PMID- 24156967
OWN - NLM
STAT- MEDLINE
DCOM- 20140616
LR  - 20220330
IS  - 1876-7605 (Electronic)
IS  - 1936-8798 (Linking)
VI  - 6
IP  - 10
DP  - 2013 Oct
TI  - Chronic obstructive pulmonary disease in patients undergoing transcatheter aortic 
      valve implantation: insights on clinical outcomes, prognostic markers, and 
      functional status changes.
PG  - 1072-84
LID - S1936-8798(13)01234-X [pii]
LID - 10.1016/j.jcin.2013.06.008 [doi]
AB  - 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.
CI  - Copyright (c) 2013 American College of Cardiology Foundation. Published by Elsevier 
      Inc. All rights reserved.
FAU - Mok, Michael
AU  - Mok M
AD  - Department of Cardiology, Quebec Heart and Lung Institute, Laval University, 
      Quebec City, Quebec, Canada.
FAU - Nombela-Franco, Luis
AU  - Nombela-Franco L
FAU - Dumont, Eric
AU  - Dumont E
FAU - Urena, Marina
AU  - Urena M
FAU - DeLarochelliere, Robert
AU  - DeLarochelliere R
FAU - Doyle, Daniel
AU  - Doyle D
FAU - Villeneuve, Jacques
AU  - Villeneuve J
FAU - Cote, Melanie
AU  - Cote M
FAU - Ribeiro, Henrique B
AU  - Ribeiro HB
FAU - Allende, Ricardo
AU  - Allende R
FAU - Laflamme, Jerome
AU  - Laflamme J
FAU - DeLarochelliere, Hugo
AU  - DeLarochelliere H
FAU - Laflamme, Louis
AU  - Laflamme L
FAU - Amat-Santos, Ignacio
AU  - Amat-Santos I
FAU - Pibarot, Philippe
AU  - Pibarot P
FAU - Maltais, Francois
AU  - Maltais F
FAU - Rodes-Cabau, Josep
AU  - Rodes-Cabau J
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - JACC Cardiovasc Interv
JT  - JACC. Cardiovascular interventions
JID - 101467004
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Aortic Valve Stenosis/complications/diagnosis/mortality/physiopathology/*therapy
MH  - *Cardiac Catheterization/adverse effects/mortality
MH  - Exercise Test
MH  - Exercise Tolerance
MH  - Female
MH  - Heart Valve Prosthesis Implantation/adverse effects/*methods/mortality
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Lung/physiopathology
MH  - Male
MH  - Patient Selection
MH  - Predictive Value of Tests
MH  - Pulmonary Disease, Chronic 
      Obstructive/*complications/diagnosis/mortality/physiopathology
MH  - Recovery of Function
MH  - Risk Factors
MH  - Severity of Illness Index
MH  - Spirometry
MH  - Time Factors
MH  - Treatment Outcome
MH  - Walking
OTO - NOTNLM
OT  - 6-min walk test
OT  - 6MWT
OT  - BMI
OT  - CI
OT  - COPD
OT  - DASI
OT  - Duke Activity Status Index
OT  - FEV(1)
OT  - HR
OT  - IQR
OT  - NYHA
OT  - New York Heart Association
OT  - ROC
OT  - SAVR
OT  - STS
OT  - Society of Thoracic Surgeons
OT  - TA
OT  - TAVI
OT  - TAo
OT  - TF
OT  - VARC
OT  - Valve Academic Research Consortium
OT  - aortic stenosis
OT  - body mass index
OT  - chronic obstructive pulmonary disease
OT  - confidence interval
OT  - eGFR
OT  - estimated glomerular filtration rate
OT  - forced expiratory volume in the first second of expiration
OT  - hazard ratio
OT  - interquartile range
OT  - pulmonary function
OT  - receiver-operating characteristic
OT  - surgical aortic valve replacement
OT  - transaortic
OT  - transapical
OT  - transcatheter aortic valve implantation
OT  - transfemoral
EDAT- 2013/10/26 06:00
MHDA- 2014/06/17 06:00
CRDT- 2013/10/26 06:00
PHST- 2013/05/15 00:00 [received]
PHST- 2013/06/18 00:00 [revised]
PHST- 2013/06/20 00:00 [accepted]
PHST- 2013/10/26 06:00 [entrez]
PHST- 2013/10/26 06:00 [pubmed]
PHST- 2014/06/17 06:00 [medline]
AID - S1936-8798(13)01234-X [pii]
AID - 10.1016/j.jcin.2013.06.008 [doi]
PST - ppublish
SO  - JACC Cardiovasc Interv. 2013 Oct;6(10):1072-84. doi: 10.1016/j.jcin.2013.06.008.