title: Chronic obstructive pulmonary disease in patients undergoing transcatheter aortic valve implantation: insights on clinical outcomes, prognostic markers, and functional status changes.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Mok
authors.forename: Luis
authors.initials: L
authors.lastname: Nombela-Franco
authors.forename: Eric
authors.initials: E
authors.lastname: Dumont
authors.forename: Marina
authors.initials: M
authors.lastname: Urena
authors.forename: Robert
authors.initials: R
authors.lastname: DeLarochellière
authors.forename: Daniel
authors.initials: D
authors.lastname: Doyle
authors.forename: Jacques
authors.initials: J
authors.lastname: Villeneuve
authors.forename: Mélanie
authors.initials: M
authors.lastname: Côté
authors.forename: Henrique B
authors.initials: HB
authors.lastname: Ribeiro
authors.forename: Ricardo
authors.initials: R
authors.lastname: Allende
authors.forename: Jerôme
authors.initials: J
authors.lastname: Laflamme
authors.forename: Hugo
authors.initials: H
authors.lastname: DeLarochellière
authors.forename: Louis
authors.initials: L
authors.lastname: Laflamme
authors.forename: Ignacio
authors.initials: I
authors.lastname: Amat-Santos
authors.forename: Philippe
authors.initials: P
authors.lastname: Pibarot
authors.forename: François
authors.initials: F
authors.lastname: Maltais
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000401:mortality; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008168:Lung / Q000503:physiopathology; D008297:Male; D018579:Patient Selection; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D020127:Recovery of Function; D012307:Risk Factors; D012720:Severity of Illness Index; D013147:Spirometry; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking
keywords: 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