Ct-Derived Pectoralis Muscle Metrics as Imaging Biomarkers of Frailty in Patients Undergoing Evaluation for Transcatheter Tricuspid Valve Intervention

Document Type

Conference Proceeding

Publication Date

7-1-2026

Publication Title

J Cardiovasc Comput Tomogr

Keywords

biological marker, adult, aged, benchmarking, clinical article, comorbidity, computed tomographic angiography, computer assisted tomography, conference abstract, controlled study, diagnosis, female, frailty, functional disease, functional status, heart failure, human, Kansas City Cardiomyopathy Questionnaire, male, muscle thickness, pectoral muscle, retrospective study, sarcopenia, sex difference, skeletal muscle, thoracic vertebra, thorax muscle, tricuspid valve, tricuspid valve regurgitation, tricuspid valve replacement

Abstract

Introduction: Severe tricuspid regurgitation (TR) is a major contributor to heart failure, morbidity, and mortality. Patients referred for transcatheter tricuspid valve replacement (TTVR) frequently have a high burden of comorbidities and functional impairment. Frailty is an important determinant of surgical and transcatheter procedural risk adversely affecting outcomes. However, evaluation of frailty is inconsistently performed and often relies on subjective or time intensive clinical tools. Skeletal muscle metrics such as pectoralis muscle area and density have been validated as imaging biomarkers of sarcopenia and physiological frailty. Routinely performed preprocedural cardiac computed tomography angiography (CCTA) provides an opportunity for objective and reproducible evaluation of frailty, but the relationship between CT derived frailty to outcomes in TTVR remains poorly defined. Methods: Fifty consecutive patients (18, 36% male) undergoing routine CCTA for TTVR between February 2024 and August 2024 were retrospectively analyzed using dedicated 3D post processing software (Vitrea, Canon Medical Informatic, Minnetonka Minnesota). Pectoral muscle width, area, and density in Hounsfield Units (HU) were measured using a region-of-interest at the level of the fourth thoracic vertebra (T4). Results: Average pectoralis muscle thickness, area, and density (HU) for men vs women were 15±2.7mm vs 9.7±3.2mm p<0.001, 1228.9±429.1mm2 vs 823.9±299.6mm2 p=0.002, and 44.1±15.2 vs 47.4±14.6 p=0.48, respectively. For men, pectoral muscle area and thickness correlated with Kansas City Cardiomyopathy Questionnaire (KCCQ) (r=0.66, r=0.44 respectively) and inversely correlated with Society of Thoracic Surgery Score (STS) mortality (r=-0.51, r=-0.44 respectively). Correlation of pectoral HU with KCCQ and STS mortality was less correlated (r=0.32 vs r=-0.38 respectively). No correlation was found with pectoral muscle area, thickness, or HU in women with KCCQ or STS mortality. Conclusions: Pectoral muscle derived metrics from CCTA for TTVR correlated with baseline functional status and risk in men but not women. In men, this is consistent with prior literature on the value of quantitative assessment of sarcopenia on CT and suggests a potential role for more systematic evaluation of preprocedural frailty. Lack of correlation in women is unexplained, but prior literature has indicated that gender-based differences in risk and outcomes exist in this population. Further study is needed to better understand the role of CT based metrics of frailty and gender differences.

Volume

20

Issue

4

First Page

S110

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