Impact of Vertebral Compression Fractures on Physical Disability and Outcome Following Transcatheter Aortic Valve Replacement

Aims Frailty has been widely accepted as a predictor of adverse outcomes in patients after transcatheter aortic valve replacement (TAVR). Vertebral compression fractures (VCFs) are the most common manifestation of osteoporosis, leading to several physical limitations. We hypothesize that VCFs could be crucial in estimating physical ability and predicting outcomes in patients after TAVR. Methods We retrospectively analyzed consecutive 100 patients (84.2 ± 4.8 years, 38 males) undergoing TAVR for severe aortic stenosis (AS) between October 2017 and March 2021. We diagnosed VCFs by routinely performed pre-procedural computed tomography. We defined frailty as the clinical frailty scale (CFS) score ≥ 5. Results This study demonstrated that 41% of participants had VCFs. There were no significant differences in age and left ventricular ejection fraction between patients with VCFs and without VCFs. Regarding pharmacological treatments, a majority (63.4%) in the VCFs group remained untreated for osteoporosis. The frequency of frailty was significantly higher in the VCFs group compared to the non-VCFs group (36.6% vs. 14.3%, p=0.01). Multivariate logistic regression analysis revealed that the presence of VCFs was independently associated with frailty, even after adjusting for potential confounders (odds ratio 3.10, p=0.03). Kaplan-Meier analysis revealed that the incidence of subsequent fragility fractures was significantly higher in the VCFs group than in the non-VCF group (38.1% vs 9.1%, p = 0.0002); however, the incidence rate of all-cause death and heart failure hospitalization were higher in the VCFs group than in the non-VCF group, though not statistically significant (31.7% vs 17.0%, p = 0.07). Conclusions Detecting VCFs might be useful for estimating physical disabilities and predicting subsequent fragility fractures in patients requiring TAVR.