Clinical Implications of Physical Function and Resilience in Patients Undergoing Transcatheter Aortic Valve Replacement
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...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2020-09-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.120.017075 |
| _version_ | 1819175113203908608 |
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| author | Kashish Goel Jared M. O’Leary Colin M. Barker Melissa Levack Vivek Rajagopal Raj R. Makkar Tanvir Bajwa Neal Kleiman Axel Linke Dean J. Kereiakes Ron Waksman Dominic J. Allocco David G. Rizik Michael J. Reardon Brian R. Lindman |
| author_facet | Kashish Goel Jared M. O’Leary Colin M. Barker Melissa Levack Vivek Rajagopal Raj R. Makkar Tanvir Bajwa Neal Kleiman Axel Linke Dean J. Kereiakes Ron Waksman Dominic J. Allocco David G. Rizik Michael J. Reardon Brian R. Lindman |
| author_sort | Kashish Goel |
| collection | DOAJ |
| description | 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.clinicaltrials.gov; Unique identifier: NCT02202434. |
| first_indexed | 2024-12-22T20:49:42Z |
| format | Article |
| id | doaj.art-c4ccb6fd14bf45c693db9ead80e84049 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-22T20:49:42Z |
| publishDate | 2020-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-c4ccb6fd14bf45c693db9ead80e840492022-12-21T18:13:07ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802020-09-0191710.1161/JAHA.120.017075Clinical Implications of Physical Function and Resilience in Patients Undergoing Transcatheter Aortic Valve ReplacementKashish Goel0Jared M. O’Leary1Colin M. Barker2Melissa Levack3Vivek Rajagopal4Raj R. Makkar5Tanvir Bajwa6Neal Kleiman7Axel Linke8Dean J. Kereiakes9Ron Waksman10Dominic J. Allocco11David G. Rizik12Michael J. Reardon13Brian R. Lindman14Structural Heart and Valve Center Vanderbilt University Medical Center Nashville TNStructural Heart and Valve Center Vanderbilt University Medical Center Nashville TNStructural Heart and Valve Center Vanderbilt University Medical Center Nashville TNStructural Heart and Valve Center Vanderbilt University Medical Center Nashville TNMarcus Heart Valve Center Piedmont Heart Institute Atlanta GASmidt Heart Institute, Cedars ‐ Sinai Heart Institute Los Angeles CAAurora Cardiovascular Services Aurora Sinai/Aurora St. Luke’s Medical Centers Milwaukee WIDepartment of Cardiovascular Surgery Houston Methodist DeBakey Heart and Vascular Center Houston TXDepartment of Internal Medicine and Cardiology Heart Center Dresden Technical University of Dresden GermanyThe Christ Hospital Heart and Vascular Center Lindner Research Center Cincinnati OHSection of Interventional Cardiology MedStar Washington Hospital Center Washington DCClinical Sciences Boston Scientific Corp Marlborough MAHonorHealth and the Scottsdale‐Lincoln Health Network Scottsdale AZDepartment of Cardiovascular Surgery Houston Methodist DeBakey Heart and Vascular Center Houston TXStructural Heart and Valve Center Vanderbilt University Medical Center Nashville TNBackground 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.clinicaltrials.gov; Unique identifier: NCT02202434.https://www.ahajournals.org/doi/10.1161/JAHA.120.017075aortic valve stenosisfrailtygait speedoutcomesphysical functiontranscatheter aortic valve replacement |
| spellingShingle | Kashish Goel Jared M. O’Leary Colin M. Barker Melissa Levack Vivek Rajagopal Raj R. Makkar Tanvir Bajwa Neal Kleiman Axel Linke Dean J. Kereiakes Ron Waksman Dominic J. Allocco David G. Rizik Michael J. Reardon Brian R. Lindman Clinical Implications of Physical Function and Resilience in Patients Undergoing Transcatheter Aortic Valve Replacement Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease aortic valve stenosis frailty gait speed outcomes physical function transcatheter aortic valve replacement |
| title | Clinical Implications of Physical Function and Resilience in Patients Undergoing Transcatheter Aortic Valve Replacement |
| title_full | Clinical Implications of Physical Function and Resilience in Patients Undergoing Transcatheter Aortic Valve Replacement |
| title_fullStr | Clinical Implications of Physical Function and Resilience in Patients Undergoing Transcatheter Aortic Valve Replacement |
| title_full_unstemmed | Clinical Implications of Physical Function and Resilience in Patients Undergoing Transcatheter Aortic Valve Replacement |
| title_short | Clinical Implications of Physical Function and Resilience in Patients Undergoing Transcatheter Aortic Valve Replacement |
| title_sort | clinical implications of physical function and resilience in patients undergoing transcatheter aortic valve replacement |
| topic | aortic valve stenosis frailty gait speed outcomes physical function transcatheter aortic valve replacement |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.120.017075 |
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