Predictors and Association With Clinical Outcomes of the Changes in Exercise Capacity After Transcatheter Aortic Valve Replacement
-
- Omar Abdul-Jawad Altisent
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d’Hebron Hospital, Barcelona, Spain (J.R.M.).
-
- Rishi Puri
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d’Hebron Hospital, Barcelona, Spain (J.R.M.).
-
- Ander Regueiro
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d’Hebron Hospital, Barcelona, Spain (J.R.M.).
-
- Chekrallah Chamandi
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d’Hebron Hospital, Barcelona, Spain (J.R.M.).
-
- Tania Rodriguez-Gabella
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d’Hebron Hospital, Barcelona, Spain (J.R.M.).
-
- Maria del Trigo
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d’Hebron Hospital, Barcelona, Spain (J.R.M.).
-
- Francisco Campelo-Parada
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d’Hebron Hospital, Barcelona, Spain (J.R.M.).
-
- Thomas Couture
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d’Hebron Hospital, Barcelona, Spain (J.R.M.).
-
- Josep Ramon Marsal
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d’Hebron Hospital, Barcelona, Spain (J.R.M.).
-
- Mélanie Côté
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d’Hebron Hospital, Barcelona, Spain (J.R.M.).
-
- Jean-Michel Paradis
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d’Hebron Hospital, Barcelona, Spain (J.R.M.).
-
- Robert DeLarochellière
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d’Hebron Hospital, Barcelona, Spain (J.R.M.).
-
- Daniel Doyle
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d’Hebron Hospital, Barcelona, Spain (J.R.M.).
-
- Siamak Mohammadi
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d’Hebron Hospital, Barcelona, Spain (J.R.M.).
-
- Eric Dumont
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d’Hebron Hospital, Barcelona, Spain (J.R.M.).
-
- Josep Rodés-Cabau
- From Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (O.A.-J.A., R.P., A.R., C.C., T.R.-G., M.d.T., F.C.-P., T.C., M.C., J.-M.P., R.D., D.D., S.M., E.D., J.R.-C.); Department of Medicine, University of Adelaide, Australia; Cleveland Clinic Coordinating Center for Clinical Research, OH (R.P.); and Epidemiology Unit of the Cardiology Department, Vall d’Hebron Hospital, Barcelona, Spain (J.R.M.).
説明
<jats:sec> <jats:title>Background:</jats:title> <jats:p>At present, there are no objective data specifically examining the clinical impact of variations in exercise capacity post–transcatheter aortic valve replacement (TAVR). We describe the changes in exercise capacity between baseline and 6 months post-TAVR, and ascertain factors associated with and clinical implications of a lack of improvement in exercise capacity post-TAVR.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>A total of 305 patients (mean age, 79±9 years; 44% men; Society of Thoracic Surgeons predicted risk mortality score, 6.7±4.2%) undergoing TAVR completed both baseline and follow-up exercise capacity assessments at 6 months post-TAVR. Exercise capacity was evaluated by the 6-minute walk test (6MWT). Clinical outcomes were compared between patients displaying greater than (n=152; improving group) versus less than (n=153; nonimproving group) the median percentage change in distance walked between baseline and 6-month follow-up examinations. The primary outcome measure was clinical event rates, measured from the 6-month post-TAVR period onward. Further dichotomization according to baseline 6MWT distance (less than versus more than median walking distance, or slow walker versus fast walker) was also assessed.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p> The mean overall distances walked pre- and post-TAVR (6 months post-TAVR) were 204±119 and 263±116 m, respectively (Δ6MWT=60±106 m), with 219 (72%) patients demonstrating an increase in their walking distance (median percentage increase of the entire population was 20% [interquartile range, 0%–80%]). Factors independently correlated with reduced exercise capacity improvement included a range of baseline clinical characteristics (older age, female sex, chronic obstructive pulmonary disease; <jats:italic>P</jats:italic> <0.05 for all), periprocedural major or life-threatening bleeding ( <jats:italic>P</jats:italic> =0.009) and new-onset anemia at 6 months post-TAVR ( <jats:italic>P</jats:italic> =0.009). Failure to improve the 6MWT distance by at least 20% was independently associated with all-cause mortality ( <jats:italic>P</jats:italic> =0.002) and cardiovascular death or rehospitalization for cardiovascular causes ( <jats:italic>P</jats:italic> =0.001). Baseline slow walkers who were able to improve the 6MWT distance presented with significantly better outcomes than nonimprovers ( <jats:italic>P</jats:italic> =0.01 for all-cause mortality; <jats:italic>P</jats:italic> =0.001 for cardiovascular end point). </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions:</jats:title> <jats:p>Approximately one-third of patients undergoing TAVR did not improve their exercise capacity postprocedure. The lack of functional improvement post-TAVR was predicted by a mix of baseline and periprocedural factors translating into poorer clinical outcomes. These results suggest that systematically implementing exercise capacity assessment pre- and post-TAVR may help to improve patient risk stratification.</jats:p> </jats:sec>
収録刊行物
-
- Circulation
-
Circulation 136 (7), 632-643, 2017-08-15
Ovid Technologies (Wolters Kluwer Health)
