TY - JOUR
T1 - Relation between six-minute walk test performance and outcomes after transcatheter aortic valve implantation (from the PARTNER Trial)
AU - Green, Philip
AU - Cohen, David J.
AU - Généreux, Philippe
AU - McAndrew, Tom
AU - Arnold, Suzanne V.
AU - Alu, Maria
AU - Beohar, Nirat
AU - Rihal, Charanjit S.
AU - Mack, Michael J.
AU - Kapadia, Samir
AU - Dvir, Danny
AU - Maurer, Mathew S.
AU - Williams, Mathew R.
AU - Kodali, Susheel
AU - Leon, Martin B.
AU - Kirtane, Ajay J.
N1 - Funding Information:
The PARTNER trial was funded by Edwards Lifesciences and designed collaboratively by the Steering Committee and the sponsor. The present analysis was carried out by academic investigators with no additional funding.
Funding Information:
Dr. Cohen has received research grant support from Medtronic and Edwards Lifesciences and consulting income from Medtronic. Dr. Mack is a nonpaid member of the Scientific Advisory Board of Edwards Lifesciences and has received travel reimbursement from Edwards for activities related to his participation on the Executive Committee of the PARTNER Trial. Dr. Williams is a consultant to Edwards Lifesciences. Dr. Kodali is a consultant to Medtronic and Edwards Lifesciences and a member of the advisory boards of Thubrikar Aortic Valve, Inc., Paieon Medical, and St. Jude Medical. Dr. Leon is a nonpaid member of the Scientific Advisory Board of Edwards Lifesciences and has received travel reimbursement from Edwards for activities related to his participation on the Executive Committee of the PARTNER Trial. The other authors have nothing to disclose.
PY - 2013/9/1
Y1 - 2013/9/1
N2 - Functional capacity as assessed by 6-minute walk test distance (6MWTD) has been shown to predict outcomes in selected cohorts with cardiovascular disease. To evaluate the association between 6MWTD and outcomes after transcatheter aortic valve implantation (TAVI) among participants in the Placement of AoRTic TraNscathetER valve (PARTNER) trial, TAVI recipients (n = 484) were stratified into 3 groups according to baseline 6MWTD: unable to walk (n = 218), slow walkers (n = 133), in whom 6MWTD was below the median (128.5 meters), and fast walkers (n = 133) with 6MWTD >128.5 meters. After TAVI, among fast walkers, follow-up 6MWTD decreased by 44 ± 148 meters at 12 months (p <0.02 compared with baseline). In contrast, among slow walkers, 6MWTD improved after TAVI by 58 ± 126 meters (p <0.001 compared with baseline). Similarly, among those unable to walk, 6MWTD distance increased by 66 ± 109 meters (p <0.001 compared with baseline). There were no differences in 30-day outcomes among 6MWTD groups. At 2 years, the rate of death from any cause was 42.5% in those unable to walk, 31.2% in slow walkers, and 28.8% in fast walkers (p = 0.02), driven primarily by differences in noncardiac death. In conclusion, among high-risk older adults undergoing TAVI, baseline 6MWTD does not predict procedural outcomes but does predict long-term mortality. Nonetheless, patients with poor baseline functional status exhibit the greatest improvement in 6MWTD. Additional work is required to identify those with poor functional status who stand to benefit the most from TAVI.
AB - Functional capacity as assessed by 6-minute walk test distance (6MWTD) has been shown to predict outcomes in selected cohorts with cardiovascular disease. To evaluate the association between 6MWTD and outcomes after transcatheter aortic valve implantation (TAVI) among participants in the Placement of AoRTic TraNscathetER valve (PARTNER) trial, TAVI recipients (n = 484) were stratified into 3 groups according to baseline 6MWTD: unable to walk (n = 218), slow walkers (n = 133), in whom 6MWTD was below the median (128.5 meters), and fast walkers (n = 133) with 6MWTD >128.5 meters. After TAVI, among fast walkers, follow-up 6MWTD decreased by 44 ± 148 meters at 12 months (p <0.02 compared with baseline). In contrast, among slow walkers, 6MWTD improved after TAVI by 58 ± 126 meters (p <0.001 compared with baseline). Similarly, among those unable to walk, 6MWTD distance increased by 66 ± 109 meters (p <0.001 compared with baseline). There were no differences in 30-day outcomes among 6MWTD groups. At 2 years, the rate of death from any cause was 42.5% in those unable to walk, 31.2% in slow walkers, and 28.8% in fast walkers (p = 0.02), driven primarily by differences in noncardiac death. In conclusion, among high-risk older adults undergoing TAVI, baseline 6MWTD does not predict procedural outcomes but does predict long-term mortality. Nonetheless, patients with poor baseline functional status exhibit the greatest improvement in 6MWTD. Additional work is required to identify those with poor functional status who stand to benefit the most from TAVI.
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UR - http://www.scopus.com/inward/citedby.url?scp=84881611062&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2013.04.046
DO - 10.1016/j.amjcard.2013.04.046
M3 - Article
C2 - 23725996
AN - SCOPUS:84881611062
SN - 0002-9149
VL - 112
SP - 700
EP - 706
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 5
ER -