Comparing Frailty Markers in Predicting Poor Outcomes after Transcatheter Aortic Valve Replacement

Aravind Krishnan, Alejandro Suarez-Pierre, Xun Zhou, Cheng Lin, Charles D. Fraser, Todd C. Crawford, Joshua Hsu, Rani Hasan, Jon R Resar, Matthews Chacko, William A Baumgartner, John V. Conte, Kaushik Mandal

Research output: Contribution to journalArticle

Abstract

Introduction Frailty is an important component of risk prognostication in transcatheter aortic valve replacement (TAVR). Objective markers of frailty, including sarcopenia, the modified Frailty Index (mFI), and albumin levels, have emerged, but little is known how such markers compare to each other in predicting outcomes after TAVR. We sought to define and compare these markers in predicting long-term outcomes after TAVR. Methods Patients who underwent TAVR at our institution from 2011 to 2016 were included. Indexed cross-sectional areas of the lumbosacral muscles on preoperative computed tomography scans were used to assess sarcopenia. Optimal cutoffs for sarcopenia were defined using a statistically validated method. mFI was calculated using an 11-point scale of clinical characteristics. The primary outcome was 2-year all-cause mortality. Adjusted survival analysis was used to analyze outcomes. Results A total of 381 patients were included in this study. Sarcopenia of the psoas muscles was associated with an increased risk of mortality on univariate (HR: 2.3, P = 0.01) and multivariate (HR: 2.5, P = 0.01) analysis. Sarcopenia of the paravertebral muscles was associated with increased risk of mortality only on univariate analysis (HR: 2.1, P = 0.03). Increased preoperative albumin levels were associated with decreased risk of mortality on univariate (HR: 0.3, P < 0.01) and multivariate analysis (HR: 0.3, P < 0.01). The (mFI) was not associated with mortality on univariate or multivariate analysis. Discussion Novel cutoffs for sarcopenia of the psoas muscles were determined and associated with decreased survival after TAVR. Sarcopenia and albumin levels may be better tools for risk prediction than mFI in TAVR.

Original languageEnglish (US)
Pages (from-to)43-54
Number of pages12
JournalInnovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Volume14
Issue number1
DOIs
StatePublished - Feb 1 2019

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Sarcopenia
Mortality
Psoas Muscles
Albumins
Multivariate Analysis
Muscles
Survival Analysis
Transcatheter Aortic Valve Replacement
Tomography
Survival

Keywords

  • frailty
  • outcomes
  • TAVR

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Comparing Frailty Markers in Predicting Poor Outcomes after Transcatheter Aortic Valve Replacement. / Krishnan, Aravind; Suarez-Pierre, Alejandro; Zhou, Xun; Lin, Cheng; Fraser, Charles D.; Crawford, Todd C.; Hsu, Joshua; Hasan, Rani; Resar, Jon R; Chacko, Matthews; Baumgartner, William A; Conte, John V.; Mandal, Kaushik.

In: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, Vol. 14, No. 1, 01.02.2019, p. 43-54.

Research output: Contribution to journalArticle

Krishnan, Aravind ; Suarez-Pierre, Alejandro ; Zhou, Xun ; Lin, Cheng ; Fraser, Charles D. ; Crawford, Todd C. ; Hsu, Joshua ; Hasan, Rani ; Resar, Jon R ; Chacko, Matthews ; Baumgartner, William A ; Conte, John V. ; Mandal, Kaushik. / Comparing Frailty Markers in Predicting Poor Outcomes after Transcatheter Aortic Valve Replacement. In: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery. 2019 ; Vol. 14, No. 1. pp. 43-54.
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T1 - Comparing Frailty Markers in Predicting Poor Outcomes after Transcatheter Aortic Valve Replacement

AU - Krishnan, Aravind

AU - Suarez-Pierre, Alejandro

AU - Zhou, Xun

AU - Lin, Cheng

AU - Fraser, Charles D.

AU - Crawford, Todd C.

AU - Hsu, Joshua

AU - Hasan, Rani

AU - Resar, Jon R

AU - Chacko, Matthews

AU - Baumgartner, William A

AU - Conte, John V.

AU - Mandal, Kaushik

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N2 - Introduction Frailty is an important component of risk prognostication in transcatheter aortic valve replacement (TAVR). Objective markers of frailty, including sarcopenia, the modified Frailty Index (mFI), and albumin levels, have emerged, but little is known how such markers compare to each other in predicting outcomes after TAVR. We sought to define and compare these markers in predicting long-term outcomes after TAVR. Methods Patients who underwent TAVR at our institution from 2011 to 2016 were included. Indexed cross-sectional areas of the lumbosacral muscles on preoperative computed tomography scans were used to assess sarcopenia. Optimal cutoffs for sarcopenia were defined using a statistically validated method. mFI was calculated using an 11-point scale of clinical characteristics. The primary outcome was 2-year all-cause mortality. Adjusted survival analysis was used to analyze outcomes. Results A total of 381 patients were included in this study. Sarcopenia of the psoas muscles was associated with an increased risk of mortality on univariate (HR: 2.3, P = 0.01) and multivariate (HR: 2.5, P = 0.01) analysis. Sarcopenia of the paravertebral muscles was associated with increased risk of mortality only on univariate analysis (HR: 2.1, P = 0.03). Increased preoperative albumin levels were associated with decreased risk of mortality on univariate (HR: 0.3, P < 0.01) and multivariate analysis (HR: 0.3, P < 0.01). The (mFI) was not associated with mortality on univariate or multivariate analysis. Discussion Novel cutoffs for sarcopenia of the psoas muscles were determined and associated with decreased survival after TAVR. Sarcopenia and albumin levels may be better tools for risk prediction than mFI in TAVR.

AB - Introduction Frailty is an important component of risk prognostication in transcatheter aortic valve replacement (TAVR). Objective markers of frailty, including sarcopenia, the modified Frailty Index (mFI), and albumin levels, have emerged, but little is known how such markers compare to each other in predicting outcomes after TAVR. We sought to define and compare these markers in predicting long-term outcomes after TAVR. Methods Patients who underwent TAVR at our institution from 2011 to 2016 were included. Indexed cross-sectional areas of the lumbosacral muscles on preoperative computed tomography scans were used to assess sarcopenia. Optimal cutoffs for sarcopenia were defined using a statistically validated method. mFI was calculated using an 11-point scale of clinical characteristics. The primary outcome was 2-year all-cause mortality. Adjusted survival analysis was used to analyze outcomes. Results A total of 381 patients were included in this study. Sarcopenia of the psoas muscles was associated with an increased risk of mortality on univariate (HR: 2.3, P = 0.01) and multivariate (HR: 2.5, P = 0.01) analysis. Sarcopenia of the paravertebral muscles was associated with increased risk of mortality only on univariate analysis (HR: 2.1, P = 0.03). Increased preoperative albumin levels were associated with decreased risk of mortality on univariate (HR: 0.3, P < 0.01) and multivariate analysis (HR: 0.3, P < 0.01). The (mFI) was not associated with mortality on univariate or multivariate analysis. Discussion Novel cutoffs for sarcopenia of the psoas muscles were determined and associated with decreased survival after TAVR. Sarcopenia and albumin levels may be better tools for risk prediction than mFI in TAVR.

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