The Utility of Psoas Muscle Assessment in Predicting Frailty in Patients Undergoing Transcatheter Aortic Valve Replacement.

Louis Koizia,George Peck,Iqbal S Malik,Sayan Sen,Mitesh Naik,Michael B Fertleman,Ghada W Mikhail,Ben Ariff

doi:10.1155/2020/5783107

Abstract

Background The rise in an ageing population has resulted in an increase in the prevalence of aortic stenosis. With the advent and rapid expansion in the use of transcatheter aortic valve replacements (TAVRs), patients with severe aortic stenosis, traditionally thought too high risk for surgical intervention, are now being treated with generally favourable results. Frailty is an important factor in determining outcome after a TAVR, and an assessment of frailty is fundamental in the identification of appropriate patients to treat. Objective The objective of the study was to identify if the psoas muscle area is associated with frailty in TAVR patients and outcome after intervention. Method In this prospective study, we measured outcomes of 62 patients who underwent TAVR procedures against the psoas muscle area and the Reported Edmonton Frail Scale (REFS). Our aim was to assess if psoas muscle assessment can be used as a simple method to predict frailty in our population group. Results A total of 60 patients met the study criteria. Mean psoas-lumbar vertebral index was 0.61, with a lower value in the frail group. There was not a statistically significant correlation between the psoas measures, REFS score (indicative of frailty), and mortality. However, there was a statistically significant relationship between the psoas size and REFS score (p=0.043). Conclusion Psoas assessment can be useful in providing additional information when planning for patients to undergo a TAVR and can be used as a screening tool to help identify frail patients within this high-risk group.

Highlights

Severe aortic stenosis is associated with poor prognosis and significant morbidity, in patients with concomitant left ventricular failure
Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of patients with aortic stenosis (AS) over the last 15 years [1], and there is evidence to suggest transcatheter aortic valve replacements (TAVRs) should be the preferred approach across the spectrum of surgical risk, with the 2019 multicenter PARTNER 3 study showing lower rates of death, stroke, or rehospitalization at 1 year with a TAVR compared with a surgical aortic valve replacement (SAVR) [2]. e U.S Food and Drug Administration (FDA) issued its approval of TAVR in low surgical risk patients, becoming the first regulatory body in the world to do so [3]
Consecutive patients with severe symptomatic aortic stenosis referred for evaluation at Imperial College Healthcare NHS Trust, considered high risk for surgical aortic valve replacement (SAVR), but eligible for TAVR, were included. is group of high-risk patients was assessed in the TAVR clinic

Summary

Introduction

Severe aortic stenosis is associated with poor prognosis and significant morbidity, in patients with concomitant left ventricular failure. Current European Society of Cardiology (ESC) and European Association for Cardiooracic Surgery (EACTS) 2017 guidelines for AS management recommend consideration for TAVR in patients with severe symptomatic AS who are deemed to be too high risk for cardiac surgery [4]. E guidelines recommend that TAVR decisions are taken by the “Heart Team,” including cardiologists, cardiothoracic surgeons, and anaesthetists. Multidisciplinary teams (MDTs) can make use of risk scores to support decision making. Used risk scores including Society of oracic Surgeons (STS) and EuroSCORE II have been found to be inaccurate at predicting mortality and morbidity in TAVR patients [5, 6]. Used risk scores including Society of oracic Surgeons (STS) and EuroSCORE II have been found to be inaccurate at predicting mortality and morbidity in TAVR patients [5, 6]. is is felt to be related to the complexity of this

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