Key result
Baseline 6-minute walk test performance was predictive of 2-year all-cause mortality in intermediate risk patients undergoing TAVR (HR 0.87 per 50 m; 95% CI 0.83 to 0.92; p < .0001).
Why the study?
While slow gait speed is linked to poor outcomes in high-risk TAVR patients, its prognostic significance in intermediate-risk patients is poorly understood.
Does baseline 6-minute walk test performance predict 2-year mortality and functional improvement in intermediate risk patients undergoing TAVR?
Cohort (n=2,037)
Does baseline 6-minute walk test performance predict 2-year mortality and functional improvement in intermediate risk patients undergoing TAVR?
Hazard Ratio: 0.87 (95% CI 0.83–0.92)
p-value: p=< .0001
Poor baseline functional capacity as measured by 6MWT is predictive of 2-year mortality in elderly intermediate-risk patients undergoing TAVR, although survivors show significant functional improvement.
May refine mortality risk stratification in intermediate-risk TAVR; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND: While slow gait speed is known to be associated with poor outcomes in patients at high surgical risk who undergo transcatheter aortic valve replacement (TAVR), the prognostic significance of slow gait speed in intermediate risk TAVR patients is poorly understood. OBJECTIVES: We assessed the association between baseline 6-min walk test (6MWT) performance and both 2-year mortality and health status in intermediate risk patients undergoing TAVR as a part of the PARTNER II/S3i studies. METHODS: The association of baseline 6MWT with mortality over 2-years after TAVR was examined using Cox regression; both unadjusted and adjusted for age, left ventricular ejection fraction, coronary artery disease, pulmonary disease, renal insufficiency, and STS score. Patients were divided into four groups according to baseline 6MWT: unable to walk and in three equal tertiles of slow, medium, and fast walkers. Among surviving patients, improvement in 6MWT and quality of life were compared. RESULTS: Among 2,037 intermediate risk TAVR patients (mean age 81.7 years, STS score 5.6%), 8.2% were unable to walk. Baseline 6MWT was associated with all-cause mortality over 2 years (Hazard ratio (HR) 0.87 per 50 m, 95% confidence interval [CI] 0.83 to 0.92, p < .0001). Among surviving patients, the adjusted absolute change in 6MWT at 2 years improved for patients unable to walk (+134.1 m, 95% CI 102.1 to 166 m, p < .0001) and slow walkers (+60.5 m, 95% CI 42.8 to 78.2 m, p < .0001), but was unchanged for medium walkers (-7.3 m, 95% CI -24.3 to 9.6 m, p = .4), and declined for fast walkers (-41.3 m, 95% CI -58.7 to -23.9 m, p < .0001). CONCLUSION: Poor functional capacity is predictive of 2-year mortality in elderly intermediate risk patients undergoing TAVR. However, surviving patients with poor baseline functional capacity had significant improvement in 6MWT performance and quality of life at 2-years following TAVR.
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Sathananthan et al. (2020) conducted a cohort in Intermediate risk patients undergoing TAVR (n=2,037). Baseline 6-min walk test (6MWT) performance was evaluated on all-cause mortality over 2 years (HR 0.87, 95% CI 0.83 to 0.92, p=< .0001). Baseline 6-minute walk test performance was predictive of 2-year all-cause mortality in intermediate risk patients undergoing TAVR (HR 0.87 per 50 m; 95% CI 0.83 to 0.92; p < .0001).
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