Clinical research in cardiology : official journal of the German Cardiac Society · 2017
Prevalence, predictors, and prognostic implications of residual impairment of functional capacity after transcatheter aortic valve implantation.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Abdelghani Mohammad, Cavalcante Rafael, Miyazaki Yosuke, de Winter Robbert J, Sarmento-Leite Rogério, Mangione José A, Abizaid Alexandre, Lemos Pedro A, Serruys Patrick W, de Brito Fabio S
Аннотация
BACKGROUND: Patients with degenerative aortic stenosis (AS) referred for transcatheter aortic valve implantation (TAVI) typically have advanced cardiac and vascular adverse remodeling and multiple comorbidities and, therefore, might not recover a normal functional capacity after valve replacement. We sought to investigate the prevalence, the predictors, and the prognostic impact of residual impairment of functional capacity after TAVI.
METHODS AND RESULTS: Out of 790 patients undergoing TAVI with impaired functional capacity (NYHA II-IV) at baseline, NYHA functional class improved in 592 (86.5%) and remained unchanged/worsened in 92 (13.5%) at follow-up [median (IQR): 419 (208-807) days] after TAVI. Normal functional capacity (NYHA I) was recovered in 65.5% (n = 448) of patients, while the rest had variable degrees of residual impairment. On multivariable regression analysis, atrial fibrillation [odds ratio-OR, 2.08 (1.21-3.58), p = 0.008], low-flow-low-gradient AS [OR, 1.97 (1.09-3.57), p = 0.026], chronic obstructive pulmonary disease [OR, 1.92 (1.19-3.12), p = 0.008], and lower hemoglobin at baseline [OR, 1.11 (1.01-1.21) for each g% decrement, p = 0.036] were independently associated with residual impairment of functional capacity. All-cause and cardiac mortality were significantly higher in those with residual impairment of functional capacity than in those in NYHA I class [hazard ratio-HR: 2.37 (95% CI: 1.51-3.72), p < 0.001 and 2.16 (95% CI: 1.08-4.35), p = 0.030, respectively]. Even mild residual functional impairment (NYHA II) was associated with a higher all-cause [HR: 2.02 (95% CI: 1.10-3.72), p = 0.023] and cardiac [HR: 2.08 (95% CI: 1.42-3.07), p < 0.001] mortality.
CONCLUSION: Residual impairment of functional capacity is common after TAVI and is independently associated with increased mortality. Predictors of residual impairment of functional status are predominantly patient-rather than procedure-related.
METHODS AND RESULTS: Out of 790 patients undergoing TAVI with impaired functional capacity (NYHA II-IV) at baseline, NYHA functional class improved in 592 (86.5%) and remained unchanged/worsened in 92 (13.5%) at follow-up [median (IQR): 419 (208-807) days] after TAVI. Normal functional capacity (NYHA I) was recovered in 65.5% (n = 448) of patients, while the rest had variable degrees of residual impairment. On multivariable regression analysis, atrial fibrillation [odds ratio-OR, 2.08 (1.21-3.58), p = 0.008], low-flow-low-gradient AS [OR, 1.97 (1.09-3.57), p = 0.026], chronic obstructive pulmonary disease [OR, 1.92 (1.19-3.12), p = 0.008], and lower hemoglobin at baseline [OR, 1.11 (1.01-1.21) for each g% decrement, p = 0.036] were independently associated with residual impairment of functional capacity. All-cause and cardiac mortality were significantly higher in those with residual impairment of functional capacity than in those in NYHA I class [hazard ratio-HR: 2.37 (95% CI: 1.51-3.72), p < 0.001 and 2.16 (95% CI: 1.08-4.35), p = 0.030, respectively]. Even mild residual functional impairment (NYHA II) was associated with a higher all-cause [HR: 2.02 (95% CI: 1.10-3.72), p = 0.023] and cardiac [HR: 2.08 (95% CI: 1.42-3.07), p < 0.001] mortality.
CONCLUSION: Residual impairment of functional capacity is common after TAVI and is independently associated with increased mortality. Predictors of residual impairment of functional status are predominantly patient-rather than procedure-related.