Psoas Muscle Area as a Predictor of Outcomes in Transcatheter Aortic Valve Implantation
Psoas Muscle Area as a Predictor of Outcomes in Transcatheter Aortic Valve Implantation
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DOI：
10.1016/j.amjcard.2016.10.019
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发表时间：
2017-02-01
影响因子：
2.8
通讯作者：
Hanson, Ivan D.
中科院分区：
文献类型：
--
作者：
Garg, Lohit;Agrawal, Sahil;Hanson, Ivan D.
脆弱是经导管主动脉瓣置入术(TAVI)后的一个强有力的预后预测因子。腰大肌面积(PMA)评估骨质疏松症是一种在手术前评估脆弱程度的有效工具。我们对PMA进行了评估。作为2011-2014年间在我所接受TAVI手术的152名连续患者的预后预测指标。术前使用计算机断层扫描来测量PMA，然后将其作为身体表面积的指标。评估的结果包括(1)早期不良结局(30天死亡率、中风、透析和长时间机械通气)，(2)1年死亡率，(3)资源利用率高(住院时间和7天，出院康复，或30天内再次入院)。指数化PMA(优势比[OR]3.19，可信区间[CI]1.3至7.83；p=0.012)和年龄(OR 1.92，CI 1.87至1.98；p=0.012)预测早期不良结局。胸外科医生学会评分预测1年死亡率(危险比3.07，可信区间1.93至6.23；p=0.011)。PMA低于中位数的患者资源利用率更高(73%比51%，OR2.65，CI1.32to5.36；p=0.006)。总而言之，指数化的PMA可以预测TAVI术后早期不良结局和高资源利用率。(C)2016 Elsevier Inc.保留所有权利。
Frailty is a powerful predictor of outcomes after transcatheter aortic valve implantation (TAVI). Sarcopenia as assessed by psoas muscle area (PMA) is a validated tool to assess frailty before surgical procedures. We evaluated PMA. as a predictor of outcomes after TAVI in 152 consecutive patients who underwent this procedure at our institution from 2011 to 2014. Preoperative computed tomography scans were used to measure PMA, which then was indexed to body surface area. Outcomes evaluated included (1) early poor outcome (30 days mortality, stroke, dialysis, and prolonged ventilation), (2) 1-year mortality, and (3) high-resource utilization (length of stay >7 days, discharge to rehabilitation, or readmission within 30 days). Indexed PMA (odds ratio [OR] 3.19, confidence interval [CI] 1.30 to 7.83; p = 0.012) and age (OR 1.92, CI 1.87 to 1.98; p = 0.012) predicted early poor outcome. Society of Thoracic Surgeons score predicted 1-year mortality (hazard ratio 3.07, CI 1.93 to 6.23; p = 0.011). High-resource utilization was observed more frequently in patients with PMA less than the median (73% vs 51%, OR 2.65, CI 1.32 to 5.36; p = 0.006). In conclusion, indexed PMA predicts early poor outcome and high-resource utilization after TAVI. (C) 2016 Elsevier Inc. All rights reserved.