Performance-Based Functional Assessment of Patients Undergoing Transcatheter Aortic Valve Implantation

May 13, 2011
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Authors:
Bagur R, Rodés-Cabau J, Dumont E, et al.
Citation:
Am Heart J 2011;161:726-734.
Summary By:
Hitinder S. Gurm, MBBS, FACC

Study Questions:

What is the impact of transcatheter aortic valve implantation (TAVI) on functional status?

Methods:

The authors assessed the Duke Activity Status Index (DASI) as a measure of functional status pre-TAVI and 6 months post-TAVI in 76 patients (80 ± 8 years old). A 6-minute walk test was also performed in 46 patients at baseline and at 6 months.

Results:

A significant increase in functional status was seen with TAVI with mean DASI increasing from 10.3 ± 5.4 to 16.3 ± 8.3 at 6 months (p < 0.0001). The increase in DASI, however, was not universal, with 30% of patients demonstrating no increase or a decrease in DASI after TAVI. The estimated glomerular filtration rate was an independent predictor of lack of improvement (or worsening) of DASI after TAVI (odds ratio, 1.7; 95% confidence interval, 1.3-2.3; p = 0.005 for each decrease in estimated glomerular filtration rate of 10 ml/min/1.73 m2).The mean distance walked in 6 minutes increased from 165 to 211 m at follow-up. There was a good correlation between baseline and final DASI and the 6-minute walk test results.

Conclusions:

The authors concluded that TAVI is associated with an improvement in functional status in most patients.

Perspective:

This study adds to the emerging data supporting the survival and symptomatic benefit of TAVI in patients with severe aortic stenosis (Leon MB, et al., N Engl J Med 2010;363:1597-607). Baseline renal dysfunction appears to be a predictor of acute kidney injury as well as of failure of functional impairment in this population, and may help identify patients who may be less likely to benefit from this procedure.

Keywords: Walking, Follow-Up Studies, Cardiology, Acute Kidney Injury, Glomerular Filtration Rate, Exercise Test


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