步态速度可预测行经导管主动脉瓣置换术患者的晚期临床结局：来自日本多中心注册研究的结果。
Gait Speed Can Predict Advanced Clinical Outcomes in Patients Who Undergo Transcatheter Aortic Valve Replacement: Insights From a Japanese Multicenter Registry.
机构信息
From the Department of Cardiology, Nagoya Heart Canter, Japan (S.K., M.Y., Y.K., T.K., K.S.); Department of Cardiology, Toyohashi Heart Canter, Japan (M.Y., T.S., A. Kagase, M. Tsuzuki, A. Kodama); Department of Cardiology, Sendai Kosei Hospital, Japan (N.T.); Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.); Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan (M.A.); Department of Cardiology, Syonan Kamakura General Hospital, Japan (F.Y.); Department of Cardiology, Kokura Memorial Hospital, Japan (S.S.); Department of Cardiology, Osaka City General Hospital, Japan (K.M.); Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan (M. Tabata); Department of Cardiology, Toyama University Hospital, Japan (H.U.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (K.T.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (A.H.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan (Y.W.); and Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (K.H.).
出版信息
Circ Cardiovasc Interv. 2017 Sep;10(9). doi: 10.1161/CIRCINTERVENTIONS.117.005088.
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; <0.001) and survival classification and regression tree group in model 2 (7.7% versus 21.9%; <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; =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; =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.
背景
步态速度反映了虚弱的一个重要因素，与心脏病患者的晚期死亡率增加有关。本研究旨在评估步态速度在接受经导管主动脉瓣置换术的老年患者中的预后价值。
方法和结果
我们使用来自日本多中心 OCEAN-TAVI 登记研究（优化导管瓣膜介入-经导管主动脉瓣植入术）的数据，调查了 1256 例接受经导管主动脉瓣植入术患者的 5 米或 15 英尺步态速度（m/sec）。根据不同的步态速度分类，比较了模型 1（正常>0.83 m/sec；n=563；44.8%）、慢（0.5-0.83 m/sec；n=429；34.2%）、最慢（<0.83 m/sec；n=205；16.3%）、无法行走（n=48；3.8%）和模型 2（分类和回归树生存模型，指示步态速度阈值为 0.385 m/sec（>0.385 m/sec；n=1080 与≤0.385 m/sec；n=117）的基线特征、手术结果和全因死亡率。在模型 1 中，经典步态速度组的 1 年累积死亡率有显著差异（分别为 7.6%、6.6%、18.2%和 40.7%；<0.001），在模型 2 中，生存分类和回归树组的差异也有显著差异（7.7%与 21.9%；<0.001）。最慢的步行者和不能行走的人在调整了几个混杂因素后，与中期死亡率增加独立相关（危险比，1.83，4.28；95%置信区间，1.03-3.26，2.22-8.72；=0.039，<0.001）。通过分类和回归树确定的步态速度<0.385 m/sec 也与预后不良独立相关（危险比，2.40；95%置信区间，1.75-5.88；=0.001）。
结论
使用传统和特定分类的步态速度可作为预测经导管主动脉瓣置换术后易发生不良临床结局的脆弱患者的潜在标志物。
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