Gait Speed Predicts 30-Day Mortality After Transcatheter Aortic Valve Replacement

Alfredsson, Joakim; Stebbins, Amanda; Brennan, James M.; Matsouaka, Roland; Afilalo, Jonathan; Peterson, Eric D.; Vemulapalli, Sreekanth; Rumsfeld, John S.; Shahian, David M.; Mack, Michael J.; Alexander, Karen P.

doi:10.1161/circulationaha.115.020279

Cited by 115 publications

(48 citation statements)

References 40 publications

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“…The importance of subgrouping based on gait speed, especially in TAVR cohorts, has been demonstrated in previous investigations. 15,16 Moreover, a previous report indicated that the optimal marker of frailty in terms of gait speed was a gait speed of <0.57 m/sec, which is close to gait speed <0.5 m/sec and our results of survival CART. 16 Although our cutoff value for gait speed was similar to those in previous investigations, potential ethnic differences should be considered.…”

Section: Discussionsupporting

confidence: 87%

“…A cutoff point of 0.83 m/sec has been advocated as defining slow walkers for patients undergoing cardiac surgery, 11 whereas a lower cutoff of <0.5 m/sec has been proposed for patients undergoing TAVR, who are typically older and more functionally compromised. 15,16 Therefore, the patients were categorized into 4 gait speed groups as follows: normal walkers (>0.83 m/sec), slow walkers (0.5-0.83 m/sec), the slowest walkers (<0.5 m/sec), and those unable to walk (model 1). The unable-to-walk group included patients who depended on a wheelchair or almost depended for personal care.…”

Section: Gait Speed Assessmentmentioning

confidence: 99%

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Gait Speed Can Predict Advanced Clinical Outcomes in Patients Who Undergo Transcatheter Aortic Valve Replacement

Kano¹,

Yamamoto²,

Shimura³

et al. 2017

Circ: Cardiovascular Interventions

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R ecently, the indication for transcatheter aortic valve replacement (TAVR) has been expanded not only to patients with degenerative aortic stenosis considered inoperable or of high surgical risk but also to those with intermediate surgical risk. [1][2][3] Thus, optimal patient risk stratification should be performed before the TAVR procedure. Frailty, which is not captured in the classical surgical risk model, is considered highly prevalent in elderly vulnerable patients and can be characterized by Background-Gait speed reflects an important factor of frailty and is associated with an increased risk of late mortality in patients with cardiac disease. This study sought to assess the prognostic value of gait speed in elderly patients who underwent transcatheter aortic valve replacement. Methods and Results-We investigated the 5-m or 15-feet gait speed (m/sec) in 1256 patients who underwent transcatheter aortic valve implantation using data from the OCEAN-TAVI Japanese multicenter registry (Optimized Catheter Valvular Intervention-Transcatheter Aortic Valve Implantation). Baseline characteristics, procedural outcomes, and all-cause mortality were compared among groups defined by differential gait speed classification: model 1, normal (>0.83 m/sec; n=563; 44.8%), slow (0.5-0.83 m/sec; n=429; 34.2%), slowest (<0.83 m/sec; n=205; 16.3%), unable to walk (n=48; 3.8%); and model 2, classification and regression tree survival model indicating the threshold of gait speed as 0.385 m/sec (>0.385 m/sec; n=1080 versus ≤0.385 m/sec; n=117). The cumulative 1-year mortality rate showed significant differences in the classical gait speed groups in model 1 (7.6%, 6.6%, 18.2%, and 40.7%, respectively; P<0.001) and survival classification and regression tree group in model 2 (7.7% versus 21.9%; P<0.001). The slowest walkers and those unable to walk demonstrated independent associations with increased midterm mortality after adjustment for several confounding factors (hazard ratio, 1.83, 4.28; 95% confidence interval, 1.03-3.26, 2.22-8.72; P=0.039, <0.001, respectively). Gait speed <0.385 m/sec determined by classification and regression tree also independently associated with worse prognosis (hazard ratio, 2.40; 95% confidence interval, 1.75-5.88; P=0.001). Conclusions-Gait speed using both traditional and specific classification is useful as a potential marker for predicting vulnerable patients associated with adverse clinical outcomes after transcatheter aortic valve replacement. (Circ Cardiovasc Interv. 2017;10:e005088.

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Section: Discussionsupporting

confidence: 87%

Section: Gait Speed Assessmentmentioning

confidence: 99%

Gait Speed Can Predict Advanced Clinical Outcomes in Patients Who Undergo Transcatheter Aortic Valve Replacement

Kano¹,

Yamamoto²,

Shimura³

et al. 2017

Circ: Cardiovascular Interventions

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“…(65) Gait speed predicts short-term mortality and complications after cardiac surgery or TAVR. (6-8) We found a large body of evidence to support use of mobility assessment to predict mortality at ≥6 months after major or minimally invasive procedures and functional status after minimally invasive procedures. Although 6MWT was most frequently evaluated, a simple gait speed or TUG test might be as useful, given its high correlation with 6MWT performance (0.70-0.73).…”

Section: Discussionmentioning

confidence: 99%

Preoperative Frailty Assessment and Outcomes at 6 Months or Later in Older Adults Undergoing Cardiac Surgical Procedures

et al. 2016

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Background Frailty assessment may inform surgical risk and prognosis that are not captured by conventional surgical risk scores. Purpose To evaluate the evidence for various frailty instruments to predict mortality, functional status, or major adverse cardiovascular and cerebrovascular events (MACCE) in older adults undergoing cardiac surgical procedures. Data Sources MEDLINE and EMBASE (without language restrictions), from their inception to May 2, 2016. Study Selection Cohort studies that evaluated the association of frailty with mortality or functional status at ≥6 months in patients aged ≥60 years undergoing major or minimally invasive cardiac surgical procedures. Data Extraction Two reviewers independently extracted study data and assessed study quality. Data Synthesis Mobility, disability, and nutrition were frequently assessed domains of frailty in both types of procedures. In patients undergoing major procedures (N=18388, 8 studies), 9 frailty instruments were evaluated. There was moderate-quality evidence to assess mobility or disability and very-low-to-low-quality evidence to use a multi-component instrument to predict mortality or MACCE. No studies examined functional status. In patients undergoing minimally invasive procedures (N=5177, 17 studies), 13 frailty instruments were evaluated. There was moderate-to-high-quality evidence to assess mobility to predict mortality or functional status. Several multi-component instruments predicted mortality, functional status, or MACCE, but the quality of evidence was low to moderate. Multi-component instruments that measure different frailty domains seemed to outperform single-component instruments. Limitations Heterogeneity of frailty assessment, limited generalizability of multi-component frailty instruments, few validated frailty instruments, and potential publication bias. Conclusions Frailty status, assessed by mobility, disability, and nutritional status, can predict mortality at 6 months or later after major cardiac surgical procedures and functional decline after minimally invasive cardiac surgical procedures. Primary Funding Source National Institute on Aging and National Heart, Lung, and Blood Institute; there was no registration for this review.

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“…4,5,7-10,12,18, 22 In this era of newer technology providing safer procedures, we can recognize that the risk following TAVI is getting lower, and so our questions have shifted to not only the causes of deaths but also the quality of life following TAVI. 23 In this analysis, multifaceted rather than simple one-sided, objective rather than subjective, and multi-grade rather than simple few-grade evaluation seemed superior for reflecting frailty and therefore predicting the outcomes following TAVI, because essentially frailty is complex and multifactorial.…”

Section: Discriminatory Performance Of Each Frailty Assessmentmentioning

confidence: 99%

Impact of Frailty Markers for Unplanned Hospital Readmission Following Transcatheter Aortic Valve Implantation

Higuchi

Tobaru

Iguchi

et al. 2018

Circ J

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Gait Speed Predicts 30-Day Mortality After Transcatheter Aortic Valve Replacement

Cited by 115 publications

References 40 publications

Gait Speed Can Predict Advanced Clinical Outcomes in Patients Who Undergo Transcatheter Aortic Valve Replacement

Gait Speed Can Predict Advanced Clinical Outcomes in Patients Who Undergo Transcatheter Aortic Valve Replacement

Preoperative Frailty Assessment and Outcomes at 6 Months or Later in Older Adults Undergoing Cardiac Surgical Procedures

Impact of Frailty Markers for Unplanned Hospital Readmission Following Transcatheter Aortic Valve Implantation

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