉减少症指数”（SI）作为肌肉减少症替代标志物的预测价值，并研究其与TAVR后临床结局的关联。
我们对2016年1月至2018年12月在阿根廷布宜诺斯艾利斯意大利医院接受TAVR的患者进行了一项回顾性观察研究。年龄<65岁、曾接受过外科主动脉瓣置换术、患有严重慢性肾脏病或需要血液透析的患者被排除。SI在TAVR前的基线时获得。全因死亡率和/或因充血性心力衰竭（CHF）再次入院被定义为主要终点。
共有100名患者符合本研究的纳入标准。肌肉减少症指数与计时起立行走测试（r = -0.272，p = 0.010）和步速（r = -0.278，p = 0.005）显著相关。在随访期间，100名患者中有5名在30天内死亡，100名患者中有10名在1年随访时死亡。此外，生存曲线明显更差（对数秩检验=p = 0.02），且最低SI三分位数组中CHF再次入院更为普遍（对数秩检验=p = 0.01）。在多变量Cox回归分析中，我们确定低SI（临界值≤66）是1年随访时长期不良结局的独立预测因素（HR = 4.01，95%CI = 1.31 - 12.27，p = 0.015）。
肌肉减少症指数作为骨骼肌质量（SMM）程度的替代指标，可用于预测接受TAVR患者的不良结局。
