Five-meter walk test before transcatheter aortic valve replacement and 1-year noncardiac mortality

Toshinobu Kazui; Chiu-Hsieh Hsu; Mohammad Hamidi; Deepak Acharya; Madhan Shanmugasundaram; Kwan Lee; Arka Chatterjee; David Bull

doi:10.1016/j.xjon.2022.08.003

Five-meter walk test before transcatheter aortic valve replacement and 1-year noncardiac mortality

JTCVS Open. 2022 Aug 18:12:103-117. doi: 10.1016/j.xjon.2022.08.003. eCollection 2022 Dec.

Authors

Toshinobu Kazui^{1

2}, Chiu-Hsieh Hsu³, Mohammad Hamidi², Deepak Acharya⁴, Madhan Shanmugasundaram⁴, Kwan Lee⁴, Arka Chatterjee⁴, David Bull^{1

2}

Affiliations

¹ Division of Cardiothoracic Surgery, Department of Surgery, Banner University Medical Center-Tucson/University of Arizona, Tucson, Ariz.
² Department of Surgery, Banner University Medical Center-Tucson/University of Arizona, Tucson, Ariz.
³ Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, Ariz.
⁴ Division of Cardiology, Department of Medicine, Sarver Heart Center, Banner University Medical Center-Tucson/University of Arizona, Tucson, Ariz.

Abstract

Objective: The purpose of this study is to assess whether the 5-m walk test is associated with 1-year mortality after transcatheter aortic valve replacement.

Methods: Included in the analysis were 304 patients who received the 5-m walk test and underwent transcatheter aortic valve replacement from September 2012 to March 2019. They were classified into 3 groups based on their test score: ≤7, >7, and unable to walk. Preprocedure characteristics, postprocedure outcomes, and follow-up outcomes were compared between the groups.

Results: For the 5-m walk test, 145 had a score ≤7 (Group N), 111 had a score >7 (Group S), and 48 were unable to walk (Group I). Average age in years was 80.2 ± 8.7 years in Group N, 81.2 ± 9.4 years in Group S, and 79.4 ± 9.2 in Group I (P = .23). The aortic valve mean gradient at discharge was 9.5 ± 4.1 mm Hg in Group N, 10.4 ± 5.5 mm Hg in Group S, and 8.2 ± 4.2 mm Hg in Group I (P = .05). The discharge survival was 97.2% in Group N, 96.4% in Group S, and 95.8% in Group I (P = .76). One-year survival was 92.8% in Group N, 84.1% in Group S, and 75% in Group I (P < .01) after adjusting for preprocedure characteristics. Noncardiac death was 5.1% in Group N, 13.1% in Group S, and 22.7% in Group I (P = .03). This indicates that the 5-m walk test was a risk factor for 1-year mortality. More specifically, a poor 5-m walk test score was associated with 1-year noncardiac mortality.

Conclusions: The 5-m walk test score before transcatheter aortic valve replacement was associated with 1-year mortality, especially noncardiac mortality. It may help identify patients at high risk for 1-year mortality.

Keywords: 1-year mortality; 5-m walk test; AS, aortic valve stenosis; KCCQ12, Kansas City Cardiomyopathy Questionnaire; NYHA, New York Heart Association; STS-PROM, Society of Thoracic Surgeons predicted risk of mortality score; TAVR, transcatheter aortic valve replacement; TVT Registry, Transcatheter Valve Therapy Registry; noncardiac mortality; transcatheter aortic valve replacement.