# Prognostic value of psoas muscle area and pleural effusion in patients undergoing TAVI

## TL;DR

This study found that psoas muscle area and pleural effusion are linked to cardiovascular mortality after TAVI, but adding them to existing risk models only slightly improves predictions.

## Contribution

The study evaluates the incremental prognostic value of psoas muscle area and pleural effusion beyond the EuroSCORE II model in TAVI patients.

## Key findings

- PMA and pleural effusion were independently associated with cardiovascular mortality after TAVI.
- Combined inclusion of PMA and pleural effusion modestly improved mortality prediction compared to EuroSCORE II.
- No significant associations were found between these markers and non-cardiovascular mortality.

## Abstract

Radiographic markers such as psoas muscle area (PMA) and pleural effusion have been linked to mortality after transcatheter aortic valve implantation (TAVI). We examined their relationship with cause-specific mortality and their incremental prognostic value beyond EuroSCORE II.

This retrospective study included 1090 consecutive TAVI patients treated at Heart Hospital, Tampere University Hospital between 2008 and 2020. Preoperative CT scans were reviewed for L3-level PMA and pleural effusion (>10 mm thickness). Subdistribution hazard models adjusted for age, sex, BMI, and BSA were used to analyze cause-specific mortality. Incremental prognostic value beyond EuroSCORE II was assessed using time-dependent discrimination indexes (AUC and IDI) and net-reclassification index (NRI) at 3 years.

During a median follow-up of 4.3 years (IQR 3.1–6.0), 54% (n = 590) of patients died: 64% (n = 376) from cardiovascular, 30% (n = 177) from non-cardiovascular, and 6% (n = 37) from unnatural causes. PMA and pleural effusion were associated with cardiovascular mortality (PMA: SDH/1SD 0.88, 95% CI 0.78–0.99, p = 0.037; pleural effusion: SDH 1.73, 95% CI 1.37–2.19, p < 0.001). Combined inclusion of PMA and pleural effusion improved NRI = 0.13 (p = 0.004) and IDI = 0.015 (p = 0.004) of overall mortality prediction compared to EuroSCORE II alone.

Psoas muscle area (PMA) and pleural effusion were independently associated with cardiovascular mortality after TAVI, whereas no significant associations were observed with non-cardiovascular deaths. Combined inclusion of these parameters led to a modest but not clinically meaningful improvement in the EuroSCORE II–based prediction of mortality.