As part of the TAVR preprocedural assessment done in the 2 months before intervention, a comprehensive geriatric assessment was performed by a geriatrician for all patients to assess comorbidities, physical performances, functional status, cognition, depression, and nutritional status. The complete definition of the comprehensive geriatric assessment (CGA) variables is detailed in supplementary data. In our study, physical performances were assessed by gait speed with the 4-meter gait speed test.

During the same time, all patients underwent a preprocedural CT evaluation which included chest, abdomen, and pelvis acquisition. The images were recorded on the Millennium PACS software. Skeletal muscle area was measured at the inferior margin of L3 vertebra on the abdominal scan of pre-TAVR CT (axial CT images at L3 level with both transverse processes fully visible). The level of the section was determined from the MPR application of the Millennium PACS software by adjusting the axial and sagittal sections centered on L3. A single cross-sectional CT image of L3 was selected and used to measure skeletal muscle area which was performed in a semi-automated fashion with manual “polygone” tracing tool and setting the density threshold between −29 and 150 Hounsfield units (HU). The skeletal muscle area included abdominal skeletal muscles, para-vertebral muscles and psoas (cm2). The L3 skeletal muscle mass index (SMI) was calculated as skeletal muscle area divided by height squared (cm2/m2). For psoas mass index (cm2/m2), measurements of the left and right psoas muscles were summed (cm2), then indexed to the square of the patient’s height (m2).

CT images of 50 randomly selected patients were independently analyzed by a second observer to obtain inter-observer reproducibility.

Severe sarcopenia criteria were defined according to European Working Group on Sarcopenia in Older People including:9

Loss of skeletal muscle mass index (SMI) measured on CT-scan

Gait speed measurement ≤ 0.8m/s

Because no international consensus exists on total SMI threshold, cut-off values for loss of skeletal muscle mass were defined according to previously published studies: total skeletal muscle index (total SMI) < 55.4 cm2/m2 in men and < 38.9 cm2/m2 in women.16,18–20

To discuss the results, prevalence of severe sarcopenia was assessed using the other previous total skeletal muscle index thresholds.13–21

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