Raghavendra Paknikar, BS, Jeffrey Friedman, BS, David Cron, BS, G

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Use of Psoas Muscle Size as a Frailty Assessment Tool for Open and Transcatheter Aortic Valve Replacement Raghavendra Paknikar BS Jeffrey Friedman BS David.

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Psoas muscle size as a frailty measure for open and transcatheter aortic valve replacement Raghavendra Paknikar, BS, Jeffrey Friedman, BS, David Cron, BS, G. Michael Deeb, MD, Stanley Chetcuti, MD, P. Michael Grossman, MD, Stewart Wang, MD, PhD, Michael Englesbe, MD, Himanshu J. Patel, MD The Journal of Thoracic and Cardiovascular Surgery Volume 151, Issue 3, Pages 745-751 (March 2016) DOI: 10.1016/j.jtcvs.2015.11.022 Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Schematic outlining the process for generating total psoas area. Cross-sectional imaging identifies the inferior border of L4, and the total psoas major muscle area is obtained at this level. This example identifies 2 patients with similar STS mortality risk scores (patient A, 2.35%; patient B, 2.43%). As is readily evident, patient A has a reduced total psoas area, consistent with sarcopenia (1.72 SD below the gender mean). In contrast, patient B has a robust total psoas area (2.08 SD above the gender mean. In this case, the patient with sarcopenia required readmission within 30 days (high resource utilizer), unlike patient B, who had no such adverse outcome. STS, Society of Thoracic Surgeons; TPA, total psoas area. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 745-751DOI: (10.1016/j.jtcvs.2015.11.022) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 The lack of correlation between total psoas area (y-axis) and STS mortality risk score (x-axis) for the SAVR (A) and TAVR (B) groups. The lack of correlation in either cohort suggests an opportunity to develop a novel risk assessment domain in patients undergoing AVR. AVR, Surgical aortic valve replacement; STS, Society of Thoracic Surgeons; CI, confidence interval; TPA, total psoas area. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 745-751DOI: (10.1016/j.jtcvs.2015.11.022) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 A, The entire cohort stratified according to the presence of sarcopenia (lowest-tertile TPA; 2-year survival, 85.7%) and absence of sarcopenia (2-year survival, 93.8%; P = .02, log-rank test). B, The SAVR group stratified by sarcopenia status (P = .019, log-rank test). C, The TAVR group stratified by sarcopenia status (P = .026, log-rank test). All curves include 95% confidence interval shading for each stratified group. CI, Confidence interval. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 745-751DOI: (10.1016/j.jtcvs.2015.11.022) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Mean high resource utilization rates stratified by TPA quartile and STS mortality risk score (either above or below 4%). The risk of high resource utilization is greatest in patients with sarcopenia with intermediate or higher risk scores compared with patients without sarcopenia with low STS mortality risk scores (66.7% vs 19.1%). STS, Society of Thoracic Surgeons. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 745-751DOI: (10.1016/j.jtcvs.2015.11.022) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Reduction of psoas muscle area (sarcopenia) is an important predictor of late mortality. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 745-751DOI: (10.1016/j.jtcvs.2015.11.022) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions