Valvular heart diseaseExercise Capacity in Patients With Severe Symptomatic Aortic Stenosis Before and Six Months After Transcatheter Aortic Valve Implantation
Section snippets
Methods
Of the 119 patients diagnosed with severe symptomatic AS who had undergone TAVI at our center, 64 patients, who had performed a 6MWT before and 6 months after the procedure, were included in the present study. Of the remaining 55 patients, 20 were unable to perform the 6MWT at baseline because of New York Heart Association (NYHA) class IV in 7, severely limited mobility in 3, oxygen dependency in 3, and logistical reasons in 7. Another 28 patients did not perform the 6MWT at follow-up because
Results
The clinical, echocardiographic, and procedural characteristics of the study population are listed in Table 1. All patients performed the 6MWT with no complications. The results of the 6MWT are summarized in Table 2. The mean distance walked improved from 165.3 ± 79.7 m at baseline to 231.7 ± 88.9 m at 6 months after TAVI, for a mean increase of 66.4 ± 81.7 m (Δ83%, 95% confidence interval 39 to 127) versus baseline (p <0.0001). However, this mean distance walked remained much shorter than the
Discussion
The present study showed the usefulness of the 6MWT in a high-risk population of octogenarian patients with severe symptomatic AS. The exercise capacity of these patients was very poor (mean distance walked <200 m), and TAVI was associated with a significant increase in the mean distance walked at 6 months after TAVI. However, up to 25% of the patients did not improve or even decreased their exercise capacity at 6 months after TAVI. A greater degree of renal dysfunction, lower postprocedural
Acknowledgment
We thank Jacinthe Aubé, RN, for her outstanding work on the 6MWTs and patient follow-up and Ms. Nathalie Boudreault for patient follow-up. Rodrigo Bagur, MD, received a 1-year scholarship from the “Centre de Recherche de l'Institute Universitaire de Cardiologie et Pneumologie de Québec.”
References (30)
- et al.
Effect of aging on respiratory skeletal muscles
Clin Chest Med
(1993) - et al.
Feasibility and initial results of percutaneous aortic valve implantation including selection of the transfemoral or transapical approach in patients with severe aortic stenosis
Am J Cardiol
(2008) - et al.
The 6-min walk test: a quick measure of functional status in elderly adults
Chest
(2003) - et al.
Physiologic, psychological, and health predictors of 6-minute walk performance in older people
Arch Phys Med Rehabil
(2002) - et al.
Anemia and decline in physical performance among older persons
Am J Med
(2003) - et al.
Frailty as a predictor of surgical outcomes in older patients
J Am Coll Surg
(2010) - et al.
Distance walked in the 6-minute test soon after cardiac surgery: toward an efficient use in the individual patient
Chest
(2004) - et al.
Standardized endpoint definitions for transcatheter aortic valve implantation clinical trials: a consensus report from the Valve Academic Research Consortium
J Am Coll Cardiol
(2011) ATS Statement: guidelines for the six-minute walk test
Am J Respir Crit Care Med
(2002)- et al.
Common chronic diseases and general impairments as determinants of walking disability in the oldest-old population
J Am Geriatr Soc
(2002)
Predictors of outcomes in low-flow, low-gradient aortic stenosis: results of the multicenter TOPAS Study
Circulation
Preoperative 6-minute walk test adds prognostic information to Euroscore in patients undergoing aortic valve replacement
Heart
Measurement of feelings using visual analogue scales
Proc R Soc Med
Comparison of clinical dyspnea ratings and psychophysical measurements of respiratory sensation in obstructive airway disease
Am Rev Respir Dis
A comparison of the visual analogue scale and modified Borg scale for the measurement of dyspnoea during exercise
Clin Sci Lond
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Comprehensive Geriatric Assessment and Exercise Capacity in Cardiac Rehabilitation for Patients Referred to Transcatheter Aortic Valve Implantation
2021, American Journal of CardiologyCitation Excerpt :Even so, above results highlight the importance of CGA-based CR for TAVI patients specifically, rather than conventional CR. 6MWT, a simply performable and safe test, has been used to assess the exercise tolerance in elderly patients after TAVI.25 An increase in 6MWD was demonstrated to be associated with improved clinical outcomes in patients after TAVI.26
Improvement in the nutritional status after transcatheter aortic valve implantation
2021, Journal of CardiologyCitation Excerpt :Several studies have shown that baseline malnutrition, evaluated by objective nutritional indexes, such as the prognostic nutritional index (PNI) and geriatric nutritional risk index (GNRI), was an important risk factor for all-cause mortality [7-9]. TAVI can improve the prognosis as well as the exercise capacity and quality of life of patients [10, 11]. Although the nutritional status of the elderly deteriorates with time, an improvement may be seen following TAVI, similar to changes in other parameters.
The Physiological Burden of the 6-Minute Walk Test Compared With Cardiopulmonary Exercise Stress Test in Patients With Severe Aortic Atenosis
2021, CJC OpenCitation Excerpt :In patients with symptomatic severe AS eligible for a transcatheter aortic valve implantation procedure, a 6MWT distance > 182 meters has been reported to be associated with higher survival at 1-year follow-up.12 Although the overall 6MWT distance may increase after a transcatheter aortic valve implantation procedure, a significant proportion of patients may not improve their distance at follow-up vs baseline.25,26 Following our findings, and considering that our patients with severe AS sustained a high intensity for a long period during the 6MWT and reached comparable V̇O2peak values in both the 6MWT and CPET, one may speculate that the prognostic value of the 6MWT may be explained by the fact that in this population, the 6MWT may be very demanding and should be considered as a maximal exercise test27,28 as it is the case in patients with heart failure.9
Improved Exercise Tolerance, Oxygen Delivery, and Oxygen Utilization After Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis
2020, CJC OpenCitation Excerpt :In line with these findings, an average 50% gain in walking distance has been reported at 6 months after TAVI using the 6-minute walk test. However, 25%–28% of patients also failed to exhibit functional improvement despite successful procedures, and these low-responders were at higher risk of mortality and adverse cardiovascular events over the ensuing 4 years.29,30 In addition to muscular weakness, preexisting diastolic and systolic ventricular dysfunction likely influence the early physical performance following TAVI.
Rehabilitation of valvular patient
2019, Annales de Cardiologie et d'AngeiologieSix-minute walking test and long term prognosis in patients with asymptomatic aortic valve stenosis
2017, International Journal of CardiologyCitation Excerpt :The 6MWT is currently used to stratify risk and guide treatment in patients with congestive heart failure [16,17]. In symptomatic aortic valve stenosis, recent studies have suggested that the 6MWT might be used as a measure of treatment efficacy, as walking distance is often increased after AVR [18–20]. Accordingly, it appears likely that the 6MWT could contribute to risk assessment of patients without symptoms, yet with aortic valve stenosis.
This study was supported in part by grant P57745 from the Canadian Institutes of Health Research, Ottawa, Ontario, Canada.
Drs. Dumont and Rodés-Cabau are consultants for Edwards Lifesciences, Inc., Irvine, California. Dr. Pibarot has received honoraria for presentations and research grants from Edwards Lifesciences, Inc.