Albumin Is Predictive of 1-Year Mortality After Transcatheter Aortic Valve Replacement
dc.contributor.advisor | DiMaio, J. Michael | en |
dc.contributor.committeeMember | Edgerton, James | en |
dc.contributor.committeeMember | Hamandi, Mohanad | en |
dc.creator | Hebeler, Katherine Rachel | en |
dc.creator.orcid | 0000-0003-0610-6538 | |
dc.date.accessioned | 2022-06-24T20:59:13Z | |
dc.date.available | 2022-06-24T20:59:13Z | |
dc.date.created | 2020-05 | |
dc.date.issued | 2020-05-01T05:00:00.000Z | |
dc.date.submitted | May 2020 | |
dc.date.updated | 2022-06-24T20:59:14Z | |
dc.description | The general metadata -- e.g., title, author, abstract, subject headings, etc. -- is publicly available, but access to the submitted files is restricted to UT Southwestern campus access and/or authorized UT Southwestern users. | en |
dc.description.abstract | BACKGROUND: A validated model for predicting 1-year outcomes after transcatheter aortic valve replacement (TAVR) does not exist. Frailty markers have been proposed as potential variables to assess individual patient risk. TAVR-specific risk models may benefit from frailty markers, and sarcopenia may represent an objective frailty marker. OBJECTIVE: This study assessed the predictive ability of sarcopenia and frailty markers on 1-year mortality after TAVR. METHODS: We evaluated 470 patients undergoing TAVR at a single center. Frailty was assessed using 4 markers (gait speed, handgrip strength, serum albumin, and Katz activities of daily living). Sarcopenia was measured as the cross-sectional psoas muscle area on pre-TAVR computed tomography. Performance of four models incorporating Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM), frailty, and/or sarcopenia metrics for predicting 1-year mortality was assessed with area under the curve, Hosmer-Lemeshow statistics, and calibration plots. RESULTS: A total of 63 (13.4%) deaths occurred by 1-year. STS-PROM alone was poorly predictive of 1-year mortality (AUC 0.52, 95%CI: 0.42, 0.68). Only the model including both sarcopenia and all frailty markers (AUC 0.61, 95%CI: 0.53, 0.68) significantly improved predictive ability compared to STS-PROM alone (p = 0.05). Albumin was the only frailty marker significantly associated with increased risk for 1-year mortality (p=0.03). Psoas muscle area, as a surrogate for sarcopenia, was not significantly associated with increased risk for 1-year mortality. CONCLUSIONS: Most commonly used pre-TAVR risk assessments are poorly predictive of 1-year mortality. Albumin was the only frailty marker that was associated with higher mortality. Future studies should investigate whether optimization of nutritional status can improve outcomes following TAVR. | en |
dc.format.mimetype | application/pdf | en |
dc.identifier.oclc | 1333220385 | |
dc.identifier.uri | https://hdl.handle.net/2152.5/9886 | |
dc.language.iso | en | en |
dc.subject | Albumins | en |
dc.subject | Aortic Valve Stenosis | en |
dc.subject | Cause of Death | en |
dc.subject | Sarcopenia | en |
dc.subject | Transcatheter Aortic Valve Replacement | en |
dc.title | Albumin Is Predictive of 1-Year Mortality After Transcatheter Aortic Valve Replacement | en |
dc.type | Thesis | en |
dc.type.material | text | en |
thesis.degree.department | UT Southwestern Medical School | en |
thesis.degree.discipline | Research | en |
thesis.degree.grantor | UT Southwestern Medical Center | en |
thesis.degree.level | Doctoral | en |
thesis.degree.name | M.D. with Distinction | en |