Department of Internal Medicine, Cleveland Clinic, Cleveland, OH.
Department of Internal Medicine, Cleveland Clinic, Cleveland, OH; Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC.
Am Heart J. 2024 Oct;276:49-59. doi: 10.1016/j.ahj.2024.07.007. Epub 2024 Jul 18.
Skeletal muscle mass (SMM) plays a crucial role in risk assessment in transcatheter aortic valve replacement (TAVR) candidates, yet it remains underutilized. Traditional methods focus on weakness or performance but omit SMM. This study compared traditional and novel markers of sarcopenia and frailty in terms of their ability to predict adverse outcomes post-TAVR.
Three risk models were evaluated for the composite outcome of perioperative complications, 1-year rehospitalization, or 1-year mortality: (1) sarcopenia by combining low muscle mass (LMM) and weakness/performance assessed by hand grip strength or gait speed; (2) frailty by an Adapted Green score; and (3) frailty by the Green-SMI score incorporating LMM by multilevel opportunistic pre-TAVR thoracic CT segmentation.
In this study we included 184 eligible patients from January to December of 2018, (96.7%) of which were balloon expandable valves. The three risk models identified 22.8% patients as sarcopenic, 63.6% as frail by the Adapted Green score, and 53.8% as frail by the Green-SMI score. There were higher rates of the composite outcome in patients with sarcopenia (54.8%) and frailty (41.9% with the Adapted Green and 50.5% with the Green-SMI score) compared to their nonsarcopenic (30.3%) and nonfrail counterparts (25.4% with the Adapted Green and 18.8% with the Green-SMI score). Sarcopenia and frailty by Green-SMI, but not by the Adapted Green, were associated with higher risks of the composite outcome on multivariable adjustment (HR 2.2 [95% CI: 1.25-4.02], P = .007 and HR 3.4 [95% CI: 1.75-6.65], P < .001, respectively).
The integration of preoperative CT-based SMM to a frailty score significantly improves the prediction of adverse outcomes in patients undergoing TAVR.
骨骼肌质量（SMM）在经导管主动脉瓣置换术（TAVR）患者的风险评估中起着至关重要的作用，但目前尚未得到充分利用。传统方法侧重于虚弱或表现，但忽略了 SMM。本研究比较了肌少症和衰弱的传统和新型标志物在预测 TAVR 后不良结局方面的能力。
评估了 3 种风险模型的复合结局：围手术期并发症、1 年再入院或 1 年死亡率：（1）通过结合低肌肉质量（LMM）和握力或步态速度评估的肌肉无力/表现来评估肌少症；（2）通过适应性格林评分评估衰弱；（3）通过纳入多层机会性 TAVR 前胸部 CT 分割的 LMM 的格林-SMI 评分来评估衰弱。
本研究纳入了 2018 年 1 月至 12 月的 184 名符合条件的患者，其中 96.7%为球囊扩张瓣膜。这 3 种风险模型确定了 22.8%的患者为肌少症，63.6%的患者为适应性格林评分衰弱，53.8%的患者为格林-SMI 评分衰弱。肌少症（54.8%）和衰弱（适应性格林评分 41.9%和格林-SMI 评分 50.5%）患者的复合结局发生率高于非肌少症（30.3%）和非衰弱患者（适应性格林评分 25.4%和格林-SMI 评分 18.8%）。在多变量调整后，格林-SMI 评估的肌少症和衰弱（但不是适应性格林评分）与复合结局的风险增加相关（HR 2.2[95%CI：1.25-4.02]，P =.007 和 HR 3.4[95%CI：1.75-6.65]，P <.001）。
术前 CT 检测的 SMM 与衰弱评分相结合可显著提高 TAVR 患者不良结局的预测能力。
