Author + information
- Mohammad Abdelghani,
- Rafael Cavalcante,
- Yosuke Miyazaki,
- Robbert de Winter,
- Rogerio Sarmento-Leite,
- José Mangione,
- Alexandre Abizaid,
- Pedro Lemos,
- Patrick Serruys and
- Fabio de Brito Jr.
Background: Patients with degenerative aortic stenosis (AS) referred for transcatheter aortic valve implantation (TAVI) typically have advanced cardiac and vascular adverse remodeling and multiple comorbidities and, therefore, might not recover a normal functional capacity after valve replacement.
Methods: We sought to investigate the prevalence, the predictors, and the prognostic impact of residual impairment of functional capacity after TAVI.
Results: Out of 790 patients with impaired functional capacity (NYHA II-IV) at baseline, NYHA functional class improved in 592 (86.5%) and remained unchanged/worsened in 92 (13.5%) at follow-up (median [IQR]: 419[208-807] days) after TAVI. Normal functional capacity (NYHA I) was recovered in 65.5% (n=448) of patients, while the rest had variable degrees of residual impairment. On multivariable logistic regression analysis, atrial fibrillation/flutter (odds ratio-OR, 2.08[1.21-3.58], p=0.008), low-flow low-gradient AS (OR, 1.97[1.09-3.57], p=0.026), chronic obstructive pulmonary disease (OR, 1.92 [1.19-3.12], p=0.008), and lower hemoglobin at baseline (OR, 1.11[1.01-1.21] for each g% decrement, p=0.036) were independently associated with residual impairment of functional capacity after TAVI. All-cause and cardiac mortality were significantly higher in those with residual impairment of functional capacity than in those in NYHA I class (hazard ratio: 2.37 [95%CI: 1.51-3.72], p<0.001 and 2.16 [95%CI: 1.08-4.35], p=0.030; respectively). Even mild residual functional impairment (NYHA II) was associated with a higher all-cause (HR: 2.02 [95%CI: 1.10-3.72], p=0.023) and cardiac (HR: 2.08 [95%CI: 1.42-3.07], p<0.001) mortality.
Conclusions: Residual impairment of functional capacity is common after TAVI and, even if mild, is associated with increased mortality. Predictors of residual impairment of functional status are predominantly patient- rather than procedure-related.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Interventional Cardiology: TAVR 4
Abstract Category: 17. Interventional Cardiology: Aortic Valve Disease
Presentation Number: 1283-135
- 2017 American College of Cardiology Foundation