Abstract 12909: Usefulness of Sarcopenia Index for Predicting Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement

Abstract

Introduction: Sarcopenia, a marker of biological senescence, is a robust prognostic indicator of outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) for aortic stenosis (AS). However, there are no serum markers routinely available for estimating skeletal muscle mass (SMM). The present study aimed to describe a new sarcopenia index (SI, serum creatinine value/cystatin C value x 100) and investigate its association with outcomes after TAVR. Methods: The study cohort comprised 100 patients ≥ 65 years of age (mean 83.9±5.7; 36% men) who underwent transfemoral TAVR at Hospital Italiano de Buenos Aires, Argentina from 2016 to 2018. The mean Society of Thoracic Surgeons (STS) score was 3.3±1.7. Sarcopenia was defined according to ROC curve for SI (AUC 0.731, CI 95% 0.599-0.863, p-value=0.001) for predicting the primary endpoint. Both all-cause mortality and/or readmissions for congestive heart failure (CHF) were defined as the primary endpoint within the first year after TAVR. Results: According to SI cutoff, half of the study population (SI ≤66) was sarcopenic before TAVR. The 30-day mortality increased significantly in the lowest SI tertile (sarcopenia+) group (12, 3, and 0%, p=.05, respectively). SI strongly correlated with timed-up and go and gait speed but not with body mass index and baseline C-reactive protein levels. Overall survival was worse (Log-rank test= p=0.02) and CHF readmissions were more prevalent in the lowest SI tertile (Log-rank test=p=0.01). On Cox regression analysis, a low SI (SI ≤66) had a significantly higher risk of the primary endpoint (adjusted hazard ratio: 4.01, 95% CI: 1.31-12.27, p=.015). Conclusions: SI, a novel-non-invasive method for assessing SMM was able to predict mid-term mortality and CHF readmissions. We suggest careful consideration of sarcopenia prior to TAVR in order to decide the best treatment approaches.