1
|
Aleksandrowicz KA, Aleksandrowicz KM, Witkowski TG, Kosowski M, Kübler P, Grześkowiak K, Golański GP, Kulig DJ, Rachwalik MF, Przybylski R, Reczuch K, Protasiewicz M. Early Heart Rate Recovery after a 6-min Walking Test Predicts Clinical Benefits in Patients after Percutaneous Aortic Valve Implantation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4270. [PMID: 36901280 PMCID: PMC10002365 DOI: 10.3390/ijerph20054270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 02/20/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND It was hypothesized that the time-appropriate return to a resting heart rate (HR) after cessation of exercise could be a marker for predicting outcomes in patients with heart failure (HF). We aimed to evaluate the prognostic value of HR recovery in functional improvement among adults with severe aortic stenosis undergoing percutaneous aortic valve implantation (TAVI). METHODS We performed a 6 min walk test (6MWT) in 93 individuals before TAVI and 3 months after the procedure. The change in walking distance was calculated. During the pre-TAVI 6MWT, we analyzed the differences between baseline HR, HR at the end of the test, and HR at the 1st, 2nd, and 3rd minute of recovery. RESULTS After 3 months, 6MWT distances improved by 39 ± 63 m and reached a total of 322 ± 117 m. Multiple linear regression proved the differences between HR after 2 min of recovery and baseline HR in pre-TAVI after a 6MWT was the only significant predictor of waking distance improvement during follow-up. CONCLUSIONS Our study suggests that analysis of HR recovery after a 6MWT may be a helpful and easy parameter to assess improvements in exercise capacity after TAVI. This simple method can help to identify patients in whom no significant benefit in functional improvement can be expected despite successful valve implantation.
Collapse
Affiliation(s)
- Krzysztof Artur Aleksandrowicz
- Department of Physiotherapy, Faculty of Health Sciences, Wroclaw Medical University, 50-367 Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland
| | | | - Tomasz Grzegorz Witkowski
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland
- Department of Cardiology, Faculty of Medicine, Institute of Heart Diseases, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Michał Kosowski
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland
- Department of Cardiology, Faculty of Medicine, Institute of Heart Diseases, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Piotr Kübler
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland
- Department of Cardiology, Faculty of Medicine, Institute of Heart Diseases, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | | | | | | | - Maciej Filip Rachwalik
- Department of Cardiac Surgery and Heart Transplantation, Faculty of Medicine, Institute of Heart Diseases, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Roman Przybylski
- Department of Cardiac Surgery and Heart Transplantation, Faculty of Medicine, Institute of Heart Diseases, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Krzysztof Reczuch
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland
- Department of Cardiology, Faculty of Medicine, Institute of Heart Diseases, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Marcin Protasiewicz
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland
- Department of Cardiology, Faculty of Medicine, Institute of Heart Diseases, Wroclaw Medical University, 50-367 Wroclaw, Poland
| |
Collapse
|
2
|
Bardan S, Kvaslerud AB, Andresen K, Kløve SF, Edvardsen T, Gullestad L, Broch K. Intravenous ferric derisomaltose in iron-deficient patients undergoing transcatheter aortic valve implantation due to severe aortic stenosis: study protocol of the randomised controlled IIISAS trial. BMJ Open 2022; 12:e059546. [PMID: 36691165 PMCID: PMC9442485 DOI: 10.1136/bmjopen-2021-059546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 07/13/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Iron deficiency is a prevalent comorbidity in patients with severe aortic stenosis and may be associated with procedural and clinical outcomes after transcatheter aortic valve implantation (TAVI). In the Intravenous Iron Supplement for Iron Deficiency in Patients with Severe Aortic Stenosis (IIISAS) trial, we aim to examine whether a single administration of ferric derisomaltose can improve physical capacity after TAVI. METHODS AND ANALYSIS This randomised, double-blind, placebo-controlled trial aims to enrol 150 patients with iron deficiency who are scheduled for TAVI due to severe aortic stenosis. The study drug and matching placebo are administered approximately 3 months prior to TAVI, and the patients are followed for 3 months after TAVI. Inclusion criteria are iron deficiency, defined as serum ferritin<100 µg/L or ferritin between 100 and 300 µg/L in combination with a transferrin saturation<20% and written informed consent. Exclusion criteria include haemoglobin<10 g/dL, red blood cell disorders, end-stage kidney failure, intolerance to ferric derisomaltose, and ongoing infections. The primary endpoint is the baseline-adjusted distance walked on a 6 min walk test (6MWT) 3 months after TAVI. Secondary end points include quality of life, New York Heart Association functional class (NYHA functional class), and skeletal muscle strength. ETHICS AND DISSEMINATION Ethical approval was obtained from the Regional Committee for Medical and Health Research of South-Eastern Norway and The Norwegian Medicines Agency. Enrolment has begun, and results are expected in 2022. The results of the IIISAS trial will be disseminated by presentations at international and national conferences and by publications in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04206228.
Collapse
Affiliation(s)
- Sara Bardan
- Faculty of Medicine, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anette Borger Kvaslerud
- Faculty of Medicine, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
- K.G. Jebsen Cardiac Research Center and Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kristoffer Andresen
- Faculty of Medicine, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Sophie Foss Kløve
- Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Thor Edvardsen
- Faculty of Medicine, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Lars Gullestad
- Faculty of Medicine, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
- K.G. Jebsen Cardiac Research Center and Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kaspar Broch
- Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
3
|
Patel KP, Treibel TA, Scully PR, Fertleman M, Searle S, Davis D, Moon JC, Mullen MJ. Futility in Transcatheter Aortic Valve Implantation: A Search for Clarity. Interv Cardiol 2022; 17:e01. [PMID: 35111240 PMCID: PMC8790725 DOI: 10.15420/icr.2021.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/05/2021] [Indexed: 12/12/2022] Open
Abstract
Although transcatheter aortic valve implantation (TAVI) has revolutionised the landscape of treatment for aortic stenosis, there exists a cohort of patients where TAVI is deemed futile. Among the pivotal high-risk trials, one-third to half of patients either died or received no symptomatic benefit from the procedure at 1 year. Futility of TAVI results in the unnecessary exposure of risk for patients and inefficient resource utilisation for healthcare services. Several cardiac and extra-cardiac conditions and frailty increase the risk of mortality despite TAVI. Among the survivors, these comorbidities can inhibit improvements in symptoms and quality of life. However, certain conditions are reversible with TAVI (e.g. functional mitral regurgitation), attenuating the risk and improving outcomes. Quantification of disease severity, identification of reversible factors and a systematic evaluation of frailty can substantially improve risk stratification and outcomes. This review examines the contribution of pre-existing comorbidities towards futility in TAVI and suggests a systematic approach to guide patient evaluation.
Collapse
Affiliation(s)
- Kush P Patel
- Institute of Cardiovascular Sciences, University College London London, UK.,Barts Heart Centre, St Bartholomew's Hospital London, UK
| | - Thomas A Treibel
- Institute of Cardiovascular Sciences, University College London London, UK.,Barts Heart Centre, St Bartholomew's Hospital London, UK
| | - Paul R Scully
- Institute of Cardiovascular Sciences, University College London London, UK.,Barts Heart Centre, St Bartholomew's Hospital London, UK
| | - Michael Fertleman
- Cutrale Perioperative and Ageing Group, Department of Bioengineering, Imperial College London London, UK
| | - Samuel Searle
- MRC Unit for Lifelong Health and Ageing, University College London London, UK
| | - Daniel Davis
- MRC Unit for Lifelong Health and Ageing, University College London London, UK
| | - James C Moon
- Institute of Cardiovascular Sciences, University College London London, UK.,Barts Heart Centre, St Bartholomew's Hospital London, UK
| | - Michael J Mullen
- Institute of Cardiovascular Sciences, University College London London, UK.,Barts Heart Centre, St Bartholomew's Hospital London, UK
| |
Collapse
|
4
|
Yu Z, Zhao Q, Ye Y, Wang M, Zhou Z, Zhang H, Zhao Z, Liu Q, Zhang Z, Wu Y, Xu H. Comprehensive Geriatric Assessment and Exercise Capacity in Cardiac Rehabilitation for Patients Referred to Transcatheter Aortic Valve Implantation. Am J Cardiol 2021; 158:98-103. [PMID: 34465453 DOI: 10.1016/j.amjcard.2021.07.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
Comprehensive geriatric assessment (CGA)-based cardiac rehabilitation (CR) program is essential for patients before and after transcatheter aortic valve implantation (TAVI). This study aimed to explore the values of CGA and exercise capacity in CR for patients referred to TAVI. A retrospective analysis was conducted in 90 patients referred to TAVI from January to October 2019. CR strategies started before TAVI. The association between clinical characteristics, CGA, and change in six-minute walk distance (Δ6MWD) was analyzed with multivariate regression models. Most of patients had cognitive impairment (50%), malnutrition (61%), and frailty (83%). After the CR, the proportion of cognitive impairment, malnutrition, and frail patients was significantly decreased by 21%, 40%, and 57%, respectively (p = 0.002, p <0.001, p <0.001). The 6MWD at a month after discharge (291.9 ± 98.8 m) was significantly improved than that at discharge after TAVI (218.8 ± 114.3m, p <0.001). The multivariate regression analysis indicated body mass index (BMI; Δ6MWD:12.0, 95% confidence interval [CI] 0.3 to 23.8, p = 0.045), frailty (Δ6MWD: -57.9, 95% CI -81.8 to -34.1, p <0.001) and malnutrition (Δ6MWD: -25.1, 95% CI -47.0 to -3.2, p = 0.026) as the associated predictors of Δ6MWD. In conclusion, functional status in patients referred to TAVI could be improved by CGA-based CR. BMI, frailty, and malnutrition were associated with the efficacy of CR on exercise capacity. CGA can play the important role in the evaluation and making strategies for CR in patients.
Collapse
|
5
|
Poirier P, Bastien M, Auclair A, Nadreau É, Clavel MA, Pibarot P, Bagur R, Forman DE, Rodès-Cabau J. The Physiological Burden of the 6-Minute Walk Test Compared With Cardiopulmonary Exercise Stress Test in Patients With Severe Aortic Atenosis. CJC Open 2021; 3:769-777. [PMID: 34169256 PMCID: PMC8209404 DOI: 10.1016/j.cjco.2021.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/02/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Management of aortic stenosis (AS) relies on symptoms. Exercise testing is recommended for asymptomatic patients with significant AS but is often experienced as forbidding and/or technically unrealistic for patients who are often frail, deconditioned, and intimidated by the exercise test. We compared the physiological burden assessed with gas exchange assessments to gauge and respiratory exchange ratio (RER) of a 6-minute walk test (6MWT) to a cardiopulmonary exercise stress test (CPET) in patients with severe AS. peak oxygen utilization. METHODS Adults with equivocal symptoms and severe AS (1-aortic valve area [AVA] ≤ 1.0 cm2 or AVA index ≤ 0.6 cm2/m2, 2-peak aortic jet velocity ≥ 4.0 m/sec, 3-mean transvalvular pressure gradient ≥ 40 mm Hg by rest or dobutamine stress echocardiography, or 4-aortic valve calcification ≥ 1200 in women or ≥ 2000 AU in men) were studied. All participants completed both a 6MWT and symptom-limited progressive bicycle exercise testing. Breath-by-breath gas analysis and 12-lead electrocardiography were completed during 6MWT and CPET. Results: Eleven patients were studied. Patients walked on average 330 ± 75 m during the 6MWT and achieved a maximal workload of 48 ± 14 watts during the CPET. During the 6MWT, peak maximal oxygen uptake (V ˙ O2peak) was 12.8 ± 2.5 vs 10.8 ± 4.2 mL/kg/min during the CPET. Respiratory exchange ratio exceeded 1.1 in both the 6MWT and CPET indicating similarly high exertion. Compared with the CPET, a larger proportion of the 6MWT was performed at a high intensity level (78% ± 28% vs 33% ± 24% at > 85% V̇O2peak; P = 0.004). CONCLUSIONS The 6MWT with breath-by-breath gas analysis was well tolerated and able to achieve a physiological intense RER andV ˙ O2peak that are similar to symptom-limited CPET in patients with severe AS.
Collapse
Affiliation(s)
- Paul Poirier
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Quebec City, Quebec, Canada
- Faculty of Pharmacy, Laval University, Quebec City, Quebec, Canada
| | - Marjorie Bastien
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Quebec City, Quebec, Canada
- Faculty of Pharmacy, Laval University, Quebec City, Quebec, Canada
| | - Audrey Auclair
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Éric Nadreau
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Marie-Anick Clavel
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Quebec City, Quebec, Canada
- Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Philippe Pibarot
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Quebec City, Quebec, Canada
- Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Rodrigo Bagur
- Division of Cardiology of London Health Sciences Centre, Department of Medicine, Western University, London, Ontario, Canada
| | - Daniel E. Forman
- University of Pittsburgh, University of Pittsburgh Medical Center and VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Joseph Rodès-Cabau
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Quebec City, Quebec, Canada
- Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| |
Collapse
|
6
|
Improvement in the nutritional status after transcatheter aortic valve implantation. J Cardiol 2021; 78:250-254. [PMID: 33992501 DOI: 10.1016/j.jjcc.2021.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/03/2021] [Accepted: 04/06/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND A poor nutritional status of patients before transcatheter aortic valve implantation (TAVI) has been reported to be associated with poor clinical outcomes. However, changes in the nutritional status following TAVI have not been fully elucidated. METHODS In this single-center retrospective observational study, 129 patients whose nutritional status at baseline and 6 months after TAVI were available were investigated. The prognostic nutritional index (PNI) and geriatric nutritional risk index (GNRI) were used to assess the nutritional status of the patients at baseline and at 6 months. We further assessed changes in the nutritional status of patients in the subgroups stratified according to the baseline levels as low and high. RESULTS The PNI and GNRI values at 6 months were significantly better than at baseline [PNI, baseline: 44.5 (41.0-48.0), 6 months: 46.0 (41.9-48.3), p = 0.02; GNRI, baseline: 95.3 (89.0-100.3), 6 months: 97.8 (91.5-101.4), p = 0.006]. Both PNI and GNRI values at 6 months were significantly better in the patients with a low baseline nutritional status, while no significant change was observed in those with high baseline levels [PNI, low; baseline: 36.8 (36.1-39.4), 6 months: 40.8 (39.0-43.4), p = 0.002, high; baseline: 47.0 (43.0-49.5), 6 months: 46.5 (43.5-50.5), p = 0.44 and GNRI, low; baseline: 86.4 (81.7-88.7), 6 months: 88.6 (83.4-95.3), p = 0.001, high; baseline: 99.8 (95.3-102.8), 6 months: 100.7 (96.8-103.4), p = 0.34]. CONCLUSION Nutritional status of patients might improve during the chronic phase after TAVI, especially in those with poor baseline levels.
Collapse
|
7
|
Early Hemodynamics after Aortic Valve Replacement. ACTA ACUST UNITED AC 2020; 56:medicina56120674. [PMID: 33297308 PMCID: PMC7762237 DOI: 10.3390/medicina56120674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/02/2020] [Accepted: 12/04/2020] [Indexed: 11/16/2022]
Abstract
Background and objectives: The aims of this study were to investigate changes in the hemodynamics associated with different types of aortic prostheses and to evaluate patient-prosthesis mismatch (PPM) at rest and after exercise. Materials and Methods: We retrospectively analyzed 150 patients who presented with indications for aortic valve replacement (AVR) with/without concomitant surgery from March 2019 to January 2020. The study population included 90 (60%) men and 60 (40%) women (mean age, 67.33 ± 10.22 years; range, 37-88 years). Echocardiography data such as peak and mean transprosthetic pressure gradients (Gmax, Gmean), velocity (V), effective orifice area (EOA), and indexed EOA (iEOA) were derived at rest and after exercise at baseline and before discharge. The study patients performed the six-minute walk test (6MWT) on the 5th-7th postoperative day. Results: Stented tissue valves showed excellent performance at rest and after exercise in comparison with mechanical valves, which showed favorable hemodynamics at rest only. At the time of discharge, moderate PPM was observed in 7/74 patients (9.5%) at rest and 5/98 (3.3%) patients after exercise. None of the patients showed severe PPM. EOA and iEOA were not significantly different between the groups. However, the stented group showed more pronounced changes in EOA and iEOA after exercise, whereas the changes in the mechanical valve group did not reach significance. Conclusions: In the early postoperative period, mechanical valves and stented valves showed favorable resting hemodynamics. The PPM rate measured after exercise was lower than that at rest.
Collapse
|
8
|
Lorenzoni G, Azzolina D, Fraccaro C, Di Liberti A, D'Onofrio A, Cavalli C, Fabris T, D'Amico G, Cibin G, Nai Fovino L, Ocagli H, Gerosa G, Tarantini G, Gregori D. Using Wearable Devices to Monitor Physical Activity in Patients Undergoing Aortic Valve Replacement: Protocol for a Prospective Observational Study. JMIR Res Protoc 2020; 9:e20072. [PMID: 33180023 PMCID: PMC7691084 DOI: 10.2196/20072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/21/2020] [Accepted: 08/25/2020] [Indexed: 12/25/2022] Open
Abstract
Background In last few decades, several tools have been developed to measure physical function objectively; however, their use has not been well established in clinical practice. Objective This study aims to describe the preoperative physical function and to assess and compare 6-month postoperative changes in the physical function of patients undergoing treatment for aortic stenosis with either surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). The study also aims to evaluate the feasibility of wearable devices in assessing physical function in such patients. Methods This is a prospective observational study. The enrollment will be conducted 1 month before patients’ SAVR/TAVR. Patients will be provided with the wearable device at baseline (activity tracker device, Garmin vívoactive 3). They will be trained in the use of the device, and they will be requested to wear it on the wrist of their preferred hand until 12 months after SAVR/TAVR. After baseline assessment, they will undergo 4 follow-up assessments at 1, 3, 6, and 12 months after SAVR/TAVR. At baseline and each follow-up, they will undergo a set of standard and validated tests to assess physical function, health-related quality of life, and sleep quality. Results The ethics committee of Vicenza in Veneto Region in Italy approved the study (Protocol No. 943; January 4, 2019). As of October 2020, the enrollment of participants is ongoing. Conclusions The use of the wearable devices for real-time monitoring of physical activity of patients undergoing aortic valve replacement is a promising opportunity for improving the clinical management and consequently, the health outcomes of such patients. Trial Registration Clinicaltrials.gov NCT03843320; https://tinyurl.com/yyareu5y International Registered Report Identifier (IRRID) DERR1-10.2196/20072
Collapse
Affiliation(s)
- Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Danila Azzolina
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Chiara Fraccaro
- Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Alessandro Di Liberti
- Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Augusto D'Onofrio
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Chiara Cavalli
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Tommaso Fabris
- Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Gianpiero D'Amico
- Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Giorgia Cibin
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Luca Nai Fovino
- Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Honoria Ocagli
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Gino Gerosa
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Giuseppe Tarantini
- Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| |
Collapse
|
9
|
Suppan M, Barcelos G, Luise S, Diaper J, Frei A, Ellenberger C, Adamopoulos D, Noble S, Licker M. Improved Exercise Tolerance, Oxygen Delivery, and Oxygen Utilization After Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis. CJC Open 2020; 2:490-496. [PMID: 33305208 PMCID: PMC7710946 DOI: 10.1016/j.cjco.2020.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/11/2020] [Indexed: 12/19/2022] Open
Abstract
Background Transcatheter aortic valve implantation (TAVI) represents an effective therapeutic procedure, particularly in patients with severe aortic stenosis. We hypothesized that the decreased afterload induced by TAVI would improve exercise capacity by enhancing oxygen uptake in working muscles. Methods A standardized exercise test was performed in patients with severe aortic stenosis the day before TAVI and within 5 days thereafter. The main study endpoint was the workload achieved during a 5-minute standardized exercise test. Using electrical cardiometry and near-infrared spectroscopy, we explored and compared the changes in cardiac index (CI), as well as muscular and cerebral tissue oximetry, during the 2 exercise tests. Results Thirty patients completed the study protocol. Compared with the pre-TAVI period, patients achieved a higher median workload after TAVI (316 Joules [interquartile range {IQR}: 169–494] vs 190 Joules [IQR: 131–301], P = 0.002). Baseline CI increased from 2.5 l/min per m2 (IQR: 2.1–2.9) to 2.9 l/min per m2 (IQR: 2.5–3.2; P = 0.009), whereas CI at the end of the exercise test increased from 4.5 l/min per m2 (IQR: 3.4–5.3) to 4.7 l/min per m2 (3.4–6.4; P = 0.019). At the end of the exercise test, cerebral tissue oximetry increased from 70% (IQR: 65–72) to 74% (IQR: 66–78), and muscle tissue oximetry increased from 62% (IQR: 58–65) to 71% (65–74; P = 0.046 and P < 0.001, respectively). Conclusions Early improvement of exercise capacity after TAVI is associated with increased CI and better oxygen utilization in the brain and skeletal muscles.
Collapse
Affiliation(s)
- Mélanie Suppan
- Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | - Gleicy Barcelos
- Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | - Stéphane Luise
- Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | - John Diaper
- Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | - Angela Frei
- Division of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Christoph Ellenberger
- Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | | | - Stéphane Noble
- Division of Cardiology, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Marc Licker
- Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| |
Collapse
|
10
|
Frailty and Exercise Training: How to Provide Best Care after Cardiac Surgery or Intervention for Elder Patients with Valvular Heart Disease. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9849475. [PMID: 30302342 PMCID: PMC6158962 DOI: 10.1155/2018/9849475] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/01/2018] [Accepted: 08/29/2018] [Indexed: 12/13/2022]
Abstract
The aim of this literature review was to evaluate existing evidence on exercise-based cardiac rehabilitation (CR) as a treatment option for elderly frail patients with valvular heart disease (VHD). Pubmed database was searched for articles between 1980 and January 2018. From 2623 articles screened, 61 on frailty and VHD and 12 on exercise-based training for patients with VHD were included in the analysis. We studied and described frailty assessment in this patient population. Studies reporting results of exercise training in patients after surgical/interventional VHD treatment were analyzed regarding contents and outcomes. The tools for frailty assessment included fried phenotype frailty index and its modifications, multidimensional geriatric assessment, clinical frailty scale, 5-meter walking test, serum albumin levels, and Katz index of activities of daily living. Frailty assessment in CR settings should be based on functional, objective tests and should have similar components as tools for risk assessment (mobility, muscle mass and strength, independence in daily living, cognitive functions, nutrition, and anxiety and depression evaluation). Participating in comprehensive exercise-based CR could improve short- and long-term outcomes (better quality of life, physical and functional capacity) in frail VHD patients. Such CR program should be led by cardiologist, and its content should include (1) exercise training (endurance and strength training to improve muscle mass, strength, balance, and coordination), (2) nutrition counseling, (3) occupational therapy (to improve independency and cognitive function), (4) psychological counseling to ensure psychosocial health, and (5) social worker counseling (to improve independency). Comprehensive CR could help to prevent, restore, and reduce the severity of frailty as well as to improve outcomes for frail VHD patients after surgery or intervention.
Collapse
|
11
|
Six-minute walking test and long term prognosis in patients with asymptomatic aortic valve stenosis. Int J Cardiol 2017; 249:334-339. [DOI: 10.1016/j.ijcard.2017.09.183] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/13/2017] [Accepted: 09/20/2017] [Indexed: 11/22/2022]
|
12
|
Pressler A. Cardiac rehabilitation after transcatheter aortic valve implantation: Growing needs in a growing population. Eur J Prev Cardiol 2017; 24:685-687. [DOI: 10.1177/2047487317693953] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Axel Pressler
- Department of Prevention, Rehabilitation and Sports Medicine, Technische Universität München, Germany
| |
Collapse
|
13
|
Pressler A, Christle JW, Lechner B, Grabs V, Haller B, Hettich I, Jochheim D, Mehilli J, Lange R, Bleiziffer S, Halle M. Exercise training improves exercise capacity and quality of life after transcatheter aortic valve implantation: A randomized pilot trial. Am Heart J 2016; 182:44-53. [PMID: 27914499 DOI: 10.1016/j.ahj.2016.08.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 08/21/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is increasingly applied for aortic stenosis in elderly patients with impaired mobility and reduced quality of life. These patients may particularly benefit from postinterventional exercise programs, but no randomized study has evaluated the safety and efficacy of exercise in this population. METHODS In a prospective pilot study, 30 patients after TAVI (mean age, 81±6 years, 44% female, 83±34 days postintervention) were randomly allocated 1:1 to a training group (TG) performing 8 weeks of supervised combined endurance and resistance exercise or to usual care. The formal primary efficacy end point was between-group difference in change in peak oxygen uptake assessed by cardiopulmonary exercise testing; secondary end points included muscular strength, 6-minute walk distance, and quality of life (Kansas City Cardiomyopathy Questionnaire and Medical Outcomes Study 12-Item Short-Form Health Survey questionnaires). Safety was assessed by documenting training-related adverse events, prosthesis, and renal function. RESULTS Significant changes in favor of TG were observed for peak oxygen uptake (group difference, 3.7 mL/min per kg [95% CI, 1.1-6.3; P=.007]), muscular strength (bench press, 6 kg [95% CI, 3-10; P=.002]; rowing, 7 kg [95% CI, 3-11; P<.001]; pulldown, 9 kg [95% CI, 4-14; P=.001]; shoulder press, 5 kg [95% CI, 1-8; P=.008]; leg press, 17 kg [95% CI 6-28; P=.005]), components of quality of life (Kansas City Cardiomyopathy Questionnaire physical limitation, 19.2 [95% CI, 4.1-34.2; P=.015]; symptom burden, 12.3 [95% CI, 0.5-24.0; P=.041]; clinical summary, 12.4 [3.4-21.4; P=.009]), but not for other questionnaire subscales and 6-minute walk distance (15 m [95% CI, -23 to 53; P=.428]). Three dropouts unrelated to exercise occurred (TG=2; usual care,=1); prosthesis and renal function were not affected by the exercise intervention. CONCLUSIONS In patients after TAVI, exercise training appears safe and highly effective with respect to improvements in exercise capacity, muscular strength, and quality of life. CLINICAL TRIAL REGISTRATION Clinicaltrials.govNCT01935297.
Collapse
Affiliation(s)
- Axel Pressler
- Department of Prevention, Rehabilitation and Sports Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
| | - Jeffrey W Christle
- Department of Prevention, Rehabilitation and Sports Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Benjamin Lechner
- Department of Prevention, Rehabilitation and Sports Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Viola Grabs
- Department of Prevention, Rehabilitation and Sports Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Bernhard Haller
- Institute for Medical Statistics and Epidemiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Ina Hettich
- Department of Pneumology, University Hospital Freiburg, Freiburg, Germany
| | - David Jochheim
- Cardiology Department, Munich University Clinic, Munich, Germany
| | - Julinda Mehilli
- Cardiology Department, Munich University Clinic, Munich, Germany; DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Rüdiger Lange
- Clinic for Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - Sabine Bleiziffer
- Clinic for Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - Martin Halle
- Department of Prevention, Rehabilitation and Sports Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany; Else Kröner-Fresenius-Zentrum am Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| |
Collapse
|
14
|
Le VDT, Jensen GVH, Kjøller-Hansen L. Observed change in peak oxygen consumption after aortic valve replacement and its predictors. Open Heart 2016; 3:e000309. [PMID: 27252876 PMCID: PMC4885434 DOI: 10.1136/openhrt-2015-000309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 03/18/2016] [Accepted: 04/25/2016] [Indexed: 11/23/2022] Open
Abstract
Objective To assess the change in peak oxygen consumption (pVO2) and determine its outcome predictors after aortic valve replacement (AVR) for aortic stenosis (AS). Methods Patients with AS and preserved left ventricular ejection fraction who were referred for single AVR had cardiopulmonary exercise testing prior to and 9 months post-AVR. Predictors of outcome for pVO2 were determined by multivariate linear and logistic regression analyses. A significant change in pVO2 was defined as a relative change that was more than twice the coefficient of repeatability by test–retest (>10%). Results The pre-AVR characteristics of the 37 study patients included the following: median age (range) 72 (46–83) years, aortic valve area index (AVAI) 0.41 (SD 0.11) cm2/m2, mean gradient (MG) 49.1 (SD 15.3) mm Hg and New York Heart Association (NYHA)≥II 27 (73%). Pre-AVR and post-AVR mean pVO2 was 18.5 and 18.4 mL/kg/m2 (87% of the predicted), respectively, but the change from pre-AVR was heterogeneous. The relative change in pVO2 was positively associated with the preoperative MG (β=0.50, p=0.001) and negatively associated with brain natriuretic peptide > upper level of normal according to age and gender (β=−0.40, p=0.009). A relative increase in pVO2 exceeding 10% was found in 9 (24%), predicted by lower pre-AVR AVAI (OR 0.18; 95% CI 0.04 to 0.82, p=0.027) and lower peak O2 pulse (OR 0.94; 95% CI 0.88 to 0.99, p=0.045). Decreases in pVO2 exceeding 10% were found in 11 (30%) and predicted by lower MG (OR 0.93; 95% CI 0.86 to 0.99, p=0.033). Conclusions Change in pVO2 was heterogeneous. Predictors of favourable and unfavourable outcomes for pVO2 were identified.
Collapse
Affiliation(s)
- Van Doan Tuyet Le
- Department of Cardiology , Roskilde University Hospital , Roskilde , Denmark
| | | | - Lars Kjøller-Hansen
- Department of Cardiology , Roskilde University Hospital , Roskilde , Denmark
| |
Collapse
|
15
|
Hiltrop N, Belmans A, Claes M, Hornikx M, Peeters B, Flamaing J, Adriaenssens T, De Praetere H, Herregods MC, Herijgers P, Dubois C. Functional performance and quality of life in high-risk comorbid patients undergoing transcatheter aortic valve implantation for symptomatic aortic valve stenosis. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2016; 2:184-192. [DOI: 10.1093/ehjqcco/qcw001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Indexed: 11/13/2022]
|
16
|
The Clinical Impact of 6-Min Walk Test Distance as a Predictor of Complications in Patients Undergoing Major Surgery. World J Surg 2015; 39:2845. [PMID: 26304609 DOI: 10.1007/s00268-015-3202-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
17
|
Impact of left ventricular conduction defect with or without need for permanent right ventricular pacing on functional and clinical recovery after TAVR. Clin Res Cardiol 2015; 104:964-74. [DOI: 10.1007/s00392-015-0865-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 04/30/2015] [Indexed: 10/23/2022]
|
18
|
Kim CA, Rasania SP, Afilalo J, Popma JJ, Lipsitz LA, Kim DH. Functional status and quality of life after transcatheter aortic valve replacement: a systematic review. Ann Intern Med 2014; 160:243-54. [PMID: 24727842 PMCID: PMC4039034 DOI: 10.7326/m13-1316] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The functional and quality-of-life benefits of transcatheter aortic valve replacement (TAVR) have not been established. PURPOSE To evaluate the changes in functional status and quality of life after TAVR. DATA SOURCES MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from 1 January 2002 to 30 September 2013. STUDY SELECTION Studies of TAVR that reported the New York Heart Association (NYHA) class, Short Form-12/36 Health Survey physical and mental component summary (points), or other measures of functional status. DATA EXTRACTION Two reviewers independently extracted the mean change (follow-up minus baseline) in primary outcomes. Because of substantial heterogeneity, data were not pooled; the range of mean change was summarized. DATA SYNTHESIS We identified 60 observational studies (56 pre–post comparison and 4 head-to-head comparative studies) and 2 randomized, controlled trials (11 205 patients). Most studies showed a clinically important decrease in NYHA class at 6 to 11 months (range, -0.8 to -2.1 classes) and 12 to 23 months (range, -0.8 to -2.1 classes). The improvement in the Short Form-12/36 Health Survey physical component score was clinically important over 12 months (range, 4.9 to 26.9 points), and the change in mental component score was smaller (range, 1.0 to 8.9 points).Clinically important improvements were seen in other disease-specific measures but were less consistently seen in general health measures. LIMITATIONS Comparative evidence is limited by few head-to-head studies. Survivor bias may have overestimated the benefits. CONCLUSION Transcatheter aortic valve replacement provides clinically important benefits in physical function and disease-specific measures of quality of life but modest benefits in psychological and general health measures. More comparative studies on functional status and quality of life are needed for informed treatment decision making.
Collapse
Affiliation(s)
- Caroline A. Kim
- From Beth Israel Deaconess Medical Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, and Harvard School of Public Health, Boston, Massachusetts; Jewish General Hospital and McGill University, Montreal, Quebec, Canada; and Geisinger Medical Center, Danville, Pennsylvania
| | - Suraj P. Rasania
- From Beth Israel Deaconess Medical Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, and Harvard School of Public Health, Boston, Massachusetts; Jewish General Hospital and McGill University, Montreal, Quebec, Canada; and Geisinger Medical Center, Danville, Pennsylvania
| | - Jonathan Afilalo
- From Beth Israel Deaconess Medical Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, and Harvard School of Public Health, Boston, Massachusetts; Jewish General Hospital and McGill University, Montreal, Quebec, Canada; and Geisinger Medical Center, Danville, Pennsylvania
| | - Jeffrey J. Popma
- From Beth Israel Deaconess Medical Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, and Harvard School of Public Health, Boston, Massachusetts; Jewish General Hospital and McGill University, Montreal, Quebec, Canada; and Geisinger Medical Center, Danville, Pennsylvania
| | - Lewis A. Lipsitz
- From Beth Israel Deaconess Medical Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, and Harvard School of Public Health, Boston, Massachusetts; Jewish General Hospital and McGill University, Montreal, Quebec, Canada; and Geisinger Medical Center, Danville, Pennsylvania
| | - Dae Hyun Kim
- From Beth Israel Deaconess Medical Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, and Harvard School of Public Health, Boston, Massachusetts; Jewish General Hospital and McGill University, Montreal, Quebec, Canada; and Geisinger Medical Center, Danville, Pennsylvania
| |
Collapse
|
19
|
Dvir D, Waksman R, Barbash IM, Kodali SK, Svensson LG, Tuzcu EM, Xu K, Minha S, Alu MC, Szeto WY, Thourani VH, Makkar R, Kapadia S, Satler LF, Webb JG, Leon MB, Pichard AD. Outcomes of Patients With Chronic Lung Disease and Severe Aortic Stenosis Treated With Transcatheter Versus Surgical Aortic Valve Replacement or Standard Therapy. J Am Coll Cardiol 2014; 63:269-79. [DOI: 10.1016/j.jacc.2013.09.024] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 09/08/2013] [Accepted: 09/10/2013] [Indexed: 02/06/2023]
|
20
|
Reinöhl J, von Zur Mühlen C, Moser M, Sorg S, Bode C, Zehender M. TAVI 2012: state of the art. J Thromb Thrombolysis 2013; 35:419-35. [PMID: 23114537 DOI: 10.1007/s11239-012-0825-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The development of "transcatheter aortic valve implantation (TAVI)" is changing the field of cardiovascular medicine rapidly. The basic principle of TAVI is the percutaneous implantation of a bioprosthesis mounted in a metal frame. The prosthesis, which is attached to the tip of the catheter, is positioned in the native aortic valve and expanded. The first successful implantation was made by Alain Cribier in 2002. Several smaller mono- and multicenter studies later confirmed the technical feasibility of this procedure. Its true value as an important, therapeutic alternative to open heart surgery in inoperable and high-risk patients is now confirmed in large multicenter registries and by the prospective, randomized PARTNER trial. Decisive for the future acceptance of the procedure and for a possible expansion of the indication spectrum will be (1) continuous further development of the implantation technique and the prosthesis design, (2) reduction of TAVI-associated complications, (3) confirmation of the initial positive long-term results and (4) confirmation of the promising results in the treatment of surgical prosthesis dysfunctions and of patients with low to intermediate risk.
Collapse
Affiliation(s)
- Jochen Reinöhl
- Department of Cardiology, Heart Center Freiburg University, Hugstetter Str. 55, 79106, Freiburg, Germany.
| | | | | | | | | | | |
Collapse
|
21
|
Relation between six-minute walk test performance and outcomes after transcatheter aortic valve implantation (from the PARTNER trial). Am J Cardiol 2013; 112:700-6. [PMID: 23725996 DOI: 10.1016/j.amjcard.2013.04.046] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 04/22/2013] [Accepted: 04/22/2013] [Indexed: 01/14/2023]
Abstract
Functional capacity as assessed by 6-minute walk test distance (6MWTD) has been shown to predict outcomes in selected cohorts with cardiovascular disease. To evaluate the association between 6MWTD and outcomes after transcatheter aortic valve implantation (TAVI) among participants in the Placement of AoRTic TraNscathetER valve (PARTNER) trial, TAVI recipients (n = 484) were stratified into 3 groups according to baseline 6MWTD: unable to walk (n = 218), slow walkers (n = 133), in whom 6MWTD was below the median (128.5 meters), and fast walkers (n = 133) with 6MWTD >128.5 meters. After TAVI, among fast walkers, follow-up 6MWTD decreased by 44 ± 148 meters at 12 months (p <0.02 compared with baseline). In contrast, among slow walkers, 6MWTD improved after TAVI by 58 ± 126 meters (p <0.001 compared with baseline). Similarly, among those unable to walk, 6MWTD distance increased by 66 ± 109 meters (p <0.001 compared with baseline). There were no differences in 30-day outcomes among 6MWTD groups. At 2 years, the rate of death from any cause was 42.5% in those unable to walk, 31.2% in slow walkers, and 28.8% in fast walkers (p = 0.02), driven primarily by differences in noncardiac death. In conclusion, among high-risk older adults undergoing TAVI, baseline 6MWTD does not predict procedural outcomes but does predict long-term mortality. Nonetheless, patients with poor baseline functional status exhibit the greatest improvement in 6MWTD. Additional work is required to identify those with poor functional status who stand to benefit the most from TAVI.
Collapse
|
22
|
Mok M, Nombela-Franco L, Urena M, Delarochellière R, Doyle D, Ribeiro HB, Côté M, Pibarot P, Delarochellière H, Laflamme L, Poirier P, Dumont E, Rodés-Cabau J. Prognostic value of exercise capacity as evaluated by the 6-minute walk test in patients undergoing transcatheter aortic valve implantation. J Am Coll Cardiol 2013; 61:897-8. [PMID: 23428221 DOI: 10.1016/j.jacc.2012.10.050] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 10/16/2012] [Accepted: 10/23/2012] [Indexed: 10/27/2022]
|
23
|
Barker CM. Aortic Valve Surgery and Transcatheter Aortic Valve Replacement for the Very Old: Improved Interventional Therapeutic Options for Aortic Stenosis for Elderly. CURRENT CARDIOVASCULAR RISK REPORTS 2012. [DOI: 10.1007/s12170-012-0264-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
24
|
Généreux P, Head SJ, Wood DA, Kodali SK, Williams MR, Paradis JM, Spaziano M, Kappetein AP, Webb JG, Cribier A, Leon MB. Transcatheter aortic valve implantation 10-year anniversary: review of current evidence and clinical implications. Eur Heart J 2012; 33:2388-98. [PMID: 22851654 DOI: 10.1093/eurheartj/ehs220] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Surgical aortic valve replacement (SAVR) is currently the standard of care to treat patients with severe symptomatic aortic stenosis (AS) and is generally accepted to alleviate symptoms and prolong survival. Based on the results of randomized trials, transcatheter aortic valve implantation (TAVI) is the new standard of care for patients with symptomatic AS who are deemed 'inoperable'. Debatably, TAVI is also an alternative to SAVR in selected patients who are at high risk but operable. As we approach 10 years of clinical experience with TAVI, with over 50 000 implantations in 40 countries, a review of the current literature and clinical outcomes with this rapidly evolving technology is appropriate.
Collapse
Affiliation(s)
- Philippe Généreux
- Columbia University Medical Center and the Cardiovascular Research Foundation, 161 Fort Washington Avenue, 6th Floor, New York, NY 10032, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Généreux P, Head SJ, Van Mieghem NM, Kodali S, Kirtane AJ, Xu K, Smith C, Serruys PW, Kappetein AP, Leon MB. Clinical outcomes after transcatheter aortic valve replacement using valve academic research consortium definitions: a weighted meta-analysis of 3,519 patients from 16 studies. J Am Coll Cardiol 2012; 59:2317-26. [PMID: 22503058 DOI: 10.1016/j.jacc.2012.02.022] [Citation(s) in RCA: 443] [Impact Index Per Article: 36.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 02/07/2012] [Accepted: 02/23/2012] [Indexed: 12/13/2022]
Abstract
OBJECTIVES This study sought to perform a weighted meta-analysis to determine the rates of major outcomes after transcatheter aortic valve replacement (TAVR) using Valve Academic Research Consortium (VARC) definitions and to evaluate their current use in the literature. BACKGROUND Recently, the published VARC definitions have helped to add uniformity to reporting outcomes after TAVR. METHODS A comprehensive search of multiple electronic databases from January 1, 2011, through October 12, 2011, was conducted using predefined criteria. We included studies reporting at least 1 outcome using VARC definitions. RESULTS A total of 16 studies including 3,519 patients met inclusion criteria and were included in the analysis. The pooled estimate rates of outcomes were determined according to VARC's definitions: device success, 92.1% (95% confidence interval [CI]: 88.7% to 95.5%); all-cause 30-day mortality, 7.8% (95% CI: 5.5% to 11.1%); myocardial infarction, 1.1% (95% CI: 0.2% to 2.0%); acute kidney injury stage II/III, 7.5% (95% CI: 5.1% to 11.4%); life-threatening bleeding, 15.6% (95% CI: 11.7% to 20.7%); major vascular complications, 11.9% (95% CI: 8.6% to 16.4%); major stroke, 3.2% (95% CI: 2.1% to 4.8%); and new permanent pacemaker implantation, 13.9% (95% CI: 10.6% to 18.9%). Medtronic CoreValve prosthesis use was associated with a significant higher rate of new permanent pacemaker implantation compared with the Edwards prosthesis (28.9% [95% CI: 23.0% to 36.0%] vs. 4.9% [95% CI: 3.9% to 6.2%], p < 0.0001). The 30-day safety composite endpoint rate was 32.7% (95% CI: 27.5% to 38.8%) and the 1-year total mortality rate was 22.1% (95% CI: 17.9% to 26.9%). CONCLUSIONS VARC definitions have already been used by the TAVR clinical research community, establishing a new standard for reporting clinical outcomes. Future revisions of the VARC definitions are needed based on evolving TAVR clinical experiences.
Collapse
Affiliation(s)
- Philippe Généreux
- Columbia University Medical Center/New York-Presbyterian Hospital, The Cardiovascular Research Foundation, New York, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
|