Lin Shuangxiang, Liu Chenjia, Ding Xingfa, Wang Shuyue, Wu Jiaxing, Wang Xinhong, Sun Jianzhong
Department of Radiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310000, China.
Siemens Healthineers, No.399, West Haiyang Road, Shanghai, 200126, China.
BMC Cardiovasc Disord. 2024 Dec 23;24(1):739. doi: 10.1186/s12872-024-04400-1.
The aim of this study was to evaluate the prognostic impact of computed tomography (CT)-based body composition parameters in metabolically unhealthy normal-weight patients (MUHNW) with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).
This prospective cohort study involved adults with normal weight scheduled for TAVR. Patients were divided into two groups: metabolically healthy normal-weight (MHNW) and MUHNW. The primary outcome was major adverse cardiovascular events (MACEs), and the secondary outcomes were all-cause mortality and prolonged hospital stay. Logistic regression was used to explore the relationships between variables and outcomes, and Cox regression models were applied to examine the effects of different parameters on patient prognosis. Incremental discriminative improvement (IDI) and the C-index were used to determine the influence of hybrid parameters on the predictive efficiency of the model.
The cohort study included 182 patients divided into two groups: MHNW metabolically healthy normal-weight (n = 97) and MUHNW (n = 85). Over a median follow-up of 0.8 years, multivariable logistic regression analysis revealed significant associations of the skeletal muscle index (SMind) (HR: 0.50, 95% CI: 0.29 - 0.84, p = 0.01), subcutaneous adipose tissue index (SATind) (HR: 0.63, 95% CI: 0.45 - 0.88, p = 0.01), and visceral adipose tissue index (VATind) (HR: 1.34, 95% CI: 1.10 - 1.63, p < 0.01) with the risk of experiencing MACEs, whereas epicardial adipose tissue (EAT) was not significantly associated with the risk of experiencing MACEs in the multivariable model (HR: 1.10, 95% CI: 0.97 - 1.24, p = 0.14). For the primary outcome, adjusted for significant covariates, the model had an IDI of 0.25 and a C-index of 0.8, with significant associations of SMind (HR: 0.73, 95% CI: 0.62 - 0.87, p < 0.01), SATind (HR: 0.87, 95% CI: 0.78 - 0.97, p = 0.01), and VATind (HR: 1.25, 95% CI: 1.12-1.40, p < 0.01) with the risk of experiencing MACEs. For the secondary outcome, the model had an IDI of 0.36 and a C-index of 0.93, with EAT showing a significant protective effect against all-cause mortality and prolonged hospital stay (HR: 0.97, 95% CI: 0.93 - 0.99; p = 0.04).
Body composition parameters, including, VATind, SMind, and SATind, are significant predictors of MACEs in patients undergoing TAVR. Additionally, EAT shows a significant protective effect against all-cause mortality and prolonged hospital stay. These findings highlight the potential importance of comprehensive body composition assessments in the risk stratification and management of AS patients.
本研究旨在评估基于计算机断层扫描（CT）的身体成分参数对接受经导管主动脉瓣置换术（TAVR）的代谢不健康正常体重主动脉瓣狭窄（AS）患者（MUHNW）预后的影响。
这项前瞻性队列研究纳入了计划接受TAVR的正常体重成年人。患者分为两组：代谢健康正常体重（MHNW）组和MUHNW组。主要结局是主要不良心血管事件（MACE），次要结局是全因死亡率和住院时间延长。采用逻辑回归探讨变量与结局之间的关系，并应用Cox回归模型检验不同参数对患者预后的影响。使用增量判别改善（IDI）和C指数来确定混合参数对模型预测效率的影响。
该队列研究包括182例患者，分为两组：MHNW代谢健康正常体重组（n = 97）和MUHNW组（n = 85）。在中位随访0.8年期间，多变量逻辑回归分析显示，骨骼肌指数（SMind）（HR：0.50，95%CI：0.29 - 0.84，p = 0.01）、皮下脂肪组织指数（SATind）（HR：0.63，95%CI：0.45 - 0.88，p = 0.01）和内脏脂肪组织指数（VATind）（HR：1.34，95%CI：1.10 - 1.63，p < 0.01）与发生MACE的风险显著相关，而在多变量模型中，心外膜脂肪组织（EAT）与发生MACE的风险无显著相关性（HR：1.10，95%CI：0.97 - 1.24，p = 0.14）。对于主要结局，在调整显著协变量后，模型的IDI为0.25，C指数为0.8，SMind（HR：0.73，95%CI：0.62 - 0.87，p < 0.01）、SATind（HR：0.87，95%CI：0.78 - 0.97，p = 0.01）和VATind（HR：1.25，95%CI：1.12 - 1.40，p < 0.01）与发生MACE的风险显著相关。对于次要结局，模型的IDI为0.36，C指数为0.93，EAT对全因死亡率和住院时间延长显示出显著的保护作用（HR：0.97，95%CI：0.93 - 0.99；p = 0.04）。
包括VATind、SMind和SATind在内的身体成分参数是接受TAVR患者发生MACE的重要预测指标。此外，EAT对全因死亡率和住院时间延长显示出显著的保护作用。这些发现凸显了全面身体成分评估在AS患者风险分层和管理中的潜在重要性。
