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Functional and metabolic frailty predicts mortality in patients undergoing TAVI: Insights from the OBSERVANT II study

Published:October 03, 2022DOI:https://doi.org/10.1016/j.ejim.2022.09.022

      Highlights

      • Frailty is highly prevalent among elderly subjects undergoing TAVI and it should be assessed in the therapeutic decision-making for those patients.
      • We examined 1-year survival of a large real-world cohort of TAVI patients treated with new generation devices and stratified in 4 groups according to a comprehensive evaluation of frailty.
      • We concluded that the occurrence of combined frailty (functional and metabolic) had a significant and incremental impact on 1-year mortality.

      Abstract

      Background/aim

      Despite the prognostic role of frailty among elderly patients undergoing transcatheter aortic valve implantation (TAVI) is known, its assessment still represents a challenge due to the multitude of scales proposed in literature. The aim of this study was to define the prognostic impact of a simple combined frailty model including both functional and metabolic parameters in a large cohort of patients undergoing TAVI with new generation devices.

      Methods and results

      We examined 1-year survival of patients affected by aortic valve stenosis treated with new generation TAVI devices from the OBSERVANT II study. Frailty of patients undergoing TAVI was stratified in four groups according to a combination of functional (geriatric status scale - GSS) and metabolic (global nutritional risk index - GNRI) assessment. Among 1985 patients included in the analysis, 1008 (51%) had no significant frailty, 246 (12%) had only functional impairment, 522 (26%) had only metabolic impairment and 209 (11%) had both functional and metabolic impairment. The presence of combined functional and metabolic frailty was associated with a two-fold increased risk of 1-year all-cause mortality (HR 2.06 [95% CI 1.35–3.14]; p = 0.001). GNRI as a single parameter had a lower impact on mortality (HR 1.48 [95% CI 1.05 – 2.09]; p = 0.027), whereas GSS did not impact on mortality (HR 1.23 [95% CI 0.77–1.97]; p = 0.386).

      Conclusions

      In a large real-world cohort of patients undergoing TAVI with new generation devices, combined functional and metabolic frailty had a significant and incremental impact on 1-year mortality.
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      References

        • Fried L.P.
        • Tangen C.M.
        • Walston J.
        • Newman A.B.
        • Hirsch C.
        • Gottdiener J.
        • Seeman T.
        • Tracy R.
        • Kop W.J.
        • Burke G.
        • McBurnie M.A.
        Frailty in older adults: evidence for a phenotype.
        J Gerontol A Biol Sci Med Sci. 2001; 56 (United States): M146-M156
        • Vahanian A.
        • Beyersdorf F.
        • Praz F.
        • Milojevic M.
        • Baldus S.
        • Bauersachs J.
        • et al.
        2021 ESC/EACTS Guidelines for the management of valvular heart disease.
        Eur Heart J. 2022; 43: 561-632
        • Baritello O.
        • Salzwedel A.
        • Sündermann S.H.
        • Niebauer J.
        • Völler H.
        The pandora’s box of frailty assessments: which is the best for clinical purposes in TAVI patients? A critical review.
        J Clin Med. 2021; 104506
        • Li Z.
        • Dawson E.
        • Moodie J.
        • Martin J.
        • Bagur R.
        • Cheng D.
        • Kiaii B.
        • Hashi A.
        • Bi R.
        • Yeschin M.
        • John-Baptiste A.
        Measurement and prognosis of frail patients undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis.
        BMJ Open. 2021; 11e040459
        • Emami S.
        • Rudasill S.
        • Bellamkonda N.
        • Sanaiha Y.
        • Cale M.
        • Madrigal J.
        • Christian-Miller N.
        • Benharash P.
        Impact of malnutrition on outcomes following transcatheter aortic valve implantation (from a National Cohort).
        Am J Cardiol. 2020; 125 (United States): 1096-1101
        • Massussi M.
        • Metra M.
        • Adamo M.
        Sarcopenia detected by computed tomography: a simple tool for screening transcatheter aortic valve implantation candidates.
        J Cardiovasc Med. 2022; 23 (Hagerstown). United States: 69-70
        • Rosato S.
        • Biancari F.
        • D’Errigo P.
        • Barbanti M.
        • Tarantini G.
        • Bedogni F.
        • et al.
        • Group OBOTOIR
        One-year outcomes after surgical versus transcatheter aortic valve replacement with newer generation devices.
        J Clin Med. 2021; 103703
        • Kappetein A.P.
        • Head S.J.
        • Généreux P.
        • Piazza N.
        • Mieghem N.M.V.
        • Blackstone E.H.
        • Brott T.G.
        • Cohen D.J.
        • Cutlip D.E.
        • Es G.A.V.
        • Hahn R.T.
        • Kirtane A.J.
        • Krucoff M.W.
        • Kodali S.
        • Mack M.J.
        • Mehran R.
        • Rodés-Cabau J.
        • Vranckx P.
        • Webb J.G.
        • Windecker S.
        • Serruys P.W.
        • Leon M.B
        Updated standardized endpoint definitions for transcatheter aortic valve implantation: the valve academic research consortium-2 consensus document (VARC-2).
        Eur J Cardio Thorac Surg. 2012; 42 (Off J Eur Assoc Cardio Thoracic Surg Germany): S45-S60
        • Rockwood K.
        • Stadnyk K.
        • MacKnight C.
        • McDowell I.
        • Hébert R.
        • Hogan D.B.
        A brief clinical instrument to classify frailty in elderly people.
        Lancet. 1999; 353 (London, England). England: 205-206
        • Bouillanne O.
        • Morineau G.
        • Dupont C.
        • Coulombel I.
        • Vincent J.-.P.
        • Nicolis I.
        • Benazeth S.
        • Cynober L.
        • Aussel C.
        Geriatric nutritional risk index: a new index for evaluating at-risk elderly medical patients.
        Am J Clin Nutr. 2005; 82 (United States): 777-783
        • Dent E.
        • Hoogendijk E.O.
        • Visvanathan R.
        • Wright O.R.L.
        Malnutrition screening and assessment in hospitalised older people: a review.
        J Nutr Health Aging. 2019; 23 (France): 431-441
        • Hao X.
        • Li D.
        • Zhang N.
        Geriatric nutritional risk index as a predictor for mortality: a meta-analysis of observational studies.
        Nutr Res. 2019; 71 (United States): 8-20
        • Seoudy H.
        • Al-Kassou B.
        • Shamekhi J.
        • Sugiura A.
        • Frank J.
        • Saad M.
        • Bramlage P.
        • Seoudy A.K.
        • Puehler T.
        • Lutter G.
        • Schulte D.M.
        • Laudes M.
        • Nickenig G.
        • Frey N.
        • Sinning J.M.
        • Frank D.
        Frailty in patients undergoing transcatheter aortic valve replacement: prognostic value of the geriatric nutritional risk index.
        J Cachexia Sarcopenia Muscle. 2021; 12: 577-585
        • Pepe M.S.
        The statistical evaluation of medical tests for classification and prediction.
        Oxford University Press, USA2003
        • Perkins N.J.
        • Schisterman E.F.
        The inconsistency of ‘optimal’ cutpoints obtained using two criteria based on the receiver operating characteristic curve.
        Am J Epidemiol. 2006; 163: 670-675
        • Walpot J.
        • Herck P.V.
        • Collas V.
        • Bossaerts L.
        • Vandendriessche T.
        • Heyning C.M.V.D.
        • Heidbuchel H.
        • Rodrigus I.
        • Bosmans J
        Computed tomography measured psoas muscle attenuation predicts mortality after transcatheter aortic valve implantation.
        J Cardiovasc Med. 2022; 23 (Hagerstown) United States: 60-68
        • Waduud M.A.
        • Giannoudi M.
        • Drozd M.
        • Sucharitkul P.P.J.
        • Slater T.A.
        • Blackman D.J.
        • Scott D.J.A.
        Morphometric and traditional frailty assessment in transcatheter aortic valve implantation.
        J Cardiovasc Med. 2020; 21 (Hagerstown) United States: 779-786
        • Arnold S.V.
        • Zhao Y.
        • Leon M.B.
        • Sathananthan J.
        • Alu M.
        • Thourani V.H.
        • Smith C.R.
        • Mack M.J.
        • Cohen D.J.
        Impact of frailty and prefrailty on outcomes of transcatheter or surgical aortic valve replacement.
        Circ Cardiovasc Interv. 2022; 15 (United States)e011375
        • Goldfarb M.
        • Lauck S.
        • Webb J.G.
        • Asgar A.W.
        • Perrault L.P.
        • Piazza N.
        • Martucci G.
        • Lachapelle K.
        • Noiseux N.
        • Kim D.H.
        • Popma J.J.
        • Lefèvre T.
        • Labinaz M.
        • Lamy A.
        • Peterson M.D.
        • Arora R.C.
        • Morais J.A.
        • Morin J.F.
        • Rudski L.G.
        • Afilalo J.
        Malnutrition and mortality in frail and non-frail older adults undergoing aortic valve replacement.
        Circulation. 2018; 138 (United States): 2202-2211
        • Adamo M.
        • Curello S.
        • Metra M.
        Renal failure after trans-catheter aortic valve implantation.
        Eur J Intern Med. 2021; 83 (Netherlands): 86-87
        • Marzo V.D.
        • Crimi G.
        • Benenati S.
        • Buscaglia A.
        • Pescetelli F.
        • Vercellino M.
        • Bona R.D.
        • Sarocchi M.
        • Canepa M.
        • Ameri P.
        • Balbi M.
        • Porto I.
        BMI and acute kidney injury post transcatheter aortic valve replacement: unveiling the obesity paradox.
        J Cardiovasc Med. 2021; 22 (Hagerstown) United States: 579-585
        • Malavasi V.L.
        • Valenti A.C.
        • Ruggerini S.
        • Manicardi M.
        • Orlandi C.
        • Sgreccia D.
        • et al.
        Kidney function according to different equations in patients admitted to a cardiology unit and impact on outcome.
        J Clin Med. 2022; 11: 891
        • Green P.
        • Arnold S.V.
        • Cohen D.J.
        • Kirtane A.J.
        • Kodali S.K.
        • Brown D.L.
        • Rihal C.S.
        • Xu K.
        • Lei Y.
        • Hawkey M.C.
        • Kim R.J.
        • Alu M.C.
        • Leon M.B.
        • Mack M.J.
        Relation of frailty to outcomes after transcatheter aortic valve replacement (from the PARTNER trial).
        Am J Cardiol. 2015; 116: 264-269
        • Vitale C.
        • Jankowska E.
        • Hill L.
        • Piepoli M.
        • Doehner W.
        • Anker S.D.
        • Lainscak M.
        • Jaarsma T.
        • Ponikowski P.
        • Rosano G.M.C.
        • Seferovic P.
        • Coats A.J.
        Heart failure association/European society of cardiology position paper on frailty in patients with heart failure.
        Eur J Heart Fail. 2019; 21 (England): 1299-1305
        • Brouwer J.
        • Nijenhuis V.J.
        • Delewi R.
        • Hermanides R.S.
        • Holvoet W.
        • Dubois C.L.F.
        • Frambach P.
        • Bruyne B.D.
        • Houwelingen G.K.V.
        • Van Der H.J.A.S.
        • Toušek P.
        • van der K.F.
        • Buysschaert I.
        • Schotborgh C.E.
        • Ferdinande B.
        • van der H.P.
        • Roosen J.
        • Peper J.
        • Thielen F.W.F.
        • Veenstra L.
        • Chan Pin Yin D.R.P.P.
        • Swaans M.J.
        • Rensing B.J.W.M.
        • van't Hof A.W.J.
        • Timmers L.
        • Kelder J.C.
        • Stella P.R.
        • Baan J.
        • Ten Berg J.M.
        Aspirin with or without clopidogrel after transcatheter aortic-valve implantation.
        N Engl J Med. 2020; 383 (United States): 1447-1457
        • Ten B.J.
        • Sibbing D.
        • Rocca B.
        • Van Belle E.
        • Chevalier B.
        • Collet J.P.
        • Dudek D.
        • Gilard M.
        • Gorog D.A.
        • Grapsa J.
        • Grove E.L.
        • Lancellotti P.
        • Petronio A.S.
        • Rubboli A.
        • Torracca L.
        • Vilahur G.
        • Witkowski A.
        • Mehilli J
        Management of antithrombotic therapy in patients undergoing transcatheter aortic valve implantation: a consensus document of the ESC Working Group on thrombosis and the European association of percutaneous cardiovascular interventions (EAPCI), in collabo.
        Eur Heart J. 2021; 42 (England): 2265-2269
        • Yanagisawa R.
        • Tanaka M.
        • Yashima F.
        • Arai T.
        • Kohno T.
        • Shimizu H.
        • Fukuda K.
        • Naganuma T.
        • Mizutani K.
        • Araki M.
        • Tada N.
        • Yamanaka F.
        • Shirai S.
        • Tabata M.
        • Ueno H.
        • Takagi K.
        • Higashimori A.
        • Watanabe Y.
        • Yamamoto M.
        • Hayashida K.
        Frequency and consequences of cognitive impairmentin patients underwent transcatheter aortic valve implantation.
        Am J Cardiol. 2018; 122 (United States): 844-850