Changes in Exercise Capacity Following TAVR

Jun 16, 2017
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Authors:
Altisent OA, Puri R, Regueiro A, et al.
Citation:
Predictors and Association With Clinical Outcomes of the Changes in Exercise Capacity Following Transcatheter Aortic Valve Replacement. Circulation 2017;Jun 6:[Epub ahead of print].
Summary By:
Elizabeth A. Jackson, MD, FACC

Study Questions:

Does exercise capacity improve after transcatheter aortic valve replacement (TAVR)?

Methods:

Patients who were undergoing TAVR were included in the present study. Mean age was 79.9 years and 44% were male. Mean Society of Thoracic Surgeons (STS) score was 6.7% ± 4.2%. Exercise capacity was assessed at baseline and 6 months post-TAVR with 6-minute walk testing (6MWT). Clinical outcomes included all-cause death, cardiovascular death, rehospitalization for cardiovascular reasons, and a combined cardiovascular endpoint of cardiovascular death or re-hospitalization for cardiovascular reasons.

Results:

A total of 305 patients were included in this study. The mean overall distances walked pre- and 6 months post-TAVR were 204 ± 119 and 263 ± 116 m, respectively (change in 6MWT = 60 ± 106 m), with 219 (72%) patients demonstrating an increase in their walking distance. Older age, female sex, and chronic obstructive pulmonary disease were associated with reduced improvement in exercise capacity. Bleeding (periprocedural or life-threatening) and new-onset anemia at 6 months post-TAVR were also associated with lack of improvement. Failure to improve the 6MWT distance by at least 20% was independently associated with all-cause death (p = 0.002), cardiovascular death, or re-hospitalization for cardiovascular causes (p = 0.001). Patients who were slow walkers and who were able to improve the 6MWT distance presented with significantly better outcomes than non-improvers (p = 0.01 for all-cause death; p = 0.001 for cardiovascular endpoint).

Conclusions:

The authors concluded that the lack of functional improvement post-TAVR was predicted by a mix of baseline and periprocedural factors translating into poorer clinical outcomes. These results suggest that systematically implementing exercise capacity assessment pre- and post-TAVR may help to improve patient risk-stratification.

Perspective:

These data suggest that functional testing can give providers and patients added information on risk for worse outcomes, and may be used to improve shared decision making.

Keywords: Anemia, Cardiac Surgical Procedures, Geriatrics, Heart Function Tests, Heart Valve Diseases, Hemorrhage, Outcome Assessment, Health Care, Primary Prevention, Pulmonary Disease, Chronic Obstructive, Transcatheter Aortic Valve Replacement, Walking


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