Predictors of functional decline in elderly patients undergoing transcatheter aortic valve implantation (TAVI)
Andreas W. Schoenenberger,Stefan Stortecky,Stephanie Neumann,André Moser,Peter Jüni,Thierry Carrel,Christoph Huber,Marianne Gandon,Seraina Bischoff,Christa-Maria Schoenenberger,Andreas E. Stuck,Stephan Windecker,Peter Wenaweser +12 more
TLDR
Over a 6-month period, functional status worsened only in a minority of patients surviving TAVI, and the frailty index, but not established risk scores, was predictive of functional decline.Abstract:
Aims This study aimed to assess functional course in elderly patients undergoing transcatheter aortic valve implantation (TAVI) and to find predictors of functional decline. Methods and results In this prospective cohort, functional course was assessed in patients ≥70 years using basic activities of daily living (BADL) before and 6 months after TAVI. Baseline EuroSCORE, STS score, and a frailty index (based on assessment of cognition, mobility, nutrition, instrumental and basic activities of daily living) were evaluated to predict functional decline (deterioration in BADL) using logistic regression models. Functional decline was observed in 22 (20.8%) of 106 surviving patients. EuroSCORE (OR per 10% increase 1.18, 95% CI: 0.83-1.68, P = 0.35) and STS score (OR per 5% increase 1.64, 95% CI: 0.87-3.09, P = 0.13) weakly predicted functional decline. In contrast, the frailty index strongly predicted functional decline in univariable (OR per 1 point increase 1.57, 95% CI: 1.20-2.05, P = 0.001) and bivariable analyses (OR: 1.56, 95% CI: 1.20-2.04, P = 0.001 controlled for EuroSCORE; OR: 1.53, 95% CI: 1.17-2.02, P = 0.002 controlled for STS score). Overall predictive performance was best for the frailty index [Nagelkerke's R(2) (NR(2)) 0.135] and low for the EuroSCORE (NR(2) 0.015) and STS score (NR(2) 0.034). In univariable analyses, all components of the frailty index contributed to the prediction of functional decline. Conclusion Over a 6-month period, functional status worsened only in a minority of patients surviving TAVI. The frailty index, but not established risk scores, was predictive of functional decline. Refinement of this index might help to identify patients who potentially benefit from additional geriatric interventions after TAVI.read more
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Book ChapterDOI
Cardiovascular Health and Healthy Aging
TL;DR: Though not a modifiable risk factor, age alone outranks hyperlipidemia, hypertension, and smoking as a clinical predictor of CVD events and is the strongest determinant of heart disease and stroke in several risk factor algorithms.
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The clinical impact of chronic liver disease in patients undergoing transcatheter and surgical aortic valve replacement: Systematic analysis of the 2011-2017 US hospital database.
David U. Lee,John Han,Gregory H. Fan,David Jeffrey Hastie,Jean Kwon,Ki Jung Lee,Elyse Ann Addonizio,Raffi Karagozian +7 more
TL;DR: In this article, the authors used a national database to evaluate post-transcatheter (TAVR)/surgical aortic valve replacement (SAVR) outcomes stratified using chronic liver disease (CLD).
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Perioperative Risikostratifizierung geriatrischer Patienten bei nichtkardialen Eingriffen
TL;DR: In this article, a perioperative Risikostratifizierung unterstutzt die Behandlungsteams, risikopatienten zu erkennen, und den Be-Handlungsplan entsprechend auszurichten.
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Immunological markers of frailty predict outcomes beyond current risk scores in aortic stenosis following transcatheter aortic valve replacement: Role of neopterin and tryptophan
Adam Csordas,Dietmar Fuchs,Antonio H. Frangieh,Gilbert Reibnegger,Barbara E. Stähli,Martin Cahenzly,Fabian Nietlispach,Willibald Maier,Francesco Maisano,Ronald K. Binder,Christoph Liebetrau,Won-Keun Kim,Helge Möllmann,Christian W. Hamm,Thomas F. Lüscher +14 more
TL;DR: Increased immune activation and associated tryptophan degradation serve as hallmarks of frailty underscoring the prognostic role of baseline inflammation for outcome in patients with severe aortic stenosis undergoing TAVR, and thus may provide a future therapeuthic target in this elderly patient population.
Journal ArticleDOI
Physical components of frailty in predicting mortality after transcatheter aortic valve implantation (TAVI).
Sofie Van de Velde-Van De Ginste,Stany Perkisas,Paul Vermeersch,Maurits Vandewoude,Anne-Marie De Cock +4 more
TL;DR: Mainly nutritional and physical components of frailty were associated with 1-year mortality after TAVI.
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