Valvular heart disease
Relation Between Six-Minute Walk Test Performance and Outcomes After Transcatheter Aortic Valve Implantation (from the PARTNER Trial)

https://doi.org/10.1016/j.amjcard.2013.04.046Get rights and content

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.

Section snippets

Methods

The design and initial results of the PARTNER trial have been published previously.10, 11 The PARTNER trial enrolled patients with severe symptomatic AS. Patients were divided into 2 cohorts: those who were considered to be candidates for surgery despite being at high surgical risk (cohort A) and those who were not considered to be suitable candidates for surgery because of severe coexisting conditions (cohort B). Patients in cohort B with a suitable iliofemoral vessel were randomized to

Results

Among the 699 participants enrolled in the PARTNER trial cohort A and the 358 participants enrolled in the PARTNER trial cohort B, 322 participants from cohort A and 162 from cohort B received TAVI and attempted the 6-minute walk test at baseline and therefore were included in this analysis (n = 484). Among the 484 participants, 218 (124 from cohort A and 94 from cohort B) were unable to perform the 6-minute walk test at baseline and were categorized as “unable” to walk. Among the patients who

Discussion

The current report, drawn from a cohort of 484 patients with severe symptomatic AS who underwent TAVI, evaluated the association between physical performance as estimated by the 6MWTD and long-term prognosis after TAVI. We found that compared with those with 6MWTD above the median value, those who were unable to walk experienced a higher rate of death after TAVI. In contrast, patients who were unable to walk and those were slow walkers at baseline experienced an improvement in functional status

Disclosures

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

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      2020, Journal of Cardiology
      Citation Excerpt :

      Slow and fast walkers are sometimes defined by use of distance in 6MWT (6MWD). For instance, among the studies included in the present meta-analysis, Abdul-Jawad Altisent et al. [4] and Green et al. [5] categorized patients with <median (<190 m [4] and <128.5 m [5]) 6MWD into slow walkers and those with >median 6MWD into fast walkers. In the present meta-analysis, 5 studies utilizing 6MWT [4,5,13–15] were included together with 7 studies applying 4mWT/5mWT/15fWT [6–12], which may bring about non-negligible heterogeneity in gait-speed evaluation.

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    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.

    This trial is registered at clinicaltrials.gov (#NCT00530894).

    See page 705 for disclosure information.

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