Korean Journal of Radiology · Nov 2026

Association of CT-Based Sarcopenia, Clinical Frailty, and Nutritional Status With Mortality After Aortic Valve Replacement for Severe Aortic Stenosis

By Park JH, Zhang HS, Lee S et al.

OBJECTIVE: This study investigated the association between multiple frailty-related markers-Clinical Frailty Scale (CFS), Controlling Nutritional Status (CONUT) score, and computed tomography (CT)-based sarcopenia-and overall survival after aortic valve replacement (AVR) for severe aortic stenosis (AS), with particular emphasis on the first year after AVR. MATERIALS AND METHODS: A total of 407 patients with severe AS who underwent surgical or transcatheter AVR at a tertiary center between November 2020 and December 2022 were retrospectively included. Three frailty-related markers were analyzed: CFS score for functional frailty, CONUT score for nutritional status, and CT-defined sarcopenia for structural muscle depletion. The CONUT score was calculated using serum markers, and sarcopenia was defined according to cohort-specific tertiles of the paravertebral muscle index quantified at the 12th thoracic vertebra (T12) vertebral level using CT. Multivariable Cox proportional hazards analysis was performed to assess the prognostic associations of the Society of Thoracic Surgeons (STS) score and the three frailty-related markers with all-cause mortality after AVR. RESULTS: Within 1 year after AVR, 32 patients (7.9%) died. In the overall multivariable analysis, higher CFS scores and CT-defined sarcopenia were independently associated with mortality, with hazard ratios (HRs) of 1.82 (95% confidence interval [CI], 1.40-2.38; P < 0.001) and 2.63 (95% CI, 1.22-5.67; P = 0.014), respectively. The STS score and CONUT scores were not associated with survival, with HRs of 1.00 (95% CI, 0.95-1.06; P = 0.883) and 1.05 (95% CI, 0.90-1.22; P = 0.563), respectively. A significant interaction was observed between the CONUT score and sarcopenia. CONCLUSION: Among patients with severe AS undergoing AVR, higher CFS scores and CT-based sarcopenia were independently associated with survival after adjustment for the STS score. The prognostic association of the CONUT score differed according to sarcopenia status. These findings support the incorporation of functional and structural vulnerabilities into risk assessment for patients undergoing AVR for AS; however, the role of nutritional status requires further investigation.

doi.org/10.3348/kjr.2026.0589 Open access PubMed 42984197 Biomarkers