Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan; Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan; Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
J Cardiol. 2024 Mar;83(3):155-162. doi: 10.1016/j.jjcc.2023.07.011. Epub 2023 Jul 28.
When frailty is considered in patient selection, better outcomes are achieved in transcatheter aortic valve replacement (TAVR) procedures. This study investigated whether patient photographs could be utilized to qualitatively assess patient frailty and independently predict poor outcomes following TAVR.
This study included 1345 patients with severe aortic stenosis who underwent TAVR at the Sakakibara Heart Institute, Japan, between 2013 and 2022. Patient photographs were taken prior to the initial outpatient clinic examination or at discharge in case the patient's first visit was unplanned admission. Frailty was assessed from patient photographs using a four-point photographic frailty scale; 1 (non-frail), 2 (vulnerable), 3 (mild frail), and 4 (frail). Photographic frailty scale of 3 and 4 were defined as high. The primary endpoint was all-cause mortality following TAVR.
Seven hundred ninety-six patients who had their facial photographs taken within six months before the TAVR procedure were analyzed. Patients with a higher photographic frailty scale belonged to New York Heart Association classes III/IV, and had higher Society of Thoracic Surgeons scores, higher incidence of wheelchair usage, lower hemoglobin, and smaller aortic valve areas. According to the frailty assessment, patients with a higher photographic frailty scale exhibited slower performance in the 5-m walk test, reduced hand grip strength, more severe dementia, had a higher clinical frailty scale, and lower serum albumin level. Multivariable Cox regression analysis revealed that the high photographic frailty scale was independently associated with all-cause mortality (adjusted hazard ratio 1.62, 95 % confidence interval 1.12-2.33, p = 0.010). Kaplan-Meier analysis indicated that patients with high photographic frailty scale had higher all-cause mortality rates compared to those with low scale (log-rank p = 0.011).
Patient registration photographs can be used to obtain qualitative assessments of frailty in severe aortic stenosis cases, and such assessments can independently predict poor outcomes following TAVR.
在选择患者时考虑虚弱程度，可以在经导管主动脉瓣置换术（TAVR）中获得更好的结果。本研究调查了患者照片是否可用于定性评估患者的虚弱程度，并独立预测 TAVR 后的不良结局。
本研究纳入了 2013 年至 2022 年期间在日本酒井心脏研究所接受 TAVR 的 1345 例严重主动脉瓣狭窄患者。患者在首次门诊就诊前或计划入院时拍摄患者照片。使用四点照片虚弱量表从患者照片中评估虚弱程度；1（非虚弱）、2（脆弱）、3（轻度虚弱）和 4（虚弱）。照片虚弱量表 3 和 4 定义为高。主要终点是 TAVR 后的全因死亡率。
对 796 例在 TAVR 术前 6 个月内拍摄面部照片的患者进行了分析。照片虚弱程度较高的患者属于纽约心脏协会心功能分级 III/IV 级，STS 评分较高，使用轮椅的发生率较高，血红蛋白较低，主动脉瓣面积较小。根据虚弱评估，照片虚弱程度较高的患者在 5 米步行测试中表现较慢，握力下降，痴呆程度更严重，临床虚弱程度更高，血清白蛋白水平更低。多变量 Cox 回归分析显示，高照片虚弱程度与全因死亡率独立相关（调整后的危险比 1.62，95%置信区间 1.12-2.33，p=0.010）。Kaplan-Meier 分析表明，与低评分组相比，高照片虚弱程度组的全因死亡率更高（对数秩检验 p=0.011）。
患者登记照片可用于获取严重主动脉瓣狭窄病例虚弱程度的定性评估，此类评估可独立预测 TAVR 后的不良结局。
