Fat Tissue Distribution and Muscle Loss Affect TAVR Short- and Long-Term Morbidity and Mortality: Predictability by GDF-15 Levels

Background: TAVR patients are at the highest risk due to chronic morbidity. Despite cardiovascular pathogenicity, the effect of long-term outcome improvement in chronic diseases is described for obesity. We examined the relevance of fat and lean tissue distribution and the predictability of long-term death by markers of Sarkopenia in TAVR patients.

Method: Consecutive TAVR patients were quantified for subcutaneous, visceral and epicardial fat and muscle area (preoperative CT) and serum markers of Sarkopenia (ELISA). Correlation and risk calculation for perioperative morbidity and short- and long-term mortality was performed. We analyzed the predictive value of the quantification of muscle and fat tissue and serum markers for mortality.

Results: A total of 403 patients (51% female, 97 transapical (TA), 306 transfemoral (TF)) aged 79.8 ± 1.4 years (TA) and 81.3 ± 0.4 years (TF) (p = 0.174) showed overall survival (30 days)/1 year) of 97/86% (TA) and 98/87% (TF). Sarcopenia and obesity as well as combinations of both parameters led to increased morbidity and mortality. The dimensions of muscle and fat tissue were independent. Overweight patients showed higher morbidity despite younger age. Obesity was associated with increased perioperative morbidity. BMI increase correlated to 30-day mortality and to reduced 1-, 2-, 3-year survival. Increased epicardial fat and visceral abdominal fat showed significant positive correlation to mortality. Short- and long-term mortality was increased in patients with high epicardial and visceral fat deposits and lumbar muscle reduction. Sarcopenia was a strong independent predictor of long-term mortality. In particular, increased visceral fat/muscle ratios and a reduction in muscle volume alone increased 30-day and 1-year mortality. Serum GDF15 was significantly increased in obese patients (BMI > 35 kg/m²) but also in lean patients, suggesting impaired skeletal muscle performance in these BMI groups. Furthermore, mortality was associated with higher GDF15 serum levels in all groups, further emphasizing the importance of this biomarker. Receiver operating characteristic (ROC) curve analyses showed high sensitivity and specificity of GDF15 (AUC: 0.94, 95% CI: 0.90–0.97, p < 0.001, sensitivity of 50.0%, and specificity of 88.2%) for mortality.

Conclusion: The operative results in this aged and chronically ill cohort of TAVR patients depend on the balance of the individual's body composition. Morbidly increased visceral fat and epicardium levels contribute to increased inflammation, deterioration in metabolism, perioperative adverse events and escalated mortality. Sarcopenia is an independent enhancer of mortality. GDF15 serum concentration might be used as a predictor for mid-term-mortality in these patients.

Publication History

Article published online:
03 February 2022