Osteosarcopenia found in CT scans predicts higher mortality after TAVR in older adults

Detecting osteosarcopenia in older adults using CT scans appears to be useful for identifying those with frailty, who may have a threefold increased risk of mortality following transcatheter aortic valve replacement (TAVR), according to a study.

For the study, researchers conducted a post hoc analysis of the Frailty in Aortic Valve Replacement (FRAILTY-AVR) study and McGill extension that involved patients at least 70 years of age undergoing TAVR. All participants underwent CT scans prior to TAVR. The resulting images were analysed 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.

A total of 605 participants (mean age 82.6 years, 45 percent female) were included in the analysis. The mean PMA was 22.1 cm² in men and 15.4 cm² in women, while the mean VBD was 104.8 and 98.8 Hounsfield units (HU), respectively. Osteosarcopenia was identified in 91 participants (15 percent), who had higher rates of frailty, fractures, and malnutrition at baseline.

The primary outcome of 1-year all-cause mortality was highest in patients with osteosarcopenia (32 percent), followed by those with low PMA alone (14 percent) and low VBD alone (11 percent).

Osteosarcopenia was associated with two-to-threefold greater odds of 1-year all-cause mortality (odds ratio [OR], 3.18, 95 percent confidence interval [CI], 1.54–6.57) and 1-year worsening disability (OR, 2.11, 95 percent CI, 1.19–3.74). These associations were not observed for low VBD or low PMA alone.

The association was robust to sensitivity analyses that controlled for the Essential Frailty Toolset, Clinical Frailty Scale, and geriatric conditions such as malnutrition and disability.

The findings underscore CT imaging as an opportunistic method for osteosarcopenia assessment that could be used to improve risk prediction, support decision-making, and trigger rehabilitation interventions in older adults.