Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan; Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
Department of Shizuoka Physical Therapy, Faculty of Health Science, Tokoha University, Shizuoka, Japan.
J Cardiol. 2020 Jun;75(6):600-605. doi: 10.1016/j.jjcc.2020.01.014. Epub 2020 Feb 22.
To determine whether baseline gait speed predicts mortality after transcatheter aortic valve implantation (TAVI), a meta-analysis of currently available studies was performed.
To identify all studies researching the impact of preprocedural gait speed on mortality after TAVI, PubMed and Web of Science were searched through May 2019. Adjusted (if unavailable, unadjusted) hazard/odds ratios (ORs/HRs) with their confidence interval of mortality for slow (if available, the slowest) versus fast (if available, the fastest) gait speed (with cut-off values defined in each study) and those for unable to walk versus walker (if available, with the fastest gait speed) were extracted from each study, and then separately pooled by means of inverse variance-weighted averages of logarithmic ORs/HRs in the random-effects model.
Twelve eligible studies (7 and 5 based on the distance-limited and time-limited walk test, respectively) were identified and integrated in the present meta-analysis. The pooled analysis of all ORs/HRs demonstrated that slow walkers (primary meta-analysis; OR/HR, 2.38; p < 0.00001) and unable to walk (OR/HR, 1.75; p = 0.01) were significantly associated with increased mortality. The subgroup analysis for the primary meta-analysis indicated no significant subgroup difference between studies utilizing the 4-m/5-m/15-foot walk test and those applying the 6-min walk test (p = 0.45). Combining studies with 1-year follow-up did not alter the primary result (p < 0.0001). Pooling studies with adjusted ORs/HRs did not change the principal result (p = 0.0002). No funnel plot asymmetry for the primary meta-analysis was identified.
Slow baseline gait speed (and unable to walk) is associated with increased mortality after TAVI.
为了确定基线步态速度是否可预测经导管主动脉瓣植入术（TAVI）后的死亡率，对目前可用的研究进行了荟萃分析。
通过 2019 年 5 月之前的 PubMed 和 Web of Science 搜索，确定了所有研究术前步态速度对 TAVI 后死亡率影响的研究。从每项研究中提取调整后的（如果不可用，则为未调整的）死亡率的调整后风险/优势比（OR/HR）及其置信区间（CI），用于慢（如果可用，则为最慢）与快（如果可用，则为最快）步态速度（在每个研究中定义了截止值），以及无法行走与行走者（如果可用，则以最快的步态速度）之间的风险比，并通过随机效应模型中对数 OR/HR 的逆方差加权平均值分别进行汇总。
确定了 12 项符合条件的研究（分别基于距离限制和时间限制步行测试的 7 项和 5 项），并将其纳入本荟萃分析。对所有 OR/HR 的汇总分析表明，慢行者（主要荟萃分析；OR/HR，2.38；p<0.00001）和无法行走者（OR/HR，1.75；p=0.01）与死亡率增加显著相关。对主要荟萃分析的亚组分析表明，使用 4 米/5 米/15 英尺步行测试和应用 6 分钟步行测试的研究之间没有显著的亚组差异（p=0.45）。合并具有 1 年随访的研究并没有改变主要结果（p<0.0001）。合并调整后的 OR/HR 的研究并没有改变主要结果（p=0.0002）。主要荟萃分析没有发现漏斗图不对称。
基线步态速度较慢（和无法行走）与 TAVI 后死亡率增加相关。
