Abe Takahiro, Nagai Toshiyuki, Yuasa Atsunori, Tokuda Yusuke, Ishizaka Suguru, Takenaka Sakae, Mizuguchi Yoshifumi, Nakao Motoki, Sato Takuma, Temma Taro, Kamiya Kiwamu, Anzai Toshihisa
Department of Rehabilitation, Hokkaido University Hospital, Sapporo, Japan.
Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan.
Cardiovasc Interv Ther. 2025 Jan;40(1):144-151. doi: 10.1007/s12928-024-01043-z. Epub 2024 Sep 2.
Frailty assessment is essential for deciding the treatment strategy for patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Recently, the revised Japanese version of the Cardiovascular Health Study (J-CHS) criteria has been proposed for the frailty assessment; however, it is unclear whether the criteria are useful for the risk stratification in these patients. We investigated the impact of frailty assessment using the revised J-CHS criteria on clinical outcomes in patients with AS undergoing TAVR. We examined 205 consecutive severe AS patients who underwent TAVR at two tertiary hospitals from May 2018 to December 2022. Frailty was defined by the revised J-CHS criteria (score ≥ 3) before TAVR. The primary outcome was major adverse cardiac or cerebrovascular events (MACCE). Among the studied patients, the mean age was 84 years and 65% were female. Frailty was present in 51% of patients. During a median follow-up period of 1000 (interquartile range 677-1210) days, MACCE occurred in 22 patients. Frailty was significantly independently associated with higher risks of the MACCE adjusted for confounders related to nutritional status, severity of AS, comorbidities [hazard ratio (HR) 5.09, 95% confidence interval (CI) 1.70-15.23; HR 3.94, 95% CI 1.34-11.55; HR 3.12, 95% CI 1.14-8.53; HR 3.31, 95% CI 1.21-9.02, respectively]. Frailty determined by the revised J-CHS criteria was associated with clinical outcomes, suggesting these criteria would be useful for risk stratification in Japanese patients with AS undergoing TAVR.
虚弱评估对于决定接受经导管主动脉瓣置换术（TAVR）的主动脉瓣狭窄（AS）患者的治疗策略至关重要。最近，已提出心血管健康研究（J-CHS）标准的修订版日文版用于虚弱评估；然而，尚不清楚这些标准是否对这些患者的风险分层有用。我们研究了使用修订后的J-CHS标准进行虚弱评估对接受TAVR的AS患者临床结局的影响。我们检查了2018年5月至2022年12月在两家三级医院接受TAVR的205例连续性重度AS患者。在TAVR前，根据修订后的J-CHS标准（评分≥3）定义虚弱。主要结局是主要不良心脏或脑血管事件（MACCE）。在所研究的患者中，平均年龄为84岁，65%为女性。51%的患者存在虚弱。在中位随访期1000（四分位间距677-1210）天期间，22例患者发生了MACCE。在针对与营养状况、AS严重程度、合并症相关的混杂因素进行调整后，虚弱与MACCE的较高风险显著独立相关[风险比（HR）5.09，95%置信区间（CI）1.70-15.23；HR 3.94，95%CI 1.34-11.55；HR 3.12，95%CI 1.14-8.53；HR 3.31，95%CI 1.21-9.02]。由修订后的J-CHS标准确定的虚弱与临床结局相关，表明这些标准对于接受TAVR的日本AS患者的风险分层将是有用的。
