经导管主动脉瓣植入术后行心脏康复治疗患者的生存预测因素。
Predictors of survival in patients undergoing cardiac rehabilitation after transcatheter aortic valve implantation.
机构信息
Department of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Turin.
Department of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Milan.
出版信息
J Cardiovasc Med (Hagerstown). 2019 Sep;20(9):606-615. doi: 10.2459/JCM.0000000000000829.
AIMS
Cardiac rehabilitation may improve physical and functional recovery after transcatheter aortic valve implantation (TAVI), but outcome predictors in TAVI patients are usually based on assessments made before or at the time of TAVI without regard to cardiac rehabilitation referral. We aimed to assess exercise-based cardiac rehabilitation-derived parameters that may predict 3-year outcome in TAVI patients undergoing residential cardiac rehabilitation.
METHODS AND RESULTS
In 95 consecutive TAVI patients (82.7 ± 4.9 years, 65% women) who underwent a 3-week cardiac rehabilitation program, at 3-year follow-up 35 deaths occurred. Compared with survivors, nonsurvivors had longer stay in cardiac rehabilitation (29.5 ± 12.3 vs. 21.6 ± 7.5 days, P = 0.0001), worse serum creatinine at admission/discharge (1.59 ± 0.86 vs. 1.26 ± 0.43 mg/dl, P = 0.0164; 1.52 ± 0.61 vs. 1.23 ± 0.44 mg/dl, P = 0.011), higher Cumulative Illness Rated State Comorbidity Index (5.4 ± 1.5 vs. 4.6 ± 1.8, P = 0.036) and Barthel Index at admission/discharge (51.8 ± 24.5 vs. 68.1 ± 23.2, P = 0.0016; 73.5 ± 27.2 vs. 88.6 ± 15.3, P = 0.0007), higher Morse Fall Risk score (35.6 ± 24 vs. 24.3 ± 14.1, P = 0.0056), and were less likely to train above the median exercise workload (fit) (11 vs. 35%, P = 0.008) or perform the 6-min walk test (6MWT) at admission/discharge (NO-6MWT: 34 vs. 12%, P = 0.008) and walked less distance on admission (6MWT: 129.6 ± 88.3 vs. 193.3 ± 69.8 m, P = 0.008). Univariate predictors of 3-year survival were cardiac rehabilitation duration, serum creatinine, Cumulative Illness Rated State Comorbidity Index, Barthel Index and NO-6MWT at admission/discharge, 6MWT at admission, Morse Fall Risk score at discharge and fit. Multivariate analysis confirmed exercise tolerance, Barthel Index and sCr at discharge as predictors.
CONCLUSION
In TAVI patients who undergo cardiac rehabilitation, lower exercise tolerance, higher Barthel Index and sCr at discharge may predict 3-year mortality.
目的
心脏康复可能会改善经导管主动脉瓣置换术（TAVI）后的身体和功能恢复，但 TAVI 患者的预后预测因素通常基于 TAVI 前或 TAVI 时的评估，而不考虑心脏康复转诊。我们旨在评估基于运动的心脏康复衍生参数，这些参数可能预测接受住院心脏康复的 TAVI 患者的 3 年结局。
方法和结果
在 95 例连续接受 3 周心脏康复计划的 TAVI 患者（82.7±4.9 岁，65%为女性）中，3 年后有 35 例死亡。与幸存者相比，非幸存者在心脏康复中的停留时间更长（29.5±12.3 与 21.6±7.5 天，P=0.0001），入院/出院时血清肌酐更差（1.59±0.86 与 1.26±0.43mg/dl，P=0.0164；1.52±0.61 与 1.23±0.44mg/dl，P=0.011），累积疾病严重程度评分（Comorbidity Index，CIRS）更高（5.4±1.5 与 4.6±1.8，P=0.036），入院/出院时巴氏量表（Barthel Index）更低（51.8±24.5 与 68.1±23.2，P=0.0016；73.5±27.2 与 88.6±15.3，P=0.0007），莫尔斯跌倒风险评分（Morse Fall Risk score）更高（35.6±24 与 24.3±14.1，P=0.0056），并且不太可能进行高于中位数的运动工作量（fit）训练（11%与 35%，P=0.008）或进行入院/出院时的 6 分钟步行测试（6MWT）（无 6MWT：34%与 12%，P=0.008），并且入院时的步行距离更短（6MWT：129.6±88.3 与 193.3±69.8m，P=0.008）。3 年生存率的单因素预测因素为心脏康复持续时间、血清肌酐、CIRS、入院/出院时的巴氏量表和无 6MWT、入院时的 6MWT、出院时的莫尔斯跌倒风险评分和 fit。多因素分析证实运动耐量、出院时的巴氏量表和血清肌酐是预测因素。
结论
在接受心脏康复的 TAVI 患者中，较低的运动耐量、较高的出院时巴氏量表和血清肌酐可能预测 3 年死亡率。
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