• J Cardiovasc Comput Tomogr · May 2018

    Computed tomography-based fat and muscle characteristics are associated with mortality after transcatheter aortic valve replacement.

    • Borek Foldyna, Fabian M Troschel, Daniel Addison, Florian J Fintelmann, Sammy Elmariah, Deborah Furman, Parastou Eslami, Brian Ghoshhajra, Michael T Lu, Venkatesh L Murthy, Udo Hoffmann, and Ravi Shah.
    • Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA; Department of Diagnostic and Interventional Radiology, University of Leipzig, Heart Center, Leipzig, Germany. Electronic address: bfoldyna@mgh.harvard.edu.
    • J Cardiovasc Comput Tomogr. 2018 May 1; 12 (3): 223-228.

    BackgroundComputed tomography (CT)-based fat and muscle measures are associated with outcome in large populations. We tested if muscle and fat characteristics are associated with long-term outcomes after TAVR.MethodsWe included 403 clinical CTs performed prior to TAVR at our center between 2008 and 2016, measuring area (cm2) and density (Hounsfield units, HU) of both psoas muscles (PM), subcutaneous adipose (SAT), and visceral adipose tissue (VAT). Area measures were indexed to height, log-transformed and both area and density were standardized for analysis. We assessed the association of each measure with all-cause mortality (adjusted for age, sex, body mass index (BMI), and the Society of Thoracic Surgeons (STS) risk score.ResultsOf the 403 individuals (83 ± 8 years; 52% female), 167 (41.4%) died during a median follow-up of 458 days (interquartile range IQR 297-840). Fat measures were feasible and rapid. Fat area was available in 242 (60%) patients with an adequate field of view. Individuals with the lowest PM area, SAT area or VAT area exhibited the highest hazard of mortality. In addition, greater SAT density was associated with a higher mortality hazard (adjusted HR per standard deviation increase in density = 1.35, 95%CI 1.10-1.67, P = 0.005).ConclusionRapid CT-based tissue characterization is feasible in patients referred for TAVR. Decreased PM area and increased SAT density are associated with long-term mortality after TAVR, even after accounting for age, sex, BMI, and STS score. Further studies are necessary to interrogate sex-specific relationships between CT tissue metrics and mortality and whether CT measures are incremental to well-established frailty metrics.Copyright © 2018 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

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