Average Density Of The Psoas Muscle Detected By Multislice Computed Tomography As A Measure Of Fragility In Patients Candidates For Transcatheter aortic valve replacement
Romina E. Trossero, Maria F. Castro, Agustina Sciancalepore, Paola Kuschnir, Teresa Politti, Maria P. Ricapito, Ricardo Ronderos.
ICBA, Ciudad Autonoma Buenos Aires, Argentina.
OBJECTIVE: The purpose of this study was to evaluate the association between the average density of both psoas muscles (ADPM) and the degree of fragility in patients undergoing transcatheter aortic valve implantation (TAVI)
METHODS: A cohort of 35 consecutive patients candidates for TAVI was studied retrospectively. All of them had a fragility test divided in 4 grades. The tomographic analysis of the psoas was performed in a section perpendicular to the major axis of the muscle, at the level of the fourth lumbar vertebra. The parameters were: bilateral area, perimeter and muscle density and then ADPM. All parameters were categorized according to their 50th percentile value. Associations were explored using univariate logistic regression models. RESULTS: The average age was 83+- 2 years, being 64 % male, and a median degree of frailty of 2. The tomographic study of both psoas muscles indicated an ADPM value of 37.3 ± 10.8 Hounsfield units, an average area of 111.8 ± 17.1 mm2 and an average perimeter of 884.1 ± 266.3 cm. Patients remained hospitalized for a median of 7 days post-TAVI. The relationship between the tomographic characteristics of both psoas and the degree of fragility was evaluated. A statistically significant relationship was found between fragility and the presence of a low ADPM (lower than the 50th percentile) (OR = 2.22, p = 0.039, 95% CI 1.04 - 4.74). No association between fragility and area (OR = 1.35, p = 0.366, 95% CI 0.71-2.57). A low ADPM (lower than the 50th percentile) showed a tendency to be associated with prolonged hospitalization (greater than the 75th percentile) (OR = 1.95, p = 0.386, 95% CI 0.43 - 8.83).
CONCLUSIONS: The degree of frailty could be associated with a low ADPM, conditioning a longer post-TAVI hospitalization. Large-scale prospective studies are needed to confirm this.
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