465 Computed Tomography (CT) Assessed Sarcopenia Predicts Mortality and Morbidity in Patients Undergoing Transcatheter Aortic Valve Implantation (TAVI)

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Frailty in TAVI patients correlates with poorer clinical outcomes. Sarcopenia as assessed on routine pre-TAVI CT imaging may provide a surrogate measure of frailty. Retrospective analysis of patients who underwent pre-TAVI CT imaging at a major tertiary hospital between 2009-2019. Skeletal muscle area was calculated on CT by 2 measures: overall cross-sectional skeletal muscle mass standardised for height (SMI) and psoas muscle area standardised for body surface (PMA) at L3 level. Sarcopenia cut-off on SMI was defined as <52.4 cm2/m2 in males and <38.5 cm2/m2 in females. We evaluated outcomes of mortality and composite endpoint of serious post-procedural complications being vascular complications, stroke, pulmonary embolus, new arrhythmia and acute kidney injury. Stepwise logistic regression was used to determine association between CT skeletal muscles measures and outcomes. In 258 patients who underwent TAVI, 191(74%) had assessable SMI and 221(80%) had assessable PMA. Mean SMI was 43.7 cm2/m2 for males and 37.7 cm2/m2 for females, with 138/191(72%) being sarcopenic. Sarcopenic patients were more likely to be male (p<0.001), non-obese (p<0.001), smokers (p=0.045), have CKD (p=0.01) and pulmonary hypertension (p=0.04). Sarcopenia defined by SMI independently predicted risk of post-procedural complications (OR 3.38, p=0.04) however did not predict mortality. PMA was inversely associated with all-cause mortality (OR 0.83, p=0.04) and risk of serious post-procedural complications (OR 0.79, p<0.001). Pre-procedural CT-defined measures of skeletal muscle indicative of sarcopenia predicts both serious post-procedural complications and all-cause mortality in patients undergoing TAVI. Further studies are warranted to compare clinical frailty markers with CT-defined measures of sarcopenia.