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Impact of osteoporotic risk in men undergoing transcatheter aortic valve replacement: a report from the LAPLACE-TAVI registry

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Abstract

Low body weight and advanced age are among the best predictors of osteoporosis. Osteoporosis Self-Assessment Tool (OST) values are calculated by a simple formula [(body weight in kilograms – age in years) × 0.2] to identify patients at increased risk of osteoporosis. In our recent single-center study, we demonstrated an association between OST and poor outcomes in postmenopausal women after transcatheter aortic valve replacement (TAVR). We aimed to investigate the impact of osteoporotic risk in men with aortic stenosis who underwent TAVR in a large cohort. In this multi-center study, 1,339 men who underwent TAVR between April 2010 and July 2023 were retrospectively analyzed. Women were excluded from the present study. All patients were deemed appropriate for TAVR after a review by a multidisciplinary team. Baseline characteristics of patients were compared by dividing patients into three tertiles, based on the OST value: ≤ − 6.16, − 6.16 to − 4.14, and − 4.14 < for tertiles 1, 2, and 3, respectively. Primary endpoint was all-cause mortality after TAVR. Tertile 1 (patients with the lowest OST values) included older patients with smaller body mass index, lower hemoglobin and albumin levels. In addition, they had greater clinical frailty scale, slower 5-meter walk test, weaker hand grip strength, and more cognitive impairment, indicating increased frailty. They were more severely symptomatic, with lower ejection fractions, smaller aortic valve areas, and more tricuspid regurgitation than were patients in the other two groups. Multivariate analysis revealed that OST tertiles 3 was associated with decreased risk of all-cause mortality (hazard ratio, 0.66; 95% confidence interval, 0.48–0.90), compared with OST tertile 1 as a reference. For OST tertiles 1, 2, and 3, the estimated 1-year survival rates of all-cause mortality post-TAVR were 83.6% ± 1.9%, 91.1% ± 1.4%, and 93.1% ± 1.3%, respectively, (log-rank, p < 0.001).　In conclusions, in men as same as women, osteoporotic risk assessed by OST values was overlapped with increased frailty. The simple OST formula was useful for predicting all-cause mortality in patients undergoing TAVR in large registry datasets.

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Data availability

The data that support the findings of this study are available from the corresponding author [MS], upon reasonable request.

Abbreviations

AS:

Aortic stenosis

DXA:

Dual-energy x-ray absorptiometry

OST:

Osteoporosis self-assessment tool

TAVR:

Transcatheter aortic valve replacement

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Acknowledgements

The authors thank all members of the Structural Heart Team of, Yamagata University, Mie University, Hirosaki University, Juntendo University, Kawasaki Saiwai Hospital and the Sakakibara Heart Institute.

Funding

This study was supported by a research grant from Sakakibara Internal Research Grant for Promotion of Sciences.

Author information

Authors and Affiliations

  1. Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan

    Takashi Funaki, Mike Saji, Ryosuke Higuchi, Itaru Takamisawa & Mamoru Nanasato

  2. Department of Cardiology and Geriatrics, Kochi University, Kochi, Japan

    Takashi Funaki & Hiroaki Kitaoka

  3. Devision of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Otaku, Tokyo, 143-8541, Japan

    Mike Saji & Takanori Ikeda

  4. Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan

    Harutoshi Tamura

  5. Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Mie, Japan

    Kei Sato

  6. Department of Cardiology, Hirosaki University Graduate School of Medicine, Aomori, Japan

    Hiroaki Yokoyama

  7. Department of Cardiovascular Biology and Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan

    Shinichiro Doi & Shinya Okazaki

  8. Department of Cardiology, Kawasaki Saiwai Hospital, Kanagawa, Japan

    Takayuki Onishi & Tetsuya Tobaru

  9. Department of Cardiology Surgery, Kawasaki Saiwai Hospital, Kanagawa, Japan

    Shuichiro Takanashi

  10. Sakakibara Heart Institute, Tokyo, Japan

    Mitsuaki Isobe

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  1. Takashi Funaki
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  2. Mike Saji
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Contributions

All the authors contributed to the conception and design of the study. The material preparation, data collection, and analysis were performed by Takashi Funaki, Ryosuke Higuchi, and Mike Saji. The first draft of the manuscript was written by Takashi Funaki, and all the authors commented on the previous versions. All authors have read and approved the final manuscript. All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

Corresponding author

Correspondence to Mike Saji.

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Conflict of interest

Dr. Isobe received honoraria from Medtronic Japan Co., Ltd. (Tokyo, Japan), Abbott Medical Japan LLC (Tokyo, Japan), Boston Scientific Japan K.K. (Tokyo, Japan), BIOTRONIK Japan, Inc. (Tokyo, Japan), Japan Lifeline Co., Ltd. (Tokyo, Japan), TERUMO CORPORATION (Tokyo, Japan), NIPRO CORPORATION (Osaka, Japan), DVx Inc. (Tokyo, Japan), Active Medical Co., Ltd. (Hokkaido, Japan), TORAY INDUSTRIES, INC. (Tokyo, Japan), KANEKA MEDIX CORPORATION (Osaka, Japan), Johnson & Johnson K. K. Medical Company (Tokyo, Japan), Nippon Boehringer Ingelheim Co., Ltd (Tokyo, Japan). Dr. Saji has received consulting fees from Abbott Medical Japan LLC (Tokyo, Japan) and Medtronic Japan Co., Ltd. (Tokyo, Japan). Dr. Takamisawa and Dr. Tobaru are on-site proctors of Medtronic, Inc. (Minneapolis, MN, USA) and Edwards Life Sciences Corporation (Irvine, CA, USA). Dr. Doi is an on-site proctor of Medtronic, Inc. (Minneapolis, MN, USA). Dr. Higuchi is a clinical proctor of Edwards Life Sciences Corporation (Irvine, CA, USA). Takashi Funaki, Mamoru Nanasato, Harutoshi Tamura, Kei Sato, Hiroaki Yokoyama, Shinya Okazaki, Takayuki Onishi, Shuichiro Takanashi, Takanori Ikeda, and Hiroaki Kitaoka declare no conflicts of interest.

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Funaki, T., Saji, M., Higuchi, R. et al. Impact of osteoporotic risk in men undergoing transcatheter aortic valve replacement: a report from the LAPLACE-TAVI registry. Cardiovasc Interv and Ther (2024). https://doi.org/10.1007/s12928-024-01011-7

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