Nick Hiltrop1, Ann Belmans2, Marina Claes1, Miek Hornikx3, Bart Peeters3, Johan Flamaing4,5, Tom Adriaenssens1,6, Herbert De Praetere7, Marie-Christine Herregods1,6, Paul Herijgers6,7, Christophe Dubois1,6. 1. Department of Cardiovascular Medicine, University Hospitals Leuven, Herestraat 49, Leuven, Belgium. 2. Department of Public Health, Biostatistical Centre, Katholieke Universiteit Leuven, Leuven, Belgium. 3. Department of Physical Medicine and Rehabilitation, Katholieke Universiteit Leuven, Leuven, Belgium. 4. Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium. 5. Department of Clinical and Experimental Medicine, Katholieke Universiteit Leuven, Leuven, Belgium. 6. Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium. 7. Department of Cardiovascular Surgery, University Hospitals Leuven, Leuven, Belgium.
Abstract
AIMS: We assessed the impact of transcatheter aortic valve implantation (TAVI) on functional performance and quality of life (QoL) in a high-risk patient population with multiple comorbidities. METHODS AND RESULTS: Between January 2009 and December 2014, 145 high-risk patients (EuroSCORE II 7.3% [4.9; 14.9]) with severe symptomatic aortic valve stenosis (AS) underwent TAVI in a single centre. We prospectively evaluated New York Heart Association (NYHA) functional class, 6-minute walking distance (6MWD), and QoL using the validated Dutch version of the EuroQol-5D (EQ-5D) descriptive assessment and a visual analogue scale (EQ-VAS) at baseline, 30 days, as well as 6, 12, and 24 months after TAVI. All patients were eligible for analysis. New York Heart Association functional class improved significantly at 30-day, 6-, 12-, and 24-month follow-up (P < 0.001 for all). The absolute 6MWD improved significantly at 30 days (+19.3 ± 8.2 m; P= 0.0499) and at 6 months (+23.3 ± 8.1 m; P = 0.0194). A favourable trend was maintained at 12 months (+17.1 ± 8.8 m; P = 0.1879), whereas at 24 months 6MWD was similar to baseline values. No significant change in the descriptive assessment of QoL (EQ5D) was observed, whereas the EQ-VAS showed a significant improvement in QoL up to 24 months (P < 0.0180 for all time-points). CONCLUSION: In high-risk comorbid patients with symptomatic AS, TAVI results in a significant but temporary improvement of functional performance when assessed with objective measures of 6MWD but not of EQ-5D. Moreover, TAVI has a significant and sustained impact on subjective well-being and exercise capacity assessed with the EQ-VAS and NYHA score.
AIMS: We assessed the impact of transcatheter aortic valve implantation (TAVI) on functional performance and quality of life (QoL) in a high-risk patient population with multiple comorbidities. METHODS AND RESULTS: Between January 2009 and December 2014, 145 high-risk patients (EuroSCORE II 7.3% [4.9; 14.9]) with severe symptomatic aortic valve stenosis (AS) underwent TAVI in a single centre. We prospectively evaluated New York Heart Association (NYHA) functional class, 6-minute walking distance (6MWD), and QoL using the validated Dutch version of the EuroQol-5D (EQ-5D) descriptive assessment and a visual analogue scale (EQ-VAS) at baseline, 30 days, as well as 6, 12, and 24 months after TAVI. All patients were eligible for analysis. New York Heart Association functional class improved significantly at 30-day, 6-, 12-, and 24-month follow-up (P < 0.001 for all). The absolute 6MWD improved significantly at 30 days (+19.3 ± 8.2 m; P= 0.0499) and at 6 months (+23.3 ± 8.1 m; P = 0.0194). A favourable trend was maintained at 12 months (+17.1 ± 8.8 m; P = 0.1879), whereas at 24 months 6MWD was similar to baseline values. No significant change in the descriptive assessment of QoL (EQ5D) was observed, whereas the EQ-VAS showed a significant improvement in QoL up to 24 months (P < 0.0180 for all time-points). CONCLUSION: In high-risk comorbid patients with symptomatic AS, TAVI results in a significant but temporary improvement of functional performance when assessed with objective measures of 6MWD but not of EQ-5D. Moreover, TAVI has a significant and sustained impact on subjective well-being and exercise capacity assessed with the EQ-VAS and NYHA score.
Authors: Aleksandra Stańska; Dariusz Jagielak; Maciej Kowalik; Maciej Brzeziński; Rafał Pawlaczyk; Jadwiga Fijałkowska; Wojciech Karolak; Jan Rogowski; Peter Bramlage Journal: J Geriatr Cardiol Date: 2018-11 Impact factor: 3.327