ImportanceOsteosarcopenia is an emerging geriatric syndrome characterized by age-related deterioration in muscle and bone. Despite the established relevance of frailty and sarcopenia among older adults undergoing transcatheter aortic valve replacement (TAVR), osteosarcopenia has yet to be investigated in this setting.ObjectiveTo determine the association between osteosarcopenia and adverse outcomes following TAVR.Design, Setting, and ParticipantsThis is a post hoc analysis of the Frailty in Aortic Valve Replacement (FRAILTY-AVR) prospective multicenter cohort study and McGill extension that enrolled patients aged 70 years or older undergoing TAVR from 2012 through 2022. FRAILTY-AVR was conducted at 14 centers in Canada, the United States, and France between 2012 and 2016, and patients at the McGill University–affiliated center in Montreal, Québec, Canada, were enrolled on an ongoing basis up to 2022.ExposureOsteosarcopenia as measured on computed tomography (CT) scans prior to TAVR.Main Outcomes and MeasuresClinically indicated CT scans acquired prior to TAVR were analyzed to quantify psoas muscle area (PMA) and vertebral bone density (VBD). Osteosarcopenia was defined as a combination of low PMA and low VBD according to published cutoffs. The primary outcome was 1-year all-cause mortality. Secondary outcomes were 30-day mortality, hospital length of stay, disposition, and worsening disability. Multivariable logistic regression was used to adjust for potential confounders.ResultsOf the 605 patients (271 [45%] female) in this study, 437 (72%) were octogenarian; the mean (SD) age was 82.6 (6.2) years. Mean (SD) PMA was 22.1 (4.5) cm2 in men and 15.4 (3.5) cm2 in women. Mean (SD) VBD was 104.8 (35.5) Hounsfield units (HU) in men and 98.8 (34.1) HU in women. Ninety-one patients (15%) met the criteria for osteosarcopenia and had higher rates of frailty, fractures, and malnutrition at baseline. One-year mortality was highest in patients with osteosarcopenia (29 patients [32%]) followed by those with low PMA alone (18 patients [14%]), low VBD alone (16 patients [11%]), and normal bone and muscle status (21 patients [9%]) (P < .001). Osteosarcopenia, but not low VBD or PMA alone, was independently associated with 1-year mortality (odds ratio [OR], 3.18; 95% CI, 1.54-6.57) and 1-year worsening disability (OR, 2.11; 95% CI, 1.19-3.74). The association persisted in sensitivity analyses adjusting for the Essential Frailty Toolset, Clinical Frailty Scale, and geriatric conditions such as malnutrition and disability.Conclusions and RelevanceThe findings suggest that osteosarcopenia detected using clinical CT scans could be used to identify frail patients with a 3-fold increase in 1-year mortality following TAVR. This opportunistic method for osteosarcopenia assessment could be used to improve risk prediction, support decision-making, and trigger rehabilitation interventions in older adults.

中文翻译：

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接受经导管主动脉瓣置换术的老年人的骨肌减少症和死亡率


重要性骨肌减少症是一种新出现的老年综合征，其特征是与年龄相关的肌肉和骨骼退化。尽管在接受经导管主动脉瓣置换术 (TAVR) 的老年人中，虚弱和肌肉减少症之间存在相关性，但骨肌肉减少症尚未在这种情况下进行研究。目的确定骨肌肉减少症与 TAVR 后不良后果之间的关联。设计、设置和参与者这是一个主动脉瓣置换术脆弱性 (FRAILTY-AVR) 前瞻性多中心队列研究和麦吉尔扩展研究的事后分析，纳入了 2012 年至 2022 年接受 TAVR 的 70 岁或以上患者。FRAILTY-AVR 在加拿大、美国的 14 个中心进行2012 年至 2016 年间，美国和法国以及位于加拿大魁北克省蒙特利尔的麦吉尔大学附属中心的患者持续入组至 2022 年。 TAVR 之前通过计算机断层扫描 (CT) 扫描测量的暴露骨肌减少症。结果和措施对 TAVR 之前获得的临床指示 CT 扫描进行分析，以量化腰肌面积 (PMA) 和椎骨密度 (VBD)。根据公布的临界值，骨肌减少症被定义为低 PMA 和低 VBD 的组合。主要结局是一年全因死亡率。次要结局是 30 天死亡率、住院时间、处置情况和残疾恶化。使用多变量逻辑回归来调整潜在的混杂因素。结果在本研究的 605 名患者（271 名 [45%] 女性）中，437 名（72%）为八旬老人；平均 (SD) 年龄为 82.6 (6.2) 岁。男性 PMA 平均值 (SD) 为 22.1 (4.5) cm2，女性为 15.4 (3.5) cm2。男性 VBD 平均值 (SD) 为 104.8 (35.5) 亨斯菲尔德单位 (HU)，女性为 98.8 (34.1) HU。 91 名患者 (15%) 符合骨肌减少症标准，并且基线时虚弱、骨折和营养不良的发生率较高。骨肌减少症患者的一年死亡率最高（29 名患者 [32%]），其次是仅低 PMA 患者（18 名患者 [14%]）、仅低 VBD 患者（16 名患者 [11%]）以及骨量正常的患者。肌肉状态（21 名患者 [9%]）（P < .001）。骨肌减少症，而非单独的低VBD或PMA，与1年死亡率（比值比[OR]，3.18；95% CI，1.54-6.57）和1年残疾恶化（OR，2.11；95% CI， 1.19-3.74）。该协会坚持进行敏感性分析，调整基本虚弱工具集、临床虚弱量表以及营养不良和残疾等老年疾病。结论和相关性研究结果表明，使用临床 CT 扫描检测到的骨肌减少症可用于识别患有 3 倍体弱的虚弱患者。 TAVR 后 1 年死亡率增加。这种骨肌减少症评估的机会方法可用于改善老年人的风险预测、支持决策并触发康复干预措施。