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Sarcopenia and aortic valve disease
  1. Manish Kumar1,
  2. Anthony Pettinato2,
  3. Feria Ladha3,
  4. Jacob E Earp4,
  5. Varun Jain5,
  6. Shivaraj Patil6,
  7. Daniel T Engelman7,
  8. Peter F Robinson8,
  9. Mohamad B Moumneh9,
  10. Parag Goyal10,11,
  11. Abdulla A Damluji12,13
  1. 1Montefiore Health System, Bronx, New York, USA
  2. 2Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  3. 3Boston Children's Hospital, Boston, Massachusetts, USA
  4. 4University of Connecticut, Storrs, Connecticut, USA
  5. 5Trinity Health of New England, Hartford, Connecticut, USA
  6. 6Albert Einstein College of Medicine, Bronx, New York, USA
  7. 7Baystate Health, Springfield, Massachusetts, USA
  8. 8Montefiore Medical Center, New York, New York, USA
  9. 9George Mason University, Fairfax, Virginia, USA
  10. 10Division of General Internal Medicine, Weill Cornell Medicine, New York, New York, USA
  11. 11Division of Cardiovascular Medicine, Weill Cornell Medicine, New York, New York, USA
  12. 12Johns Hopkins University, Baltimore, Maryland, USA
  13. 13Inova Health System, Falls Church, Virginia, USA
  1. Correspondence to Dr Abdulla A Damluji, Johns Hopkins University, Baltimore, MD 21218, USA; Abdulla.Damluji{at}jhu.edu

Abstract

Valvular heart disease, including calcific or degenerative aortic stenosis (AS), is increasingly prevalent among the older adult population. Over the last few decades, treatment of severe AS has been revolutionised following the development of transcatheter aortic valve replacement (TAVR). Despite improvements in outcomes, older adults with competing comorbidities and geriatric syndromes have suboptimal quality of life outcomes, highlighting the cumulative vulnerability that persists despite valve replacement. Sarcopenia, characterised by loss of muscle strength, mass and function, affects 21%–70% of older adults with AS. Sarcopenia is an independent predictor of short-term and long-term outcomes after TAVR and should be incorporated as a prognostic marker in preprocedural planning. Early diagnosis and treatment of sarcopenia may reduce morbidity and mortality and improve quality of life following TAVR. The adverse effects of sarcopenia can be mitigated through resistance training and optimisation of nutritional status. This is most efficacious when administered before sarcopenia has progressed to advanced stages. Management should be individualised based on the patient’s wishes/preferences, care goals and physical capability. Exercise during the preoperative waiting period may be safe and effective in most patients with severe AS. However, future studies are needed to establish the benefits of prehabilitation in improving quality of life outcomes after TAVR procedures.

  • Heart Valve Diseases

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Footnotes

  • X @vjainmd, @DrDamluji

  • Contributors All authors meet the criteria for authorship. Each author listed on the manuscript has reviewed and approved the submission of this manuscript and takes full responsibility for it.

  • Funding This work received funding from the National Heart, Lung, and Blood Institute (K23-HL153771).

  • Competing interests AAD receives research funding from the Pepper Scholars Program of the Johns Hopkins University Claude D Pepper Older Americans Independence Center funded by the National Institute on Aging (P30-AG021334), mentored patient-oriented research career development award from the National Heart, Lung, and Blood Institute (K23-HL153771), the NIH National Institute on Aging (R01-AG078153) and the Patient-Centered Outcomes Research Institute (PCORI).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.