{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T11:44:37Z","timestamp":1774957477209,"version":"3.50.1"},"reference-count":42,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2024,5,3]],"date-time":"2024-05-03T00:00:00Z","timestamp":1714694400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Transcatheter aortic valve replacement (TAVR) has evolved as first-line therapy for severe aortic valve stenosis (AS), with pre-procedural computed tomography (CT) providing critical anatomical information. While primarily used for anatomical planning, TAVR-CT also offers an opportunity to assess low bone mineral density (BMD), a known indicator of frailty. Despite this, the prognostic role of BMD in TAVR patients remains unknown. This study aimed to evaluate BMD on routine TAVR-CT and its impact on long-term survival. Methods: In this retrospective study, 770 consecutive TAVR patients (mean age 80.7 \u00b1 6.7 years, 54.0% males) between November 2015 and March 2022 were included. BMD was measured from a single axial image at the thoracic vertebral level on unenhanced CT scans. Cox regression models assessed the impact of BMD on mortality, and Restricted Cubic Spline models identified potential mortality thresholds. Results: The mean BMD value, as measured on non-contrast CT, was 147.5 \u00b1 5.4 Hounsfield units, demonstrating a noteworthy association with mortality (adjusted hazard ratio per 100 HU decrease: 1.27 [95%CI: 1.01\u20131.59], p = 0.041). Restricted cubic spline analysis indicated that BMD below 200 HU was linked to a substantial increase in mortality risk. Upon crude Cox regression analysis, every 100 HU decrease was associated with a 32% increase in risk for death (HR 1.32 [95%CI: 1.068\u20131.65)], p = 0.010). Conclusions: In conclusion, low BMD on TAVR-CT is independently associated with reduced survival, suggesting its potential as a tool for comprehensive frailty assessment and improved risk prediction in TAVR patients.<\/jats:p>","DOI":"10.3390\/jcm13092698","type":"journal-article","created":{"date-parts":[[2024,5,3]],"date-time":"2024-05-03T11:26:26Z","timestamp":1714735586000},"page":"2698","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Low Bone Mineral Density on Computed Tomography: Association with Poor Survival after Transcatheter Aortic Valve Replacement"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-1966-0637","authenticated-orcid":false,"given":"Caglayan","family":"Demirel","sequence":"first","affiliation":[{"name":"Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kseniya","family":"Halavina","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2505-8554","authenticated-orcid":false,"given":"Kevin","family":"Hamzaraj","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johanna","family":"Klement","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3135-4156","authenticated-orcid":false,"given":"Manar","family":"El-Shaer","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rayyan","family":"Hemetsberger","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2945-9742","authenticated-orcid":false,"given":"Max Paul","family":"Winter","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sophia","family":"Koschatko","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charlotte","family":"Jantsch","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Andreas","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Clinical Division of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2502-0676","authenticated-orcid":false,"given":"Christian","family":"Loewe","sequence":"additional","affiliation":[{"name":"Department of Radiology, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7632-9879","authenticated-orcid":false,"given":"Andreas","family":"Kammerlander","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8284-2994","authenticated-orcid":false,"given":"Christian","family":"Hengstenberg","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philipp E.","family":"Bartko","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,5,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1695","DOI":"10.1056\/NEJMoa1814052","article-title":"Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients","volume":"380","author":"Mack","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1706","DOI":"10.1056\/NEJMoa1816885","article-title":"Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients","volume":"380","author":"Popma","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.1056\/NEJMoa1700456","article-title":"Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients","volume":"376","author":"Reardon","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1609","DOI":"10.1056\/NEJMoa1514616","article-title":"Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients","volume":"374","author":"Leon","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1002\/ccd.28504","article-title":"Transcatheter aortic valve replacement versus surgery for symptomatic severe aortic stenosis: A reconstructed individual patient data meta-analysis","volume":"96","author":"Dowling","year":"2020","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1056\/NEJMoa1910555","article-title":"Five-Year Outcomes of Transcatheter or Surgical Aortic-Valve Replacement","volume":"382","author":"Makkar","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Demirel, C., Rothenb\u00fchler, C.F., Huber, M., Schweizer, M., Todorski, I., Gloor, D.A., Windecker, S., Lanz, J., Stortecky, S., and Pilgrim, T. (2024). Total Muscle Area and Visceral Adipose Tissue Measurements for Frailty Assessment in TAVR Patients. J. Clin. Med., 13.","DOI":"10.20944\/preprints202401.1197.v1"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1016\/j.jcin.2017.12.017","article-title":"Frailty: An Important Measure in Patients Considered for Transcatheter Aortic Valve Replacement","volume":"11","author":"Kirk","year":"2018","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1016\/j.jacc.2017.06.024","article-title":"Frailty in Older Adults Undergoing Aortic Valve Replacement: The FRAILTY-AVR Study","volume":"70","author":"Afilalo","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Ilic, I., Faron, A., Heimann, M., Potthoff, A.L., Sch\u00e4fer, N., Bode, C., Borger, V., Eichhorn, L., Giordano, F.A., and G\u00fcresir, E. (2021). Combined Assessment of Preoperative Frailty and Sarcopenia Allows the Prediction of Overall Survival in Patients with Lung Cancer (NSCLC) and Surgically Treated Brain Metastasis. Cancers, 13.","DOI":"10.3390\/cancers13133353"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.bja.2019.03.034","article-title":"Frailty assessment: From clinical to radiological tools","volume":"123","author":"Bentov","year":"2019","journal-title":"Br. J. Anaesth."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1097\/ACO.0000000000000759","article-title":"The impact of frailty and sarcopenia on patient outcomes after complex spine surgery","volume":"32","author":"Flexman","year":"2019","journal-title":"Curr. Opin. Anaesthesiol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Ko\u0142odziejska, K., Witowski, J., Tylec, P., Grochowska, A., Przytu\u0142a, N., Lis, M., P\u0119dziwiatr, M., and Rubinkiewicz, M. (2022). Radiological Features for Frailty Assessment in Patients Requiring Emergency Laparotomy. J. Clin. Med., 11.","DOI":"10.3390\/jcm11185365"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"884988","DOI":"10.3389\/fonc.2022.884988","article-title":"Measurement of Sarcopenia in Head and Neck Cancer Patients and Its Association with Frailty","volume":"12","author":"Meerkerk","year":"2022","journal-title":"Front. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1093\/ejcts\/ezz378","article-title":"Preoperative sarcopenia is associated with late mortality after off-pump coronary artery bypass grafting","volume":"58","author":"Okamura","year":"2020","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1097\/ALN.0000000000004064","article-title":"Preoperative Point-of-Care Ultrasound to Identify Frailty and Predict Postoperative Outcomes: A Diagnostic Accuracy Study","volume":"136","author":"Canales","year":"2022","journal-title":"Anesthesiology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.cjca.2015.12.002","article-title":"Psoas Muscle Area and All-Cause Mortality after Transcatheter Aortic Valve Replacement: The Montreal-Munich Study","volume":"32","author":"Mamane","year":"2016","journal-title":"Can. J. Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.amjcard.2016.04.043","article-title":"Usefulness of Psoas Muscle Area to Predict Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement","volume":"118","author":"Saji","year":"2016","journal-title":"Am. J. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1016\/j.amjcard.2015.12.015","article-title":"Prognostic Value of Fat Mass and Skeletal Muscle Mass Determined by Computed Tomography in Patients Who Underwent Transcatheter Aortic Valve Implantation","volume":"117","author":"Mok","year":"2016","journal-title":"Am. J. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"3082","DOI":"10.1253\/circj.CJ-18-0709","article-title":"Prognostic Impact of Computed Tomography-Derived Abdominal Fat Area on Transcatheter Aortic Valve Implantation","volume":"82","author":"Okuno","year":"2018","journal-title":"Circ. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2239","DOI":"10.1007\/s00198-017-4024-1","article-title":"Associations between hip bone mineral density, aortic calcification and cardiac workload in community-dwelling older Australians","volume":"28","author":"Scott","year":"2017","journal-title":"Osteoporos. Int."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"938399","DOI":"10.3389\/fendo.2022.938399","article-title":"The associations between bone mineral density and long-term risks of cardiovascular disease, cancer, and all-cause mortality","volume":"13","author":"Shi","year":"2022","journal-title":"Front. Endocrinol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1007\/s00198-010-1331-1","article-title":"Low bone mineral density is associated with increased mortality in elderly men: MrOS Sweden","volume":"22","author":"Johansson","year":"2011","journal-title":"Osteoporos. Int."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.ijcard.2020.06.053","article-title":"Low bone mineral density in adults with complex congenital heart disease","volume":"319","author":"Sandberg","year":"2020","journal-title":"Int. J. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1007\/s11914-019-00529-7","article-title":"When Low Bone Mineral Density and Fractures Is Not Osteoporosis","volume":"17","author":"Jha","year":"2019","journal-title":"Curr. Osteoporos. Rep."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Li, G., Thabane, L., Papaioannou, A., Ioannidis, G., Levine, M.A., and Adachi, J.D. (2017). An overview of osteoporosis and frailty in the elderly. BMC Musculoskelet. Disord., 18.","DOI":"10.1186\/s12891-017-1403-x"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1002\/jcsm.12870","article-title":"Associations of osteoporosis and sarcopenia with frailty and multimorbidity among participants of the Hertfordshire Cohort Study","volume":"13","author":"Laskou","year":"2022","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1007\/s00198-009-0970-6","article-title":"Low bone mineral density at femoral neck is a predictor of increased mortality in elderly Japanese women","volume":"21","author":"Suzuki","year":"2010","journal-title":"Osteoporos. Int."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1016\/j.ajog.2005.08.047","article-title":"Epidemiology, etiology, and diagnosis of osteoporosis","volume":"194","author":"Lane","year":"2006","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"588","DOI":"10.7326\/0003-4819-158-8-201304160-00003","article-title":"Opportunistic screening for osteoporosis using abdominal computed tomography scans obtained for other indications","volume":"158","author":"Pickhardt","year":"2013","journal-title":"Ann. Intern. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1007\/s00198-015-3318-4","article-title":"Opportunistic screening for osteoporosis using the sagittal reconstruction from routine abdominal CT for combined assessment of vertebral fractures and density","volume":"27","author":"Lee","year":"2016","journal-title":"Osteoporos. Int."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e58","DOI":"10.1097\/BSD.0000000000000879","article-title":"Cervical Spine Computed Tomography Hounsfield Units Accurately Predict Low Bone Mineral Density of the Femoral Neck","volume":"33","author":"Colantonio","year":"2020","journal-title":"Clin. Spine Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1148\/radiol.2020192706","article-title":"Thoracic Bone Mineral Density Derived from Cardiac CT Is Associated with Greater Fracture Rate","volume":"296","author":"Therkildsen","year":"2020","journal-title":"Radiology"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2627","DOI":"10.1007\/s00330-019-06357-8","article-title":"CT and MR imaging prior to transcatheter aortic valve implantation: Standardisation of scanning protocols, measurements and reporting-a consensus document by the European Society of Cardiovascular Radiology (ESCR)","volume":"30","author":"Francone","year":"2020","journal-title":"Eur. Radiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1123\/japa.2014-0036","article-title":"Sarcopenia Defined by Combining Height- and Weight-Adjusted Skeletal Muscle Indices is Closely Associated with Poor Physical Performance","volume":"23","author":"Meng","year":"2015","journal-title":"J. Aging Phys. Act."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1080\/13697137.2017.1329290","article-title":"Low bone mineral density is associated with breast cancer in postmenopausal women: A case-control study","volume":"20","author":"Vespoli","year":"2017","journal-title":"Climacteric"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1007\/s11657-022-01060-6","article-title":"Prognostic value of preoperative low bone mineral density in patients with digestive cancers: A systematic review and meta-analysis","volume":"17","author":"Watanabe","year":"2022","journal-title":"Arch. Osteoporos."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1007\/978-981-13-3681-2_16","article-title":"Osteoporosis and the Ageing Skeleton","volume":"91","author":"Aspray","year":"2019","journal-title":"Subcell. Biochem."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Rinonapoli, G., Ruggiero, C., Meccariello, L., Bisaccia, M., Ceccarini, P., and Caraffa, A. (2021). Osteoporosis in Men: A Review of an Underestimated Bone Condition. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22042105"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1111\/crj.13514","article-title":"Osteoporosis in COPD patients: Risk factors and pulmonary rehabilitation","volume":"16","author":"Li","year":"2022","journal-title":"Clin. Respir. J."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1016\/j.chest.2019.06.036","article-title":"Prevalence and Risk Factors for Osteoporosis in Individuals with COPD: A Systematic Review and Meta-analysis","volume":"156","author":"Chen","year":"2019","journal-title":"Chest"},{"key":"ref_42","first-page":"100891","article-title":"Low bone mineral density and coronary artery disease: A systematic review and meta-analysis","volume":"37","author":"Khandkar","year":"2021","journal-title":"Int. J. Cardiol. Heart Vasc."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/9\/2698\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:39:25Z","timestamp":1760107165000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/9\/2698"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,3]]},"references-count":42,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2024,5]]}},"alternative-id":["jcm13092698"],"URL":"https:\/\/doi.org\/10.3390\/jcm13092698","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,3]]}}}