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Copyright ©The Author(s) 2025.
World J Cardiol. May 26, 2025; 17(5): 107320
Published online May 26, 2025. doi: 10.4330/wjc.v17.i5.107320
Table 1 Characteristics of key studies on frailty and osteosarcopenia in transcatheter aortic valve replacement patients
Ref.
Year
Study type
Key inclusion/exclusion criteria
Patient’s characteristics
Assessment method
Key findings
Green et al[23]2012Single-center prospective studyInclusion: Age ≥ 60 years, severe calcific AS, with advanced cardiac symptoms, TAVR candidates. Exclusion: Inoperability159 patients, mean age 86 years, 50% maleFrailty score derived from gait speed, grip strength, serum albumin, and ADLFrailty was associated with a 35-fold increase in 1-year mortality but not with procedural complications
Green et al[24]2015Post hoc analysisInclusion: Age ≥ 60 years, severe symptomatic AS requiring TAVR, frailty assessed at 3 high-enrolling sites. Exclusion: Missing baseline frailty assessment244 patients, mean age 86 years, 51.6% maleFrailty assessed using serum albumin, grip strength, gait speed, and Katz ADL surveyFrail individuals had higher 1-year mortality (32.7% vs 15.9% nonfrail) and poor outcomes (50% vs 31.5%)
Afilalo et al[4]2017Prospective multicenter cohort studyInclusion: Age ≥ 70, severe AS, TAVR/surgical aortic valve replacement planned. Exclusion: Dementia, metastatic cancer, acute myocardial infarction < 30 days1020 patients, mean age 82 years, 59% maleFried, Fried+, Rockwood, and EFT etc.EFT strongly predicted 1-year mortality (aOR = 3.72; 95%CI: 2.54-5.45), 1-year disability (aOR = 2.13; 95%CI: 1.57-2.87), and death at 30 days (aOR = 3.29; 95%CI: 1.73-6.26)
Kundi et al[25]2019CMS MedPAR databaseInclusion: Age ≥ 70 years, referred for TAVI (2011-2015), severe symptomatic AS. Exclusion: Declined consent28531patients, mean age 815 years, 53.6% maleHospital Frailty Risk Score1-year mortality rates were 76% in low-risk patients, 17.6% in intermediate-risk patients, and 30.1% in high-risk patients (log rank P < 0.001)
Skaar et al[26]2019Prospective observational studyInclusion: Age ≥ 65 years, undergoing transcatheter mitral valve repair/TAVR. Exclusion: Age < 65 years142 patients, 54% women, mean age 83 yearsA novel geriatric assessment frailty scoreGeriatric assessment frailty score predicted mortality within 2 years, with an estimated HR of 1.79 (95%CI: 1.34–2.36, P < 0.001)
Goudzwaard et al[27]2020Prospective, observational studyInclusion: Severe symptomatic AS patients referred for TAVI239 patients, mean age 808 years, 49.8% maleErasmus Frailty ScoreFrailty was an independent predictor of deteriorated HR quality of life 1 year after TAVI (OR = 2.24, 95%CI: 1.07–4.70, P = 0.003)
Seoudy et al[28]2021Retrospective cohort studyInclusion: Symptomatic AS, underwent transfemoral TAVR, Geriatric Nutritional Risk Index1930 patients, mean age 82 years, 52.5% femaleGNRIAfter a mean follow-up of 21.1 months, all-cause mortality was significantly increased in the low-GNRI group compared with the normal-GNRI group (P < 0.001)
Arnold et al[29]2022PARTNER 2A trial, SAPIEN 3 intermediate-risk registry, and PARTNER 3 trialInclusion: Intermediate-surgical-risk or low-surgical-risk patients, Severe symptomatic AS, Enrolled in PARTNER 2A trial, SAPIEN 3 intermediate-risk registry, or PARTNER 3 trial3025 patients, mean age 793 years, 61.6% menFrailty was examined as a continuous variable based on grip strength, gait speed, albumin, and ADLIncreasing frailty (none vs prefrail vs frail) was associated with higher 2-year mortality (5.5% vs 11.1% vs 22.8%; log-rank P < 0.001) and worse 2-year health status among survivors (Kansas City Cardiomyopathy Questionnaire scores adjusted for baseline: 84.8 vs 79.6 vs 77.4, P < 0.001)
Strange et al[30]2023Danish nationwide registries studyInclusion: Undergoing first-time TAVR, Valid Hospital Frailty Risk Score5971 patients, median age 81 years, and 55.4% menHospital Frailty Risk Score1-year risk of death was 5.8% of patients in the low frailty group compared with 10.3% of patients in the intermediate frailty group and 15.6% of patients in the high frailty group
Stein et al[31]2024Multicenter prospective registryInclusion: Pre-TAVR CT available. Exclusion: Prior valve surgery, end-stage renal disease445 patients, median age 829 years, 41% female3-part definition psoas muscle area indexed to height; handgrip strength; and gait speedAmong the 3 components of sarcopenia, only slower gait speed (muscle performance) was independently associated with increased post-TAVR mortality (aHR = 1.38 per 1 SD decrease (95%CI: 1.11–1.72); P = 0.004)
Persits et al[32]2024Retrospective cohort studyInclusion: aged ≥ 70 years, undergoing TAVR, Pre-TAVR CT scans available. Exclusion: Emergent TAVR procedures, unstable vital signs, CT scans with fields of view excluding the abdomen184 patients, average age 806 years, 41.8% femaleSarcopenia was defined as having both low muscle mass and either muscle weakness or poor physical performance. Frailty status was assessed using Green scoreThere were higher rates of the postoperative adverse events in patients with sarcopenia (54.8%) and frailty (41.9% with the Adapted Green and 50.5% with the Green-SMI score) compared to their nonsarcopenic (30.3%) and nonfrail counterparts (25.4% with the Adapted Green and 18.8% with the Green-SMI score)
Petrovic et al[33]2024Prospective multicentre WIN-TAVI registryInclusion: Women, with symptomatic severe AS, Intermediate or high surgical risk, pre-TAVR Fried frailty criteria assessment. Exclusion: Missing frailty assessment data1019 women, mean age 82 yearsFried frailty criteria1-year risk of the primary outcome was significantly higher in prefrail and frail (20.2%) than in nonfrail (14.9%) women (aHR = 1.51). The risk of major bleeding was higher in prefrail or frail (19.9%) than in nonfrail (10.0%) women (aHR = 2.06)
Solla-Suarez et al[7]2024Prospective multicenter cohort studyInclusion: Undergoing TAVR, pre-TAVR CT scans available, Availability of HGS or gait speed measurements. Exclusion: Incomplete CT imaging, missing HGS or gait speed data605 patients, mean age 826 years, 45% femaleOsteosarcopenia was defined as a combination of low PMA and low VBDOne-year mortality was highest in osteosarcopenia (32%) followed by low PMA alone (14%), low VBD alone (11%), and normal bone and muscle status (9%) (P < 0.001)