Clinical Research
Chronic Obstructive Pulmonary Disease in Patients Undergoing Transcatheter Aortic Valve Implantation: Insights on Clinical Outcomes, Prognostic Markers, and Functional Status Changes

https://doi.org/10.1016/j.jcin.2013.06.008Get rights and content
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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.

Key Words

6-min walk test
aortic stenosis
COPD
pulmonary function
transcatheter aortic valve implantation

Abbreviations and Acronyms

6MWT
6-min walk test
BMI
body mass index
CI
confidence interval
COPD
chronic obstructive pulmonary disease
DASI
Duke Activity Status Index
eGFR
estimated glomerular filtration rate
FEV1
forced expiratory volume in the first second of expiration
HR
hazard ratio
IQR
interquartile range
NYHA
New York Heart Association
ROC
receiver-operating characteristic
SAVR
surgical aortic valve replacement
STS
Society of Thoracic Surgeons
TA
transapical
TAo
transaortic
TAVI
transcatheter aortic valve implantation
TF
transfemoral
VARC
Valve Academic Research Consortium

Cited by (0)

Dr. Rodes-Cabau is a consultant for Edwards Lifesciences Inc. and St. Jude Medical. Dr. Nombela-Franco has received a research grant from the Fundación Mutua Madrileña. Dr. Dumont is a consultant for Edwards Lifesciences. Dr. DeLarochellière is a consultant for St. Jude Medical. Dr. Maltais holds a GSK/CIHR Research Chair on COPD at Laval University. Dr. Pibarot has received a research grant from Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.