Chronic Obstructive Pulmonary Disease in Patients Undergoing Transcatheter Aortic Valve Implantation Insights on Clinical Outcomes, Prognostic Markers, and Functional Status Changes

被引：91

作者：

Mok, Michael ^{[1
]}

Nombela-Franco, Luis ^{[1
]}

Dumont, Eric ^{[1
]}

Urena, Marina ^{[1
]}

DeLarochelliere, Robert ^{[1
]}

Doyle, Daniel ^{[1
]}

Villeneuve, Jacques ^{[2
]}

Cote, Melanie ^{[1
]}

Ribeiro, Henrique B. ^{[1
]}

Allende, Ricardo ^{[1
]}

Laflamme, Jerome ^{[1
]}

DeLarochelliere, Hugo ^{[1
]}

Laflamme, Louis ^{[1
]}

Amat-Santos, Ignacio ^{[1
]}

Pibarot, Philippe ^{[1
]}

Maltais, Francois ^{[3
]}

Rodes-Cabau, Josep ^{[1
]}

机构：

[1] Univ Laval, Quebec Heart & Lung Inst, Dept Cardiol, Quebec City, PQ G1V 4G5, Canada

[2] Univ Laval, Quebec Heart & Lung Inst, Dept Anesthesiol, Quebec City, PQ G1V 4G5, Canada

[3] Univ Laval, Quebec Heart & Lung Inst, Dept Resp Dis, Quebec City, PQ G1V 4G5, Canada

来源：

JACC-CARDIOVASCULAR INTERVENTIONS | 2013年 / 6卷 / 10期

关键词：

6-min walk test; aortic stenosis; COPD; pulmonary function; transcatheter aortic valve implantation; HIGH-RISK PATIENTS; 6-MINUTE WALK TEST; LONG-TERM OUTCOMES; BODE INDEX; SURGERY; MORTALITY; STENOSIS; REGISTRY; COMPLICATIONS; REPLACEMENT;

D O I：

10.1016/j.jcin.2013.06.008

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives This study sought to determine the effects of chronic obstructive pulmonary disease (COPD) on clinical outcomes in patients undergoing transcatheter aortic valve implantation (TAVI) and to determine the factors associated with worse outcomes in COPD patients. Background No data exist on the factors determining poorer outcomes in COPD patients undergoing TAVI. Methods A total of 319 consecutive patients (29.5% with COPD) who underwent TAVI were studied. Functional status was evaluated by New York Heart Association (NYHA) functional class, Duke Activity Status Index, and the 6-min walk test (6MWT) at baseline and at 6 to 12 months. The TAVI treatment was considered futile if the patient either died or did not improve in NYHA functional class at 6-month follow-up. Results Survival rates at 1 year were 70.6% in COPD patients and 84.5% in patients without COPD (p = 0.008). COPD was an independent predictor of cumulative mortality after TAVI (hazard ratio: 1.84; 95% confidence interval: 1.08 to 3.13; p = 0.026). Improvement in functional status was observed after TAVI (p < 0.001 for NYHA functional class, Duke Activity Status Index, and 6MWT), but COPD patients exhibited less (p = 0.036) improvement in NYHA functional class. Among COPD patients, a shorter 6MWT distance predicted cumulative mortality (p = 0.013), whereas poorer baseline spirometry results (FEV1 [forced expiratory volume in the first second of expiration]) determined a higher rate of periprocedural pulmonary complications (p = 0.040). The TAVI treatment was futile in 40 COPD patients (42.5%) and a baseline 6MWT distance < 170 m best determined the lack of benefit after TAVI (p = 0.002). Conclusions COPD was associated with a higher rate of mortality at mid-term follow-up. Among COPD patients, a higher degree of airway obstruction and a lower exercise capacity determined a higher risk of pulmonary complications and mortality, respectively. TAVI was futile in more than one-third of the COPD patients, and a shorter distance walked at the 6MWT predicted the lack of benefit after TAVI. These results may help to improve the clinical decision-making process in this challenging group of patients. (C) 2013 by the American College of Cardiology Foundation

引用

页码：1072 / 1084

页数：13

共 30 条

[1] Performance-based functional assessment of patients undergoing transcatheter aortic valve implantation [J].