Clinical Implications of Physical Function and Resilience in Patients Undergoing Transcatheter Aortic Valve Replacement

Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Tanvir Bajwa¹  Dominic J. Allocco²  Neal Kleiman³  Michael J. Reardon³  Axel Linke⁴  David G. Rizik⁵  Vivek Rajagopal⁶  Ron Waksman⁷  Raj R. Makkar⁸  Colin M. Barker⁹  Jared M. O’Leary⁹  Brian R. Lindman⁹  Melissa Levack⁹  Kashish Goel⁹  Dean J. Kereiakes^1,10 

[1] Aurora Cardiovascular Services Aurora Sinai/Aurora St. Luke’s Medical Centers Milwaukee WI;Clinical Sciences Boston Scientific Corp Marlborough MA;Department of Cardiovascular Surgery Houston Methodist DeBakey Heart and Vascular Center Houston TX;Department of Internal Medicine and Cardiology Heart Center Dresden Technical University of Dresden Germany;HonorHealth and the Scottsdale‐Lincoln Health Network Scottsdale AZ;Marcus Heart Valve Center Piedmont Heart Institute Atlanta GA;Section of Interventional Cardiology MedStar Washington Hospital Center Washington DC;Smidt Heart Institute, Cedars ‐ Sinai Heart Institute Los Angeles CA;Structural Heart and Valve Center Vanderbilt University Medical Center Nashville TN;The Christ Hospital Heart and Vascular Center Lindner Research Center Cincinnati OH;

关键词: aortic valve stenosis;    frailty;    gait speed;    outcomes;    physical function;    transcatheter aortic valve replacement;   

DOI  :  10.1161/JAHA.120.017075

来源: DOAJ

【 摘 要 】

Background Gait speed is a reliable measure of physical function and frailty in patients with aortic stenosis undergoing transcatheter aortic valve replacement (TAVR). Slow gait speed pre‐TAVR predicts worse clinical outcomes post‐TAVR. The consequences of improved versus worsened physical function post‐TAVR are unknown. Methods and Results The REPRISE III (Repositionable Percutaneous Replacement of Stenotic Aortic Valve Through Implantation of Lotus Valve System–Randomized Clinical Evaluation) trial randomized high/extreme risk patients to receive a mechanically‐expanded or self‐expanding transcatheter heart valve. Of 874 patients who underwent TAVR, 576 with complete data at baseline and 1 year were included in this analysis. Slow gait speed in the 5‐m walk test was defined as <0.83 m/s. A clinically meaningful improvement (≥0.1 m/s) in gait speed 1 year after TAVR occurred in 39% of patients, 35% exhibited no change, and 26% declined (≥0.1 m/s). Among groups defined by baseline/1‐year post‐TAVR gait speeds, 1‐ to 2‐year mortality or hospitalization rates were as follows: 6.6% (normal/normal), 8.0% (slow/normal), 20.9% (normal/slow), and 21.5% (slow/slow). After adjustment, slow gait speed at 1 year (regardless of baseline speed) was associated with a 3.5‐fold increase in death/hospitalization between 1 and 2 years compared with those with normal baseline/1‐year gait speed. Patients whose slow gait speed normalized at 1 year had no increased risk. One‐year, but not baseline, gait speed was associated with death or hospitalization between 1 and 2 years (adjusted hazard ratio, 0.83 per 0.1 m/s faster gait; 95% CI, 0.74–0.93, P=0.001). Conclusions Marked heterogeneity exists in the trajectory of physical function after TAVR and this, more than baseline function, has clinical consequences. Identifying and optimizing factors associated with physical resilience after TAVR may improve outcomes. Registration URL: https://www.clini​caltr​ials.gov; Unique identifier: NCT02202434.

【 授权许可】

Unknown