Journal of cachexia, sarcopenia and muscle · 2025
A Simplified Frailty Measure Improves Risk Stratification in Patients Undergoing Percutaneous Mitral Valve Repair.
СтатьяНазвание и аннотация: Перевод в очереди
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Metze Clemens, Zweck Elric, Iliadis Christos, Körber Maria Isabel, Schäfer Matthieu, Westenfeld Ralf, Polzin Amin, Halbach Marcel, Baldus Stephan, Pfister Roman
Аннотация
OBJECTIVE: The aim of this study was to examine frailty measures for risk prediction in patients undergoing percutaneous mitral valve repair (PMVR).
BACKGROUND: Performance of current risk prediction models based on organ morbidity is only moderate.
METHODS: The frailty domains exhaustion, slowness, inactivity, weakness, and unintentional weight loss were prospectively assessed in patients undergoing PMVR. The association with mortality and heart failure hospitalization (HFH) during a median follow-up of 506 days was examined and relevant domains were assessed for additive predictive performance over the MitraScore.
RESULTS: Five hundred twenty-four patients were included in the study (mean age [SD]: 77 (9) years, 54.6% male). The risk of mortality and mortality/HFH were significantly increased in patients with exhaustion (hazard ratio: 2.24 [95% CI: 1.63-3.08]/1.83 [1.21-2.77]), slowness (2.74 [1.75-4.30]/1.92 [1.34-2.75]), inactivity (1.96 [1.26-3.05]/1.61 [1.12-2.31]) and weakness (1.83 [1.12-2.96]/1.34 [0.92-1.95]), but not in patients with weight loss (1.24 [0.80-1.92]/1.12 [0.78-1.61]). A simplified frailty (S-frailty) measure derived from the domains exhaustion and slowness was associated with mortality (4.45 [2.42-8.19]) and mortality/HFH (2.60 [1.64-4.13]) independently of clinical risk factors and the MitraScore, respectively. Prediction of mortality by the MitraScore was significantly improved when adding S-frailty (Harrell's C 0.645 vs. 0.700, p = 0.002). Classification of 1-year mortality risk by the MitraScore improved when adding S-frailty (net reclassification index 0.21, p = 0.012 and integrated discrimination index 0.07, p < 0.001).
CONCLUSIONS: A simplified frailty measure comprising self-reported exhaustion and gait speed significantly improved risk prediction in patients undergoing PMVR. Assessment of frailty measures should be part of the decision-making process and multiparametric risk scores in patients with severe mitral regurgitation.
BACKGROUND: Performance of current risk prediction models based on organ morbidity is only moderate.
METHODS: The frailty domains exhaustion, slowness, inactivity, weakness, and unintentional weight loss were prospectively assessed in patients undergoing PMVR. The association with mortality and heart failure hospitalization (HFH) during a median follow-up of 506 days was examined and relevant domains were assessed for additive predictive performance over the MitraScore.
RESULTS: Five hundred twenty-four patients were included in the study (mean age [SD]: 77 (9) years, 54.6% male). The risk of mortality and mortality/HFH were significantly increased in patients with exhaustion (hazard ratio: 2.24 [95% CI: 1.63-3.08]/1.83 [1.21-2.77]), slowness (2.74 [1.75-4.30]/1.92 [1.34-2.75]), inactivity (1.96 [1.26-3.05]/1.61 [1.12-2.31]) and weakness (1.83 [1.12-2.96]/1.34 [0.92-1.95]), but not in patients with weight loss (1.24 [0.80-1.92]/1.12 [0.78-1.61]). A simplified frailty (S-frailty) measure derived from the domains exhaustion and slowness was associated with mortality (4.45 [2.42-8.19]) and mortality/HFH (2.60 [1.64-4.13]) independently of clinical risk factors and the MitraScore, respectively. Prediction of mortality by the MitraScore was significantly improved when adding S-frailty (Harrell's C 0.645 vs. 0.700, p = 0.002). Classification of 1-year mortality risk by the MitraScore improved when adding S-frailty (net reclassification index 0.21, p = 0.012 and integrated discrimination index 0.07, p < 0.001).
CONCLUSIONS: A simplified frailty measure comprising self-reported exhaustion and gait speed significantly improved risk prediction in patients undergoing PMVR. Assessment of frailty measures should be part of the decision-making process and multiparametric risk scores in patients with severe mitral regurgitation.