medwireNews: Older adults undergoing transcatheter aortic valve replacement (TAVR) who have osteosarcopenia, a condition marked by simultaneous decline in muscle and bone mass, have poor outcomes, report researchers in JAMA Cardiology.
The results show that osteosarcopenia measured on computed tomography (CT) was independently associated with mortality and worsening disability at 1 year after TAVR, with the risk increased a significant threefold and twofold, respectively, in patients aged a mean of 82.6 years undergoing the procedure for aortic stenosis, compared with those without osteosarcopenia.
The researchers point out that neither low muscle mass nor bone mass alone were independently associated with these outcomes.
“Radiographic assessment of osteosarcopenia proved to be a valid and efficient approach to screen patients and identify a subpopulation with high rates of frailty, fractures, disability, and malnutrition,” say Jonathan Afilalo (Jewish General Hospital, Montreal, Quebec, Canada) and colleagues.
The study included data on 605 individuals (45% women; 72% older than 80 years of age) obtained from a post-hoc analysis of the Frailty in Aortic Valve Replacement (FRAILTY-AVR) prospective multicenter cohort study, conducted at 14 centers in Canada, the USA, and France from 2021 to 2022, and the McGill University-affiliated center, which enrolled patients on an ongoing basis up to 2022.
CT scans were conducted prior to TAVR to measure psoas muscle area (PMA) and vertebral bone density (VBD), with osteosarcopenia diagnosis based on the presence of both low PMA (<22 cm2 for men and 12 cm2 for women) and low VBD (average trabecular attenuation across first four lumbar vertebrae <90 Housfield Units [HU]).
The mean PMA was 22.1 cm² in men and 15.4 cm² in women, while mean VBD was 104.8 HU in men and 98.8 HU in women.
In all, 15% of participants met the criteria for osteosarcopenia, 21% had low PMA, 25% had low VBD, and 39% had normal muscle and bone status. Patients with osteosarcopenia and low PMA had higher rates of frailty, fractures, and malnutrition than those with normal muscle and bone status, while fractures were most common among those with low VBD.
The rate of mortality at 1 year was 32% among patients with osteosarcopenia, 14% for those with low PMA alone, 11% for those with low VBD alone, and 9% for those with normal muscle and bone status.
Rates of worsening disability at 1 year, defined as newly needing assistance with or being unable to independently carry out at least two activities of daily living, were also highest among those with osteosarcopenia, at 60%, compared with 35% in patients with low PMA, 38% in those with low VBD, and 35% in those with normal muscle and bone status.
The researchers suggest that "relying on measures of low muscle mass alone, without considering bone health or physical performance, is likely to misclassify many patients as frail."
Indeed, they found that adding the presence of osteosarcopenia to traditional measures of TAVR procedural risk (TAVI2-SCORe) improved the accuracy of mortality prediction at 1 year from 63% to 68% and to 72% with the inclusion of the short physical performance battery as well.
“Our findings support CT-based osteosarcopenia as a novel indicator of frailty and mortality risk in older adults undergoing TAVR,” say Afilalo et al.
They add that the prognostic value of osteosarcopenia is not limited to patients undergoing TAVR. It could also improve decision-making in the management of “patients with ischemic heart disease being considered for revascularization, those with advanced heart failure being considered for mechanical circulatory support, and those with mitral and tricuspid valve regurgitation being considered for surgical or transcatheter repair,” the investigators suggest.
Further to this, “osteosarcopenia is an actionable finding for referral to cardiac rehabilitation or programs in which exercise and nutritional interventions can be initiated with the goal of improving musculoskeletal health and physical functioning following TAVR,” they add.
Patrick O’Gara (Brigham and Women’s Hospital, Boston, Massachusetts, USA) and fellow editors point out in an accompanying Editor’s note that “the simplicity of this method warrants emphasis and further validation studies that may augment its uptake in practice.”
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JAMA Cardiol 2024; doi:10.1001/jamacardio.2024.0911
JAMA Cardiol 2024; doi:10.1001/jamacardio.2024.1018
