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Chronic obstructive pulmonary disease in patients undergoing transcatheter aortic valve implantation: insights on clinical outcomes, prognostic markers, and functional status changes

Mok, Michael, Nombela-Franco, Luis, Dumont, Eric, Urena, Marina, DeLarochellière, Robert, Doyle, Daniel, Villeneuve, Jacques, Côté, Mélanie, Ribeiro, Henrique B., Allende, Ricardo, Laflamme, Jerôme, DeLarochellière, Hugo, Laflamme, Louis, Amat-Santos, Ignacio, Pibarot, Philippe, Maltais, François and Rodés-Cabau, Josep 2013, Chronic obstructive pulmonary disease in patients undergoing transcatheter aortic valve implantation: insights on clinical outcomes, prognostic markers, and functional status changes, JACC: cardiovascular interventions, vol. 6, no. 10, pp. 1072-1084, doi: 10.1016/j.jcin.2013.06.008.

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Title Chronic obstructive pulmonary disease in patients undergoing transcatheter aortic valve implantation: insights on clinical outcomes, prognostic markers, and functional status changes
Author(s) Mok, Michael
Nombela-Franco, Luis
Dumont, Eric
Urena, Marina
DeLarochellière, Robert
Doyle, Daniel
Villeneuve, Jacques
Côté, Mélanie
Ribeiro, Henrique B.
Allende, Ricardo
Laflamme, Jerôme
DeLarochellière, Hugo
Laflamme, Louis
Amat-Santos, Ignacio
Pibarot, Philippe
Maltais, François
Rodés-Cabau, Josep
Journal name JACC: cardiovascular interventions
Volume number 6
Issue number 10
Start page 1072
End page 1084
Total pages 13
Publisher Elsevier
Place of publication Amsterdam, The Netherlands
Publication date 2013-10
ISSN 1936-8798
1876-7605
Keyword(s) 6-min walk test
6MWT
BMI
CI
COPD
DASI
Duke Activity Status Index
FEV(1)
HR
IQR
NYHA
New York Heart Association
ROC
SAVR
STS
Society of Thoracic Surgeons
TA
TAVI
TAo
TF
VARC
Valve Academic Research Consortium
aortic stenosis
body mass index
chronic obstructive pulmonary disease
confidence interval
eGFR
estimated glomerular filtration rate
forced expiratory volume in the first second of expiration
hazard ratio
interquartile range
pulmonary function
receiver-operating characteristic
surgical aortic valve replacement
transaortic
transapical
transcatheter aortic valve implantation
transfemoral
Aged
Aged, 80 and over
Aortic Valve Stenosis
Cardiac Catheterization
Exercise Test
Exercise Tolerance
Female
Heart Valve Prosthesis Implantation
Humans
Kaplan-Meier Estimate
Lung
Male
Patient Selection
Predictive Value of Tests
Pulmonary Disease, Chronic Obstructive
Recovery of Function
Risk Factors
Severity of Illness Index
Spirometry
Time Factors
Treatment Outcome
Walking
Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
Summary OBJECTIVES: This study sought to determine the effects of chronic obstructive pulmonary disease (COPD) on clinical outcomes in patients undergoing transcatheter aortic valve implantation (TAVI) and to determine the factors associated with worse outcomes in COPD patients.
BACKGROUND: No data exist on the factors determining poorer outcomes in COPD patients undergoing TAVI.
METHODS: A total of 319 consecutive patients (29.5% with COPD) who underwent TAVI were studied. Functional status was evaluated by New York Heart Association (NYHA) functional class, Duke Activity Status Index, and the 6-min walk test (6MWT) at baseline and at 6 to 12 months. The TAVI treatment was considered futile if the patient either died or did not improve in NYHA functional class at 6-month follow-up.
RESULTS: Survival rates at 1 year were 70.6% in COPD patients and 84.5% in patients without COPD (p = 0.008). COPD was an independent predictor of cumulative mortality after TAVI (hazard ratio: 1.84; 95% confidence interval: 1.08 to 3.13; p = 0.026). Improvement in functional status was observed after TAVI (p < 0.001 for NYHA functional class, Duke Activity Status Index, and 6MWT), but COPD patients exhibited less (p = 0.036) improvement in NYHA functional class. Among COPD patients, a shorter 6MWT distance predicted cumulative mortality (p = 0.013), whereas poorer baseline spirometry results (FEV1 [forced expiratory volume in the first second of expiration]) determined a higher rate of periprocedural pulmonary complications (p = 0.040). The TAVI treatment was futile in 40 COPD patients (42.5%) and a baseline 6MWT distance <170 m best determined the lack of benefit after TAVI (p = 0.002).
CONCLUSIONS: COPD was associated with a higher rate of mortality at mid-term follow-up. Among COPD patients, a higher degree of airway obstruction and a lower exercise capacity determined a higher risk of pulmonary complications and mortality, respectively. TAVI was futile in more than one-third of the COPD patients, and a shorter distance walked at the 6MWT predicted the lack of benefit after TAVI. These results may help to improve the clinical decision-making process in this challenging group of patients.
Language eng
DOI 10.1016/j.jcin.2013.06.008
Field of Research 110201 Cardiology (incl Cardiovascular Diseases)
1102 Cardiovascular Medicine And Haematology
Socio Economic Objective 920103 Cardiovascular System and Diseases
HERDC Research category C1.1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2013, American College of Cardiology Foundation
Persistent URL http://hdl.handle.net/10536/DRO/DU:30073384

Document type: Journal Article
Collection: School of Medicine
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