Kleczynski Pawel, Dziewierz Artur, Bagienski Maciej, Rzeszutko Lukasz, Sorysz Danuta, Trebacz Jaroslaw, Sobczynski Robert, Tomala Marek, Stapor Maciej, Dudek Dariusz
Institute of Cardiology, Jagiellonian University, Krakow, Poland.
Institute of Cardiology, Jagiellonian University, Krakow, Poland.
Am Heart J. 2017 Mar;185:52-58. doi: 10.1016/j.ahj.2016.12.005. Epub 2016 Dec 21.
We sought to investigate the relation between frailty indices and 12-month mortality after transcatheter aortic valve implantation (TAVI).
We included 101 consecutive patients with severe aortic stenosis who have undergone TAVI. Frailty indices according to Valve Academic Research Consortium-2 recommendations (5-m walk test [5MWT] and hand grip strength) as well as other available scales of frailty (Katz index, Elderly Mobility Scale [EMS], Canadian Study of Health and Aging [CSHA] scale, Identification of Seniors at Risk [ISAR] scale) were assessed at baseline. The primary endpoint was 12-month all-cause mortality.
Twelve-month all-cause mortality was 17.8%. According to 5MWT, 17.8% were frail; hand grip test: 6.9%; Katz index: 17.8%; EMS: 7.9%; CSHA scale: 16.9%; and ISAR scale: 52.5%. Associations between frailty indices and 12-month all-cause mortality after TAVI were significant in Cox regression analysis (frail vs not frail, presented as hazard ratio[95%CI] adjusted for logistic EuroSCORE): for 5MWT, 72.38 (15.95-328.44); for EMS, 23.39 (6.89-79.34); for CSHA scale, 53.97 (14.67-198.53); for Katz index, 21.69 (6.89-68.25); for hand grip strength, 51.54 (12.98-204.74); and for ISAR scale, 15.94 (2.10-120.74). Similarly, such relationship was confirmed when 5MWT, EMS, and CSHA were used as continuous variables (hazard ratio [95%CI] adjusted for logistic EuroSCORE: for 5MWT per 1-second increase, 2.55 [1.94-3.37]; for EMS per 1-point decrease, 2.90 (1.99-4.21); and for CSHA per 1-point increase, 3.13 [2.17-4.53]).
Our study confirmed a strong predictive ability of most of the proposed frailty indices for 12-month mortality after TAVI. For patients scheduled for TAVI, the use of frailty indices, which are easy and quick to assess on clinical basis but with strong performance, for example, 5MWT, EMS, or hand grip test, may be advocated.
我们旨在研究经导管主动脉瓣植入术（TAVI）后衰弱指数与12个月死亡率之间的关系。
我们纳入了101例连续接受TAVI的严重主动脉瓣狭窄患者。根据瓣膜学术研究联盟-2的建议（5米步行试验[5MWT]和握力）以及其他可用的衰弱量表（Katz指数、老年人活动量表[EMS]、加拿大健康与老龄化研究[CSHA]量表、高危老年人识别[ISAR]量表）在基线时进行评估。主要终点是12个月全因死亡率。
12个月全因死亡率为17.8%。根据5MWT，17.8%的患者衰弱；握力测试：6.9%；Katz指数：17.8%；EMS：7.9%；CSHA量表：16.9%；ISAR量表：52.5%。在Cox回归分析中，TAVI后衰弱指数与12个月全因死亡率之间的关联具有显著性（衰弱与非衰弱，以校正逻辑EuroSCORE后的风险比[95%CI]表示）：对于5MWT，72.38（15.95 - 328.44）；对于EMS，23.39（6.89 - 79.34）；对于CSHA量表，53.97（14.67 - 198.53）；对于Katz指数，21.69（6.89 - 68.25）；对于握力，51.54（12.98 - 204.74）；对于ISAR量表，15.94（2.10 - 120.74）。同样，当将5MWT、EMS和CSHA用作连续变量时，这种关系得到证实（校正逻辑EuroSCORE后的风险比[95%CI]：5MWT每增加1秒，2.55[1.94 - 3.37]；EMS每降低1分，2.90（1.99 - 4.21）；CSHA每增加1分，3.13[2.17 - 4.53]）。
我们的研究证实了大多数提议的衰弱指数对TAVI后12个月死亡率具有很强的预测能力。对于计划接受TAVI的患者，可能提倡使用在临床上易于快速评估但性能强大的衰弱指数，例如5MWT、EMS或握力测试。
