Sarcopenia and health-related quality of life in older adults after transcatheter aortic valve replacement

Abdulla Damluji, Gregory Rodriguez, Thomas Noel, Lakerria Davis, Vishal Dahya, Behnam Tehrani, Kelly Epps, Matthew Sherwood, Eric Sarin, Jeremy Walston, Karen Bandeen-Roche, Jon R Resar, Todd T. Brown, Gary Gerstenblith, Christopher M. O'Connor, Wayne Batchelor

Research output: Contribution to journalArticle

Abstract

Background: Skeletal muscle wasting, or sarcopenia, affects a significant proportion of patients undergoing transcatheter aortic valve replacement (TAVR). However, its influence on post-TAVR recovery and 1-year health-related quality of life (HR-QOL) remains unknown. We examined the relationship between skeletal muscle index (SMI), post-TAVR length of hospital stay (LOS), and 1-year QOL. Methods: The study sample consisted of 300 consecutive patients undergoing TAVR from 2012 to 2018 who had pre-TAVR computed tomographic scans suitable for analysis of body composition. Skeletal muscle mass was quantified as cm2 of skeletal mass per m2 of body surface area from the cross-sectional computed tomographic image at the third lumbar vertebra. Sarcopenia was defined using established sex-specific cutoffs (women: SMI < 39 cm2/m2; men: < 55 cm2/m2). Multivariable linear regression analysis was used to determine the relationship between SMI, LOS, and HR-QOL using the Kansas City Cardiomyopathy Questionnaire. Results: Sarcopenia was present in most (59%) patients and associated with older age (82 vs 76 years; P <.001) and lower body mass index (27 vs 33 kg/m2; P <.001). There were no other differences in baseline clinical or echocardiographic characteristics among the 4 quartiles of SMI. SMI was positively correlated with LOS and 1-year QOL. After adjusting for age, gender, race, and body mass index, SMI remained a significant predictor of both LOS (P =.01) and 1-year QOL (P =.012). For every 10 cm2/m2 higher SMI, there was an 8-point increase in Kansas City Cardiomyopathy Questionnaire score, a difference that is clinically meaningful. Conclusions: Sarcopenia is prevalent in TAVR patients. Higher SMI is associated with shorter LOS and better 1-year HR-QOL. To achieve optimal TAVR benefits, further study into how body composition influences post-TAVR recovery and durable improvement in QOL is warranted.

Original languageEnglish (US)
Pages (from-to)171-181
Number of pages11
JournalAmerican heart journal
Volume224
DOIs
StatePublished - Jun 2020

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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