Department of Medicine Columbia University Medical Center, 173 Fort Washington Ave, New York, NY 10032, USA.
Clin Cardiol. 2012 May;35(5):307-14. doi: 10.1002/clc.21974. Epub 2012 Feb 13.
In the transcatheter aortic valve replacement era, characterization of functional status in older adults with aortic stenosis (AS) is essential. Gait speed (GS) is emerging as a marker of frailty and predictor of outcomes in older adults undergoing cardiovascular intervention. The objective of this study was to delineate the prevalence of slow GS, evaluate the association of GS with factors used in standard cardiovascular assessments, and evaluate the association of GS with dependence in activities of daily living (ADLs) in older adults with AS.
We hypothesized that gait speed would not be associated with clinical factors, but would be associated with ADLs.
We evaluated GS, ADLs dependence, and Society of Thoracic Surgery score along with clinical and functional assessments in 102 older adults with AS being evaluated for transcatheter valve. Gait speed <0.5 m/s was considered slow, and GS ≥0.5 m/s was considered preserved. We assessed the association of covariates with GS as well as with ADLs dependence.
Median GS was 0.37 m/s (interquartile range, 0.0-0.65 m/s). Sixty-four (63%) subjects had slow GS. Of commonly employed clinical covariates, only prior coronary intervention and serum albumin were weakly associated with GS. However, GS was independently associated with ADLs dependence (Odds ratio: 1.52 [1.21-1.91] for every 0.1 m/s decrease in GS; P = 0.0003).
Although the prevalence of slow GS in a population of elderly patients with severe AS being screened for transcatheter valve was high, there were only weak associations between GS and other risk stratifying tools. The strong association between GS and dependent functional status suggests that assessment of gait speed is a useful, objectively measurable, risk stratification tool in this population.
在经导管主动脉瓣置换时代，对主动脉瓣狭窄（AS）老年患者的功能状态进行特征描述至关重要。步速（GS）作为衰弱的标志物和心血管介入治疗老年患者结局的预测因子，正逐渐受到关注。本研究旨在描述老年 AS 患者中步速缓慢的流行情况，评估 GS 与标准心血管评估中使用的因素之间的相关性，并评估 GS 与 AS 患者日常生活活动（ADL）依赖之间的相关性。
我们假设步速与临床因素不相关，但与 ADL 相关。
我们评估了 102 名接受经导管瓣膜评估的老年 AS 患者的 GS、ADL 依赖程度和胸外科医师学会评分，以及临床和功能评估。步速＜0.5 m/s 被认为是缓慢的，而 GS≥0.5 m/s 被认为是正常的。我们评估了协变量与 GS 以及与 ADL 依赖的相关性。
中位 GS 为 0.37 m/s（四分位距，0.0-0.65 m/s）。64 名（63%）患者步速缓慢。在常用的临床协变量中，只有既往冠状动脉介入治疗和血清白蛋白与 GS 呈弱相关。然而，GS 与 ADL 依赖独立相关（GS 每降低 0.1 m/s，ADL 依赖的优势比为 1.52[1.21-1.91]；P=0.0003）。
尽管在接受经导管瓣膜评估的老年重度 AS 患者人群中，步速缓慢的发生率较高，但 GS 与其他风险分层工具之间的相关性较弱。GS 与依赖的功能状态之间的强相关性表明，评估步速是该人群中一种有用的、客观可测量的风险分层工具。
