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©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
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] | 2012 | Single-center prospective study | Inclusion: Age ≥ 60 years, severe calcific AS, with advanced cardiac symptoms, TAVR candidates. Exclusion: Inoperability | 159 patients, mean age 86 years, 50% male | Frailty score derived from gait speed, grip strength, serum albumin, and ADL | Frailty was associated with a 35-fold increase in 1-year mortality but not with procedural complications |
Green et al[24] | 2015 | Post hoc analysis | Inclusion: Age ≥ 60 years, severe symptomatic AS requiring TAVR, frailty assessed at 3 high-enrolling sites. Exclusion: Missing baseline frailty assessment | 244 patients, mean age 86 years, 51.6% male | Frailty assessed using serum albumin, grip strength, gait speed, and Katz ADL survey | Frail individuals had higher 1-year mortality (32.7% vs 15.9% nonfrail) and poor outcomes (50% vs 31.5%) |
Afilalo et al[4] | 2017 | Prospective multicenter cohort study | Inclusion: Age ≥ 70, severe AS, TAVR/surgical aortic valve replacement planned. Exclusion: Dementia, metastatic cancer, acute myocardial infarction < 30 days | 1020 patients, mean age 82 years, 59% male | Fried, 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] | 2019 | CMS MedPAR database | Inclusion: Age ≥ 70 years, referred for TAVI (2011-2015), severe symptomatic AS. Exclusion: Declined consent | 28531patients, mean age 815 years, 53.6% male | Hospital Frailty Risk Score | 1-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] | 2019 | Prospective observational study | Inclusion: Age ≥ 65 years, undergoing transcatheter mitral valve repair/TAVR. Exclusion: Age < 65 years | 142 patients, 54% women, mean age 83 years | A novel geriatric assessment frailty score | Geriatric 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] | 2020 | Prospective, observational study | Inclusion: Severe symptomatic AS patients referred for TAVI | 239 patients, mean age 808 years, 49.8% male | Erasmus Frailty Score | Frailty 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] | 2021 | Retrospective cohort study | Inclusion: Symptomatic AS, underwent transfemoral TAVR, Geriatric Nutritional Risk Index | 1930 patients, mean age 82 years, 52.5% female | GNRI | After 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] | 2022 | PARTNER 2A trial, SAPIEN 3 intermediate-risk registry, and PARTNER 3 trial | Inclusion: Intermediate-surgical-risk or low-surgical-risk patients, Severe symptomatic AS, Enrolled in PARTNER 2A trial, SAPIEN 3 intermediate-risk registry, or PARTNER 3 trial | 3025 patients, mean age 793 years, 61.6% men | Frailty was examined as a continuous variable based on grip strength, gait speed, albumin, and ADL | Increasing 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] | 2023 | Danish nationwide registries study | Inclusion: Undergoing first-time TAVR, Valid Hospital Frailty Risk Score | 5971 patients, median age 81 years, and 55.4% men | Hospital Frailty Risk Score | 1-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] | 2024 | Multicenter prospective registry | Inclusion: Pre-TAVR CT available. Exclusion: Prior valve surgery, end-stage renal disease | 445 patients, median age 829 years, 41% female | 3-part definition psoas muscle area indexed to height; handgrip strength; and gait speed | Among 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] | 2024 | Retrospective cohort study | Inclusion: 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 abdomen | 184 patients, average age 806 years, 41.8% female | Sarcopenia was defined as having both low muscle mass and either muscle weakness or poor physical performance. Frailty status was assessed using Green score | There 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] | 2024 | Prospective multicentre WIN-TAVI registry | Inclusion: Women, with symptomatic severe AS, Intermediate or high surgical risk, pre-TAVR Fried frailty criteria assessment. Exclusion: Missing frailty assessment data | 1019 women, mean age 82 years | Fried frailty criteria | 1-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] | 2024 | Prospective multicenter cohort study | Inclusion: Undergoing TAVR, pre-TAVR CT scans available, Availability of HGS or gait speed measurements. Exclusion: Incomplete CT imaging, missing HGS or gait speed data | 605 patients, mean age 826 years, 45% female | Osteosarcopenia was defined as a combination of low PMA and low VBD | One-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) |
- Citation: Li P, Zhang HP. Osteosarcopenia in older adults undergoing transcatheter aortic valve replacement: A narrative review of mortality and frailty implications. World J Cardiol 2025; 17(5): 107320
- URL: https://www.wjgnet.com/1949-8462/full/v17/i5/107320.htm
- DOI: https://dx.doi.org/10.4330/wjc.v17.i5.107320