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Circ Cardiovasc Interv. 2017 Sep;10(9). pii: e005088. doi: 10.1161/CIRCINTERVENTIONS.117.005088.

Gait Speed Can Predict Advanced Clinical Outcomes in Patients Who Undergo Transcatheter Aortic Valve Replacement: Insights From a Japanese Multicenter Registry.

Author information

1
From the Department of Cardiology, Nagoya Heart Canter, Japan (S.K., M.Y., Y.K., T.K., K.S.); Department of Cardiology, Toyohashi Heart Canter, Japan (M.Y., T.S., A. Kagase, M. Tsuzuki, A. Kodama); Department of Cardiology, Sendai Kosei Hospital, Japan (N.T.); Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.); Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan (M.A.); Department of Cardiology, Syonan Kamakura General Hospital, Japan (F.Y.); Department of Cardiology, Kokura Memorial Hospital, Japan (S.S.); Department of Cardiology, Osaka City General Hospital, Japan (K.M.); Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan (M. Tabata); Department of Cardiology, Toyama University Hospital, Japan (H.U.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (K.T.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (A.H.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan (Y.W.); and Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (K.H.).
2
From the Department of Cardiology, Nagoya Heart Canter, Japan (S.K., M.Y., Y.K., T.K., K.S.); Department of Cardiology, Toyohashi Heart Canter, Japan (M.Y., T.S., A. Kagase, M. Tsuzuki, A. Kodama); Department of Cardiology, Sendai Kosei Hospital, Japan (N.T.); Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.); Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan (M.A.); Department of Cardiology, Syonan Kamakura General Hospital, Japan (F.Y.); Department of Cardiology, Kokura Memorial Hospital, Japan (S.S.); Department of Cardiology, Osaka City General Hospital, Japan (K.M.); Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan (M. Tabata); Department of Cardiology, Toyama University Hospital, Japan (H.U.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (K.T.); Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan (A.H.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan (Y.W.); and Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (K.H.). yamamoto@heart-center.or.jp masa-nori@nms.ac.jp.

Abstract

BACKGROUND:

Gait speed reflects an important factor of frailty and is associated with an increased risk of late mortality in patients with cardiac disease. This study sought to assess the prognostic value of gait speed in elderly patients who underwent transcatheter aortic valve replacement.

METHODS AND RESULTS:

We investigated the 5-m or 15-feet gait speed (m/sec) in 1256 patients who underwent transcatheter aortic valve implantation using data from the OCEAN-TAVI Japanese multicenter registry (Optimized Catheter Valvular Intervention-Transcatheter Aortic Valve Implantation). Baseline characteristics, procedural outcomes, and all-cause mortality were compared among groups defined by differential gait speed classification: model 1, normal (>0.83 m/sec; n=563; 44.8%), slow (0.5-0.83 m/sec; n=429; 34.2%), slowest (<0.83 m/sec; n=205; 16.3%), unable to walk (n=48; 3.8%); and model 2, classification and regression tree survival model indicating the threshold of gait speed as 0.385 m/sec (>0.385 m/sec; n=1080 versus ≤0.385 m/sec; n=117). The cumulative 1-year mortality rate showed significant differences in the classical gait speed groups in model 1 (7.6%, 6.6%, 18.2%, and 40.7%, respectively; P<0.001) and survival classification and regression tree group in model 2 (7.7% versus 21.9%; P<0.001). The slowest walkers and those unable to walk demonstrated independent associations with increased midterm mortality after adjustment for several confounding factors (hazard ratio, 1.83, 4.28; 95% confidence interval, 1.03-3.26, 2.22-8.72; P=0.039, <0.001, respectively). Gait speed <0.385 m/sec determined by classification and regression tree also independently associated with worse prognosis (hazard ratio, 2.40; 95% confidence interval, 1.75-5.88; P=0.001).

CONCLUSIONS:

Gait speed using both traditional and specific classification is useful as a potential marker for predicting vulnerable patients associated with adverse clinical outcomes after transcatheter aortic valve replacement.

KEYWORDS:

foot; heart diseases; risk; transcatheter aortic valve replacement; walkers

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