Relation between six-minute walk test performance and outcomes after transcatheter aortic valve implantation (from the PARTNER Trial)

Philip Green, David J. Cohen, Philippe Genereux, Tom McAndrew, Suzanne V. Arnold, Maria Alu, Nirat Beohar, Charanjit S. Rihal, Michael J. Mack, Samir Kapadia, Danny Dvir, Mathew S. Maurer, Mathew R. Williams, Susheel Kodali, Martin B. Leon, Ajay J. Kirtane

Research output: Contribution to journalArticle

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Abstract

Functional capacity as assessed by 6-minute walk test distance (6MWTD) has been shown to predict outcomes in selected cohorts with cardiovascular disease. To evaluate the association between 6MWTD and outcomes after transcatheter aortic valve implantation (TAVI) among participants in the Placement of AoRTic TraNscathetER valve (PARTNER) trial, TAVI recipients (n = 484) were stratified into 3 groups according to baseline 6MWTD: unable to walk (n = 218), slow walkers (n = 133), in whom 6MWTD was below the median (128.5 meters), and fast walkers (n = 133) with 6MWTD >128.5 meters. After TAVI, among fast walkers, follow-up 6MWTD decreased by 44 ± 148 meters at 12 months (p <0.02 compared with baseline). In contrast, among slow walkers, 6MWTD improved after TAVI by 58 ± 126 meters (p <0.001 compared with baseline). Similarly, among those unable to walk, 6MWTD distance increased by 66 ± 109 meters (p <0.001 compared with baseline). There were no differences in 30-day outcomes among 6MWTD groups. At 2 years, the rate of death from any cause was 42.5% in those unable to walk, 31.2% in slow walkers, and 28.8% in fast walkers (p = 0.02), driven primarily by differences in noncardiac death. In conclusion, among high-risk older adults undergoing TAVI, baseline 6MWTD does not predict procedural outcomes but does predict long-term mortality. Nonetheless, patients with poor baseline functional status exhibit the greatest improvement in 6MWTD. Additional work is required to identify those with poor functional status who stand to benefit the most from TAVI.

Original languageEnglish (US)
Pages (from-to)700-706
Number of pages7
JournalAmerican Journal of Cardiology
Volume112
Issue number5
DOIs
StatePublished - Sep 1 2013
Externally publishedYes

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Aortic Valve
Walkers
Walk Test
Transcatheter Aortic Valve Replacement
Mortality
Cause of Death
Cardiovascular Diseases

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Green, Philip ; Cohen, David J. ; Genereux, Philippe ; McAndrew, Tom ; Arnold, Suzanne V. ; Alu, Maria ; Beohar, Nirat ; Rihal, Charanjit S. ; Mack, Michael J. ; Kapadia, Samir ; Dvir, Danny ; Maurer, Mathew S. ; Williams, Mathew R. ; Kodali, Susheel ; Leon, Martin B. ; Kirtane, Ajay J. / Relation between six-minute walk test performance and outcomes after transcatheter aortic valve implantation (from the PARTNER Trial). In: American Journal of Cardiology. 2013 ; Vol. 112, No. 5. pp. 700-706.
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title = "Relation between six-minute walk test performance and outcomes after transcatheter aortic valve implantation (from the PARTNER Trial)",
abstract = "Functional capacity as assessed by 6-minute walk test distance (6MWTD) has been shown to predict outcomes in selected cohorts with cardiovascular disease. To evaluate the association between 6MWTD and outcomes after transcatheter aortic valve implantation (TAVI) among participants in the Placement of AoRTic TraNscathetER valve (PARTNER) trial, TAVI recipients (n = 484) were stratified into 3 groups according to baseline 6MWTD: unable to walk (n = 218), slow walkers (n = 133), in whom 6MWTD was below the median (128.5 meters), and fast walkers (n = 133) with 6MWTD >128.5 meters. After TAVI, among fast walkers, follow-up 6MWTD decreased by 44 ± 148 meters at 12 months (p <0.02 compared with baseline). In contrast, among slow walkers, 6MWTD improved after TAVI by 58 ± 126 meters (p <0.001 compared with baseline). Similarly, among those unable to walk, 6MWTD distance increased by 66 ± 109 meters (p <0.001 compared with baseline). There were no differences in 30-day outcomes among 6MWTD groups. At 2 years, the rate of death from any cause was 42.5{\%} in those unable to walk, 31.2{\%} in slow walkers, and 28.8{\%} in fast walkers (p = 0.02), driven primarily by differences in noncardiac death. In conclusion, among high-risk older adults undergoing TAVI, baseline 6MWTD does not predict procedural outcomes but does predict long-term mortality. Nonetheless, patients with poor baseline functional status exhibit the greatest improvement in 6MWTD. Additional work is required to identify those with poor functional status who stand to benefit the most from TAVI.",
author = "Philip Green and Cohen, {David J.} and Philippe Genereux and Tom McAndrew and Arnold, {Suzanne V.} and Maria Alu and Nirat Beohar and Rihal, {Charanjit S.} and Mack, {Michael J.} and Samir Kapadia and Danny Dvir and Maurer, {Mathew S.} and Williams, {Mathew R.} and Susheel Kodali and Leon, {Martin B.} and Kirtane, {Ajay J.}",
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Green, P, Cohen, DJ, Genereux, P, McAndrew, T, Arnold, SV, Alu, M, Beohar, N, Rihal, CS, Mack, MJ, Kapadia, S, Dvir, D, Maurer, MS, Williams, MR, Kodali, S, Leon, MB & Kirtane, AJ 2013, 'Relation between six-minute walk test performance and outcomes after transcatheter aortic valve implantation (from the PARTNER Trial)', American Journal of Cardiology, vol. 112, no. 5, pp. 700-706. https://doi.org/10.1016/j.amjcard.2013.04.046

Relation between six-minute walk test performance and outcomes after transcatheter aortic valve implantation (from the PARTNER Trial). / Green, Philip; Cohen, David J.; Genereux, Philippe; McAndrew, Tom; Arnold, Suzanne V.; Alu, Maria; Beohar, Nirat; Rihal, Charanjit S.; Mack, Michael J.; Kapadia, Samir; Dvir, Danny; Maurer, Mathew S.; Williams, Mathew R.; Kodali, Susheel; Leon, Martin B.; Kirtane, Ajay J.

In: American Journal of Cardiology, Vol. 112, No. 5, 01.09.2013, p. 700-706.

Research output: Contribution to journalArticle

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T1 - Relation between six-minute walk test performance and outcomes after transcatheter aortic valve implantation (from the PARTNER Trial)

AU - Green, Philip

AU - Cohen, David J.

AU - Genereux, Philippe

AU - McAndrew, Tom

AU - Arnold, Suzanne V.

AU - Alu, Maria

AU - Beohar, Nirat

AU - Rihal, Charanjit S.

AU - Mack, Michael J.

AU - Kapadia, Samir

AU - Dvir, Danny

AU - Maurer, Mathew S.

AU - Williams, Mathew R.

AU - Kodali, Susheel

AU - Leon, Martin B.

AU - Kirtane, Ajay J.

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N2 - Functional capacity as assessed by 6-minute walk test distance (6MWTD) has been shown to predict outcomes in selected cohorts with cardiovascular disease. To evaluate the association between 6MWTD and outcomes after transcatheter aortic valve implantation (TAVI) among participants in the Placement of AoRTic TraNscathetER valve (PARTNER) trial, TAVI recipients (n = 484) were stratified into 3 groups according to baseline 6MWTD: unable to walk (n = 218), slow walkers (n = 133), in whom 6MWTD was below the median (128.5 meters), and fast walkers (n = 133) with 6MWTD >128.5 meters. After TAVI, among fast walkers, follow-up 6MWTD decreased by 44 ± 148 meters at 12 months (p <0.02 compared with baseline). In contrast, among slow walkers, 6MWTD improved after TAVI by 58 ± 126 meters (p <0.001 compared with baseline). Similarly, among those unable to walk, 6MWTD distance increased by 66 ± 109 meters (p <0.001 compared with baseline). There were no differences in 30-day outcomes among 6MWTD groups. At 2 years, the rate of death from any cause was 42.5% in those unable to walk, 31.2% in slow walkers, and 28.8% in fast walkers (p = 0.02), driven primarily by differences in noncardiac death. In conclusion, among high-risk older adults undergoing TAVI, baseline 6MWTD does not predict procedural outcomes but does predict long-term mortality. Nonetheless, patients with poor baseline functional status exhibit the greatest improvement in 6MWTD. Additional work is required to identify those with poor functional status who stand to benefit the most from TAVI.

AB - Functional capacity as assessed by 6-minute walk test distance (6MWTD) has been shown to predict outcomes in selected cohorts with cardiovascular disease. To evaluate the association between 6MWTD and outcomes after transcatheter aortic valve implantation (TAVI) among participants in the Placement of AoRTic TraNscathetER valve (PARTNER) trial, TAVI recipients (n = 484) were stratified into 3 groups according to baseline 6MWTD: unable to walk (n = 218), slow walkers (n = 133), in whom 6MWTD was below the median (128.5 meters), and fast walkers (n = 133) with 6MWTD >128.5 meters. After TAVI, among fast walkers, follow-up 6MWTD decreased by 44 ± 148 meters at 12 months (p <0.02 compared with baseline). In contrast, among slow walkers, 6MWTD improved after TAVI by 58 ± 126 meters (p <0.001 compared with baseline). Similarly, among those unable to walk, 6MWTD distance increased by 66 ± 109 meters (p <0.001 compared with baseline). There were no differences in 30-day outcomes among 6MWTD groups. At 2 years, the rate of death from any cause was 42.5% in those unable to walk, 31.2% in slow walkers, and 28.8% in fast walkers (p = 0.02), driven primarily by differences in noncardiac death. In conclusion, among high-risk older adults undergoing TAVI, baseline 6MWTD does not predict procedural outcomes but does predict long-term mortality. Nonetheless, patients with poor baseline functional status exhibit the greatest improvement in 6MWTD. Additional work is required to identify those with poor functional status who stand to benefit the most from TAVI.

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