, Nazmi Kaştan 2
, Batuhan Topcuoğlu 1
, Bahadır Öztürk 1
, Şükriye Uslu 1
, Mustafa Sağan 3
, Nermin Bayar Çakıcı 1
, İclal Erdem Toslak 4
, Şakir Arslan 1
2Department of Radiology, Döşemealti State Hospital, Antalya, Türkiye
3Department of Radiology, Yalvaç State Hospital, Isparta, Türkiye
4Department of Radiology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Türkiye
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is increasingly performed for severe aortic stenosis with improving procedural success rates; however, post-procedural complications remain a significant clinical challenge. Growing evidence suggests that sarcopenia may adversely affect morbidity and mortality in this patient population.
Methods: This retrospective, single-center cohort study included 171 patients undergoing elective TAVI (January 2018-February 2024). Muscle area (MA), visceral, subcutaneous (SATA), and total adipose tissue area (TATA) were measured at the L3 vertebral level from pre-procedural computed tomography angiography (CTA). Primary endpoints were all-cause and cardiac mortality; secondary endpoints were permanent cardiac conduction defect, permanent pacemaker implantation (PPI), and hospital stay.
Results: The cohort comprised 95 women (55.5%) and 76 men (44.5%), median age 78.9 years, society of thoracic surgeons score 6.30 (IQR = 4.37-9.33). Over 21.8 ± 17.9 months, 43 patients (25.1%) died, including 12 cardiac deaths (7.0%). Lower MA and MA/body mass
index (BMI) ratio were independently associated with cardiac mortality in men (adjusted odds ratio [OR] = 0.935, P = .016 and OR = 0.983, P = .042). Permanent cardiac conduction defect occurred in 44 patients (27.7%); lower SATA and TATA were independent predictors in women (OR = 0.990, P = .031 and OR = 0.994, P = .024). Permanent pacemaker implantation was required in 30 patients (18.6%); adipose tissue parameters were associated with PPI in women on univariate analysis but did not retain significance after multiple adjustment.
Conclusion: Pre-procedural CTA-derived body composition assessment may contribute to the prediction of mortality and morbidity in TAVI patients without additional cost or radiation exposure. The association of lower MA with cardiac mortality in men, and of reduced adipose tissue with conduction disturbances in women, suggests that sex-specific body composition parameters may provide prognostic value beyond conventional risk scores.