Role of psoas muscle area as an indicator of adverse outcomes after transcatheter aortic valve implantation

Abstract

Introduction. Patient frailty, having muscle hypotrophy as the main component, is important in determining the treatment tactics of cardiovascular diseases due to a decrease in the physiological reserve. An objective assessment of dystrophic changes level in the total muscle mass is possible by measurig the cross-sectional area of the psoas muscle (PMA). Аim was to determine if the psoas muscle area (PMA) could predict adverse outcomes and to investigate its utility in patients after transcatheter aortic valve implantation (TAVI). Materials and methods. The study included 51 patients with critical symptomatic aortic stenosis and high risk factors according to EuroScore II and STS. The study is a retrospective, single-centre analysis of the association of PMA from preoperative multislice computed tomography with adverse outcomes after TAVI. PMA was calculated as the average area of the left and right psoas. PMA measurements were then normalized to the patient’s body surface area (m2) and showed as psoas muscle index (iPMA; cm2/m2). Results. The mean age of the patients was 78.2±9.3 years, where 29 (56.9 %) were women. Since iPMA was not normally distributed, median values were analyzed: median iPMA for men 4.35 cm2/m2 and for women 3.55 cm2/m2. In our study, we found that iPMA was lower in patients with an early adverse outcome than in patients without an early adverse outcome (3.21±0.42 vs 5.47±0.43 cm2/m2; p=0.017). Patients with low iPMA (62.8 %) required longterm hospitalization, and low iPMA can be considered a predictor of higher hospital resource costs (p=0.056). Conclusion. Our study demonstrated that computed tomography-calculated iPMA is a simple and objective predictor of early postoperative complications and prolonged hospital stay after TAVI, and consequently higher hospital resource costs.