Schörghofer Nikolaos, Knapitsch Christoph, Hecke Gretha, Clodi Nikolaus, Brandstetter Lucas, Cozowicz Crispiana, Hammerer Matthias, Hergan Klaus, Hoppe Uta C, Scharinger Bernhard, Boxhammer Elke
Department of Radiology, Paracelsus Medical University of Salzburg, Salzburg, Austria.
Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria.
J Cachexia Sarcopenia Muscle. 2025 Aug;16(4):e70012. doi: 10.1002/jcsm.70012.
Sarcopenia, characterized by progressive skeletal muscle loss, is a silent yet powerful marker associated with survival, yet its impact on long-term outcomes in transcatheter aortic valve implantation (TAVI) remains underestimated. While frailty has been recognized as a main factor of resilience and recovery, the role of muscle integrity is frequently overlooked. This study explores whether computed tomography (CT)-derived psoas muscle area (PMA) and psoas muscle area index (PMI) are key predictors of post-TAVI survival.
A total of 539 patients (mean age 82.0 ± 5.1 years; 49.9% female) undergoing TAVI were analysed in this retrospective, single-centre study. Sarcopenia was analysed via sex-specific quartiles of PMA and PMI. Long-term survival was examined using Kaplan-Meier analysis, univariate and multivariate Cox regression analysis. Interaction terms were introduced to assess whether the association between sarcopenia and survival differed by age, sex, renal function and anaemia status.
Sarcopenia emerged as a predictor of long-term mortality (HR = 1.52, p = 0.011 for PMA; HR = 1.55, p = 0.008 for PMI) after TAVI. Notably, younger patients (< 80 years) with sarcopenia faced double the mortality risk (HR = 2.48, p = 0.001 for PMA; HR = 2.55, p = 0.001 for PMI), whereas in older patients, the association was weaker. In women, who typically show a post-TAVI survival advantage, sarcopenia reduced this benefit (HR = 1.75, p = 0.020 for PMA; HR = 1.88, p = 0.008 for PMI). The most striking finding was the synergistic effect of sarcopenia and chronic kidney disease (CKD), resulting in a threefold increase in mortality risk (HR = 2.82, p = 0.027 for PMA; HR 3.14, p = 0.011). After multivariate adjustment, sarcopenia remained a strong, independent predictor of long-term mortality (HR = 1.58, p = 0.009 for PMA; HR = 1.49, p = 0.024 for PMI), reinforcing its clinical relevance in TAVI risk stratification.
Our study suggests that sarcopenia is not just a passive bystander, but may serve as a marker associated with long-term mortality in TAVI patients, especially in younger individuals, women and those with CKD or anaemia. Since muscle mass predicts survival and is potentially modifiable, assessing and intervening against sarcopenia before and after TAVI could represent a clinical priority in patients with aortic valve stenosis. This study underscores the importance of a more nuanced approach-not merely focusing on valve replacement, but on strengthening patient-centred care.
肌肉减少症以进行性骨骼肌流失为特征，是一个与生存相关的隐匿却重要的指标，但其对经导管主动脉瓣植入术（TAVI）长期预后的影响仍被低估。尽管衰弱已被认为是恢复力和恢复情况的主要因素，但肌肉完整性的作用却常常被忽视。本研究探讨了计算机断层扫描（CT）得出的腰大肌面积（PMA）和腰大肌面积指数（PMI）是否是TAVI术后生存的关键预测指标。
在这项回顾性单中心研究中，对总共539例行TAVI的患者（平均年龄82.0±5.1岁；49.9%为女性）进行了分析。通过PMA和PMI的性别特异性四分位数分析肌肉减少症。使用Kaplan-Meier分析、单因素和多因素Cox回归分析来检查长期生存情况。引入交互项以评估肌肉减少症与生存之间的关联在年龄、性别、肾功能和贫血状态方面是否存在差异。
肌肉减少症成为TAVI术后长期死亡率的预测指标（PMA的HR=1.52，p=0.011；PMI的HR=1.55，p=0.008）。值得注意的是，患有肌肉减少症的年轻患者（<80岁）面临的死亡风险加倍（PMA的HR=2.48，p=0.001；PMI的HR=2.55，p=0.001），而在老年患者中，这种关联较弱。在通常具有TAVI术后生存优势的女性中，肌肉减少症削弱了这种优势（PMA的HR=1.75，p=0.020；PMI的HR=1.88，p=0.008）。最显著的发现是肌肉减少症与慢性肾脏病（CKD）的协同作用，导致死亡风险增加两倍（PMA的HR=2.82，p=0.027；PMI的HR=3.14，p=0.011）。经过多因素调整后，肌肉减少症仍然是长期死亡率的一个强大、独立的预测指标（PMA的HR=1.58,p=0.009；PMI的HR=1.49,p=0.024），强化了其在TAVI风险分层中的临床相关性。
我们的研究表明，肌肉减少症不仅仅是一个被动的旁观者，而是可能作为TAVI患者长期死亡率的一个相关指标，特别是在年轻个体、女性以及患有CKD或贫血的患者中。由于肌肉量可预测生存且可能是可改变的，在TAVI前后评估和干预肌肉减少症可能是主动脉瓣狭窄患者的临床优先事项。本研究强调了一种更细致入微的方法的重要性——不仅仅关注瓣膜置换，还要加强以患者为中心的护理。
