Deep Learning–Derived Body Composition Analysis Predicts Long-Term Mortality After Transcatheter Aortic Valve Replacement
Year: 2026
Type: article
Study design: Observational Study
Abstract: Objective To examine the association between body composition metrics derived from pre-procedural CT angiography and all-cause mortality following TAVR. Patients and Methods We included patients who underwent TAVR between September 2011 and November 2023 at a single academic center. Skeletal muscle (SM), subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and intermuscular adipose tissue (IAT) areas (cm 2 ), as well as skeletal muscle index (SMI; cm 2 /m 2 ), were quantified from CT angiography using a validated U-Net–based deep learning model. Associations between each parameter and 3-year all-cause mortality were assessed using multivariable Cox proportional hazards models adjusted for clinical covariates, with adjusted hazard ratios (aHR) expressed per 1-standard-deviation increase. Results Among 2,642 patients (median age 80.0 [74.0–85.0] years; 59.5% male), median follow-up was 2.8 years, and 74.8% survived to 3 years. Lower SM, SAT, VAT, and SMI (analyzed as continuous variables) were independently associated with higher 3-year all-cause mortality (SM: aHR 0.831, 95% CI 0.762-0.906; SAT: aHR 0.847, 95% CI 0.775–0.926; VAT: aHR 0.826, 95% CI 0.762–0.896; SMI: aHR 0.832, 95% CI 0.763-0.907; all p ≤ 0.001). Restricted cubic spline analysis demonstrated increased mortality risk below threshold values of SM <128 cm 2 , SAT <161 cm 2 , VAT <104 cm 2 , and SMI <41 cm 2 /m 2 , sex-specific thresholds were also derived. Conclusion Reduced skeletal muscle and adipose tissue reserves are independently associated with increased mortality after TAVR. Automated CT-derived body composition assessment may improve preoperative risk stratification and guide clinical decision-making in TAVR candidates.
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,500
OpenAlex ID: W7133736159