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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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07. Syncope and Bradycardia
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CT assessment of sarcopenia in patients undergoing trans-catheter aortic valve implantation
Session:
CO8 - Doença Valvular
Speaker:
Gonçalo José Lopes Da Cunha
Congress:
CPC 2019
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.2 Valvular Heart Disease – Epidemiology, Prognosis, Outcome
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Gonçalo Lopes Da Cunha; António Ferreira; Rui Campante Teles; João Brito; Pedro de Araújo Gonçalves; Luís Raposo ; Henrique Gabriel; Tiago Nolasco; Afonso Félix De Oliveira; João Abecasis; Carla Rodrigues Carvalho; Manuel Almeida; Miguel Mendes
Abstract
<p>CT assessment of sarcopenia in patients undergoing trans-catheter aortic valve implantation</p> <p> </p> <p>Background: Frailty is one of the factors influencing treatment choice in patients with severe symptomatic aortic stenosis, but its assessment is often impractical and time-consuming. Cross-sectional area of the psoas muscle observed by CT scan is a marker of sarcopenia and correlates with prognosis in surgical procedures. The purpose of this study was to assess the demographics of sarcopenic patients undergoing trans-aortic valve implantation (TAVI) and its association with outcomes.</p> <p>Methods: Single centre cohort study of 222 consecutive TAVI patients from July 2016 through August 2018 who underwent CT for procedure planning. Cross-sectional area of the psoas muscle was measured at the level of L3 vertebra and the mean of right and left muscle area, adjusted for body surface area, was used for comparison (PAi). Sarcopenia was defined as PAi inferior to the median.</p> <p>Results: We analysed 222 patients (47% male, mean age 83 ± 6 years). PAi was 3.92cm<sup>2</sup>/m<sup>2</sup>, interquartile range 1.5 cm<sup>2</sup>/m<sup>2</sup>, with a minimum of 1.6 cm<sup>2</sup>/m<sup>2</sup> and maximum 14.2 cm<sup>2</sup>/m<sup>2</sup>. Sarcopenic patients were more often female, (75.5% vs 21.6%, p<0.001), and had lower haemoglobin levels (12±2.1g/dL vs 12.7±2.4g/dL, p<0.001). Intra-hospital death was observed in 6 patients (2.7%). During a median follow-up of 7.2 months, 23 (10.3%) patients died, 18 (8.1%) of them within the first year. In Cox regression, a lower PAi was significantly associated with an increased risk of death (HR 1.57, 95% CI 1.02-2.40, p= 0.039).</p> <p>Conclusion: Lower PAi was associated with an increased risk of death. Female gender and lower haemoglobin levels were significantly more prevalent in patients with lower PAi. Sarcopenia, evaluated by PAi, may constitute a useful tool in the assessment of frailty and mortality risk in patients referred for TAVI.</p>
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