Objectives: The aim of this study was to assess the predictive value of PMA measurement for mortality. Background: Current surgical risk stratification have limited predictive value in the transcatheter aortic valve implantation (TAVI) population. In TAVI workup, a CT scan is routinely performed but body composition is not analyzed. Psoas muscle area (PMA) reflects a patient's global muscle mass and accordingly PMA might serve as a quantifiable frailty measure. Methods: Multi-slice computed tomography scans (between 2010 and 2016) of 583 consecutive TAVI patients were reviewed. Patients were divided into equal sex-specific tertiles (low, mid, and high) according to an indexed PMA. Hazard ratios (HR) and their confidence intervals (CI) were determined for cardiac and all-cause mortality after TAVI. Results: Low iPMA was associated with cardiac and all-cause mortality in females. One-year adjusted cardiac mortality HR in females for mid-iPMA and high-iPMA were 0.14 [95%CI, 0.05–0.45] and 0.40 [95%CI, 0.15–0.97], respectively. Similar effects were observed for 30-day and 2-years cardiac and all-cause mortality. In females, adding iPMA to surgical risk scores improved the predictive value for 1-year mortality. C-statistics changed from 0.63 [CI = 0.54–0.73] to 0.67 [CI: 0.58–0.75] for EuroSCORE II and from 0.67 [CI: 0.59–0.77] to 0.72 [CI: 0.63–0.80] for STS-PROM. Conclusions: Particularly in females, low iPMA is independently associated with an higher all-cause and cardiac mortality. Prospective studies should confirm whether PMA or other body composition parameters should be extracted automatically from CT-scans to include in clinical decision making and outcome prediction for TAVI.
BACKGROUND & AIMS: Diagnosed prevalence of malnutrition and dietary intake are currently unknown in patients with severe aortic stenosis planned to undergo Transcatheter Aortic Valve Implantation (TAVI). This study describes the preprocedural nutritional status, protein intake and diet quality.METHODS: Consecutive preprocedural TAVI patients were asked to participate in this explorative study. Nutritional status was diagnosed with the global leadership initiative on malnutrition (GLIM) criteria. Preprocedural protein intake and diet quality were assessed with a three-day dietary record. To increase the record's validity, a researcher visited the participants at their homes to confirm the record. Protein intake was reported as an average intake of three days and diet quality was assessed using the Dutch dietary guidelines (score range 0-14, 1 point for adherence to each guideline).RESULTS: Of the included patients (n = 50, median age 80 ± 5, 56% male) 32% (n = 16) were diagnosed with malnutrition. Patients diagnosed with malnutrition had a lower protein intake (1.02 ± 0.28 g/kg/day vs 0.87 ± 0.21 g/kg/day, p = 0.04). The difference in protein intake mainly took place during lunch (20 ± 13 g/kg vs 13 ± 7 g/kg, p = 0.03). Patients adhered to 6.4 ± 2.2 out of 14 dietary guidelines. Adherence to the guideline of whole grains and ratio of whole grains was lower in the group of patients with malnutrition than in patients with normal nutritional status (both 62% vs 19%, p = 0.01). In a multivariate analysis diabetes mellitus was found as an independent predictor of malnutrition.CONCLUSION: Prevalence of malnutrition among TAVI patients is very high up to 32%. Patients with malnutrition had lower protein and whole grain intake than patients with normal nutritional status. Furthermore, we found diabetes mellitus as independent predictor of malnutrition. Nutrition interventions in this older patient group are highly warranted.
It is suggested that older patients waiting for an elective surgical procedure have a poor nutritional status and low physical activity level. It is unknown if this hypothesis is true and if these conditions improve after a medical procedure. We aimed to determine the trajectory of both conditions before and after transcatheter aortic valve implantation (TAVI). Included patients (n = 112, age 81 ± 5 years, 58% male) received three home visits (preprocedural, one and six months postprocedural). Nutritional status was determined with the mini nutritional assessment-short form (MNA-SF) and physical activity using an ankle-worn monitor (Stepwatch). The median MNA-SF score was 13 (11-14), and 27% of the patients were at risk of malnutrition before the procedure. Physical activity was 6273 ± 3007 steps/day, and 69% of the patients did not meet the physical activity guidelines (>7100 steps/day). We observed that nutritional status and physical activity did not significantly change after the procedure (β 0.02 [95% CI -0.03, 0.07] points/months on the MNA-SF and β 16 [95% CI -47, 79] steps/month, respectively). To conclude, many preprocedural TAVI patients should improve their nutritional status or activity level. Both conditions do not improve naturally after a cardiac procedure.
