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. 2020 Jan 31;2(3):79-84.
doi: 10.1016/j.cjco.2019.12.006. eCollection 2020 May.

Effects of Transcatheter Aortic Valve Implantation on Frailty and Quality of Life

Pishoy Gouda  1   2 , Chai Paterson  1   2 , Steven Meyer  1   2 , Miriam Shanks  1   2 , Craig Butler  1   2 , Dylan Taylor  1   2 , Benjamin Tyrrell  1   3 , Robert Welsh  1   2
Affiliations

Effects of Transcatheter Aortic Valve Implantation on Frailty and Quality of Life

Pishoy Gouda et al. CJC Open. .

Abstract
in English, French

Background: Transcatheter aortic valve implantation (TAVI) is an effective alternative to surgical valve replacement in high-risk patients with severe aortic stenosis. Although measures of frailty have been used to attempt to predict outcomes in this population, few studies have demonstrated changes in these measures.

Methods: We performed a prospective, observational study of 171 patients undergoing TAVI, of whom 44 had maximal follow-up of 1 month and 50 had maximal follow-up of 1 year. Quality of life was assessed using the Minnesota Living With Heart Failure Questionnaire, Katz Index of Independence in Activities of Daily Living questionnaire, and patient perception of overall well-being. Frailty was measured using the 10-m walk test and handgrip strength testing.

Results: In the overall cohort, participants demonstrated improvements in quality of life metrics, but deterioration in 10-m walk test and handgrip at 1 month. These trends continued at 1 year. However, patients in the lowest quintile of handgrip and 10-m walk test demonstrated a trend of improvements in these metrics during follow-up.

Conclusions: Despite improvements in quality of life after TAVI, no improvements in frailty were observed in patients at 1 year.

Contexte: Le remplacement valvulaire aortique par cathéter (TAVI) est une solution de rechange efficace à la chirurgie de remplacement valvulaire chez les patients atteints de sténose aortique grave et présentant un risque élevé. Les mesures de la fragilité sont utilisées pour tenter de prévoir les résultats au sein de cette population. Néanmoins, peu d’études ont permis d’objectiver les variations de ces mesures.

Méthodologie: Nous avons réalisé une étude observationnelle prospective portant sur 171 patients ayant subi un TAVI, dont 44 suivis pendant un mois ou moins, et 50 durant un an ou moins. La qualité de vie a été évaluée au moyen de questionnaires – Minnesota Living With Heart Failure Questionnaire et Katz Index of Independence in Activities of Daily Living Questionnaire – et en fonction de la perception du patient relativement à son bien-être général. La fragilité a été mesurée à l’aide d’un test de marche sur dix mètres et d’un test de force de préhension.

Résultats: Dans l’ensemble de la cohorte, une amélioration des mesures de la qualité de vie a été observée parallèlement à une détérioration des résultats au test de marche sur dix mètres et au test de force de préhension après un mois. Les tendances à cet égard se sont poursuivies au bout d’un an. Cependant, les résultats des patients du quintile inférieur au test de marche sur 10 m et au test de force de préhension ont eu tendance à s’améliorer au cours de la période de suivi.

Conclusions: Malgré une amélioration de la qualité de vie après le TAVI, la fragilité des patients ne s’est nullement améliorée après un an.

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Figures

Figure 1
Figure 1
Quality of life metrics at baseline, 1 month, and 1 year using all available follow-up. (A) Katz index of ADL is displayed where a higher ADL score is interpreted as higher function. MLHFQ total score (B), physical score (C), and emotional score (D) were higher. MLHFQ scores are interpreted as higher burden. ADL, activities of daily living; CI, confidence interval; MLHFQ, Minnesota Living with Heart Failure Questionnaire.
Figure 2
Figure 2
Frailty metrics at baseline, 1 month, and 1 year using all available follow-up. CI, confidence interval; 10MWT, 10-m walk test.
See this image and copyright information in PMC

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