Division of Geriatrics, Department of General Internal Medicine, Inselspital, Bern University Hospital and University of Bern, Switzerland.
Eur Heart J. 2013 Mar;34(9):684-92. doi: 10.1093/eurheartj/ehs304. Epub 2012 Sep 24.
Aims This study aimed to assess functional course in elderly patients undergoing transcatheter aortic valve implantation (TAVI) and to find predictors of functional decline. Methods and results In this prospective cohort, functional course was assessed in patients ≥70 years using basic activities of daily living (BADL) before and 6 months after TAVI. Baseline EuroSCORE, STS score, and a frailty index (based on assessment of cognition, mobility, nutrition, instrumental and basic activities of daily living) were evaluated to predict functional decline (deterioration in BADL) using logistic regression models. Functional decline was observed in 22 (20.8%) of 106 surviving patients. EuroSCORE (OR per 10% increase 1.18, 95% CI: 0.83-1.68, P = 0.35) and STS score (OR per 5% increase 1.64, 95% CI: 0.87-3.09, P = 0.13) weakly predicted functional decline. In contrast, the frailty index strongly predicted functional decline in univariable (OR per 1 point increase 1.57, 95% CI: 1.20-2.05, P = 0.001) and bivariable analyses (OR: 1.56, 95% CI: 1.20-2.04, P = 0.001 controlled for EuroSCORE; OR: 1.53, 95% CI: 1.17-2.02, P = 0.002 controlled for STS score). Overall predictive performance was best for the frailty index [Nagelkerke's R(2) (NR(2)) 0.135] and low for the EuroSCORE (NR(2) 0.015) and STS score (NR(2) 0.034). In univariable analyses, all components of the frailty index contributed to the prediction of functional decline. Conclusion Over a 6-month period, functional status worsened only in a minority of patients surviving TAVI. The frailty index, but not established risk scores, was predictive of functional decline. Refinement of this index might help to identify patients who potentially benefit from additional geriatric interventions after TAVI.
目的 本研究旨在评估行经导管主动脉瓣置换术（TAVI）的老年患者的功能进程，并寻找功能下降的预测因素。
方法和结果 在这项前瞻性队列研究中，使用基本日常生活活动（BADL）评估了≥70 岁的患者在 TAVI 前后 6 个月的功能进程。使用逻辑回归模型，根据认知、移动性、营养、工具性和基本日常生活活动评估，评估基线 EuroSCORE、STS 评分和衰弱指数（基于衰弱指数评估），以预测功能下降（BADL 恶化）。在 106 例存活患者中，有 22 例（20.8%）观察到功能下降。EuroSCORE（每增加 10%的 OR 1.18，95%CI：0.83-1.68，P=0.35）和 STS 评分（每增加 5%的 OR 1.64，95%CI：0.87-3.09，P=0.13）微弱预测功能下降。相反，衰弱指数在单变量（每增加 1 分的 OR 1.57，95%CI：1.20-2.05，P=0.001）和双变量分析（OR：1.56，95%CI：1.20-2.04，P=0.001，校正 EuroSCORE；OR：1.53，95%CI：1.17-2.02，P=0.002，校正 STS 评分）中强烈预测功能下降。衰弱指数的总体预测性能最佳[Nagelkerke 的 R²（NR²）0.135]，而 EuroSCORE（NR²0.015）和 STS 评分（NR²0.034）的预测性能较低。在单变量分析中，衰弱指数的所有组成部分均有助于预测功能下降。
结论 在 6 个月的时间内，仅有少数接受 TAVI 治疗的患者的功能状态恶化。衰弱指数而非既定的风险评分可预测功能下降。该指数的细化可能有助于识别那些在 TAVI 后可能受益于额外老年干预的患者。
