Imamura Teruhiko, Narang Nikhil, Ushijima Ryuichi, Sobajima Mitsuo, Fukuda Nobuyuki, Ueno Hiroshi, Kinugawa Koichiro
The Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan.
Advocate Christ Medical Center, Oak Lawn, IL 60453, USA.
J Clin Med. 2023 Mar 26;12(7):2504. doi: 10.3390/jcm12072504.
The six-minute walk test is a practical tool for assessing functional capacity in patients with a variety of etiologies including pulmonary disease and heart failure. Six-minute walk distance (6MWD) is associated with mortality and morbidity in patients with a variety of comorbidities. We aimed to assess the prognostic impact of baseline 6MWD in patients with severe aortic stenosis undergoing trans-catheter aortic valve replacement (TAVR).
Patients with severe aortic stenosis who underwent a six-minute walk test after index admission and underwent TAVR between 2015 and 2022 were included in this retrospective study. Patients were followed up for two years or until November 2022 following TAVR. The impact of baseline 6MWD on the primary composite outcome, defined as all-cause death and all-cause readmission during the 2-year observation period following index discharge, was assessed.
A total of 299 patients (median age 86 years old, 85 men) were included. They received a 6-min walk test prior to TAVR, underwent successful TAVR procedures, and were discharged alive. The median baseline 6MWD was 204 (143, 282) meters. Shorter baseline 6MWD was associated with higher cumulative incidence of the primary outcome with an adjusted hazard ratio of 0.76 (95% confidence interval 0.58-1.01, = 0.055) with a cutoff 6MWD of 178 m during the 2-year observation period after index discharge.
Overall, functional capacity was impaired in the elderly patients with severe aortic stenosis prior to TAVR. Patients with severe aortic stenosis having shorter baseline 6MWD tended to have higher rates of morbidity and mortality after successful TAVR. The clinical implication of aggressive cardiac rehabilitation to improve patients' functional capacity and 6MWD-guided optimal patient selection remain the future concerns.
六分钟步行试验是评估包括肺部疾病和心力衰竭在内的各种病因患者功能能力的实用工具。六分钟步行距离（6MWD）与各种合并症患者的死亡率和发病率相关。我们旨在评估基线6MWD对接受经导管主动脉瓣置换术（TAVR）的严重主动脉瓣狭窄患者的预后影响。
本回顾性研究纳入了2015年至2022年间因严重主动脉瓣狭窄入院后进行六分钟步行试验并接受TAVR的患者。患者在TAVR后随访两年或至2022年11月。评估基线6MWD对主要复合结局的影响，主要复合结局定义为出院后2年观察期内的全因死亡和全因再入院。
共纳入299例患者（中位年龄86岁，男性85例）。他们在TAVR前接受了六分钟步行试验，TAVR手术成功，且出院时存活。基线6MWD的中位数为204（143，282）米。基线6MWD较短与主要结局的累积发生率较高相关，出院后2年观察期内，6MWD临界值为178米时，调整后的风险比为0.76（95%置信区间0.58 - 1.01，P = 0.055）。
总体而言，严重主动脉瓣狭窄的老年患者在TAVR前功能能力受损。基线6MWD较短的严重主动脉瓣狭窄患者在成功TAVR后发病率和死亡率往往较高。积极的心脏康复以改善患者功能能力和6MWD指导下的最佳患者选择的临床意义仍是未来关注的问题。
