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Prognostic implications of baseline 6‐min walk test performance in intermediate risk patients undergoing transcatheter aortic valve replacement
Author(s) -
Sathananthan Janarthanan,
Green Philip,
Finn Matthew,
Wood David A.,
Lauck Sandra,
Crowley Aaron,
Alu Maria,
Arnold Suzanne V.,
Cohen David,
Kapadia Samir,
Mack Michael,
Thourani Vinod H.,
Kodali Susheel,
Leon Martin,
Webb John G.
Publication year - 2021
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28981
Subject(s) - medicine , hazard ratio , cardiology , confidence interval , ejection fraction , valve replacement , proportional hazards model , coronary artery disease , heart failure , stenosis
Background While slow gait speed is known to be associated with poor outcomes in patients at high surgical risk who undergo transcatheter aortic valve replacement (TAVR), the prognostic significance of slow gait speed in intermediate risk TAVR patients is poorly understood. Objectives We assessed the association between baseline 6‐min walk test (6MWT) performance and both 2‐year mortality and health status in intermediate risk patients undergoing TAVR as a part of the PARTNER II/S3i studies. Methods The association of baseline 6MWT with mortality over 2‐years after TAVR was examined using Cox regression; both unadjusted and adjusted for age, left ventricular ejection fraction, coronary artery disease, pulmonary disease, renal insufficiency, and STS score. Patients were divided into four groups according to baseline 6MWT: unable to walk and in three equal tertiles of slow, medium, and fast walkers. Among surviving patients, improvement in 6MWT and quality of life were compared. Results Among 2,037 intermediate risk TAVR patients (mean age 81.7 years, STS score 5.6%), 8.2% were unable to walk. Baseline 6MWT was associated with all‐cause mortality over 2 years (Hazard ratio (HR) 0.87 per 50 m, 95% confidence interval [CI] 0.83 to 0.92, p < .0001). Among surviving patients, the adjusted absolute change in 6MWT at 2 years improved for patients unable to walk (+134.1 m, 95% CI 102.1 to 166 m, p < .0001) and slow walkers (+60.5 m, 95% CI 42.8 to 78.2 m, p < .0001), but was unchanged for medium walkers (−7.3 m, 95% CI −24.3 to 9.6 m, p = .4), and declined for fast walkers (−41.3 m, 95% CI −58.7 to −23.9 m, p < .0001). Conclusion Poor functional capacity is predictive of 2‐year mortality in elderly intermediate risk patients undergoing TAVR. However, surviving patients with poor baseline functional capacity had significant improvement in 6MWT performance and quality of life at 2‐years following TAVR.