Frailty assessment using photographs in patients undergoing transcatheter aortic valve replacement.

BACKGROUND: When frailty is considered in patient selection, better outcomes are achieved in transcatheter aortic valve replacement (TAVR) procedures. This study investigated whether patient photographs could be utilized to qualitatively assess patient frailty and independently predict poor outcomes following TAVR. METHODS: This study included 1345 patients with severe aortic stenosis who underwent TAVR at the Sakakibara Heart Institute, Japan, between 2013 and 2022. Patient photographs were taken prior to the initial outpatient clinic examination or at discharge in case the patient's first visit was unplanned admission. Frailty was assessed from patient photographs using a four-point photographic frailty scale; 1 (non-frail), 2 (vulnerable), 3 (mild frail), and 4 (frail). Photographic frailty scale of 3 and 4 were defined as high. The primary endpoint was all-cause mortality following TAVR. RESULTS: Seven hundred ninety-six patients who had their facial photographs taken within six months before the TAVR procedure were analyzed. Patients with a higher photographic frailty scale belonged to New York Heart Association classes III/IV, and had higher Society of Thoracic Surgeons scores, higher incidence of wheelchair usage, lower hemoglobin, and smaller aortic valve areas. According to the frailty assessment, patients with a higher photographic frailty scale exhibited slower performance in the 5-m walk test, reduced hand grip strength, more severe dementia, had a higher clinical frailty scale, and lower serum albumin level. Multivariable Cox regression analysis revealed that the high photographic frailty scale was independently associated with all-cause mortality (adjusted hazard ratio 1.62, 95 % confidence interval 1.12-2.33, p = 0.010). Kaplan-Meier analysis indicated that patients with high photographic frailty scale had higher all-cause mortality rates compared to those with low scale (log-rank p = 0.011). CONCLUSIONS: Patient registration photographs can be used to obtain qualitative assessments of frailty in severe aortic stenosis cases, and such assessments can independently predict poor outcomes following TAVR.

Cognitive assessment using the revised Hasegawa's dementia scale to determine the mid-term outcomes following transcatheter aortic valve replacement.

BACKGROUND: Several predictors are available to guide patient selection for transcatheter aortic valve replacement (TAVR) to achieve better outcomes, and cognitive function is one of these predictors. This study investigated whether the revised Hasegawa's dementia scale (HDS-R) could independently predict mid-term outcomes following TAVR. METHODS: The study population comprised 455 patients with severe aortic stenosis who underwent TAVR at the Sakakibara Heart Institute between 2010 and 2018. The primary endpoint was all-cause mortality following TAVR. Patients were dichotomized into two groups according to the receiver operating characteristic analysis (HDS-R ≤23 and >23). RESULTS: Patients with HDS-R ≤23 were older, were more frail, were more likely to have peripheral artery disease, had lower serum albumin levels, had lower ejection fractions, and had smaller aortic valve areas than those with HDS-R >23. By definition, 81 of the 455 patients (17.8%) were considered to have dementia (HDS-R ≤20) before TAVR. The discriminatory performance for predicting all-cause mortality at 3 years was greater for dichotomization with 23/24 than that with 20/21 [area under the curve (AUC): 0.63, 95% confidence interval (CI): 0.50-0.76, p=0.047 vs. AUC: 0.52, 95% CI: 0.39-0.65, p=0.713]. From the Kaplan-Meier analysis, patients with HDS-R ≤23 had higher mortality rates than those with HDS-R >23 (86.8±3.3% and 75.4±4.7% at 3 years, respectively; log-rank p=0.001). The multivariate Cox regression analysis found that the HDS-R was independently associated with all-cause mortality (hazard ratio 2.11, 95% CI 1.21-3.69, p=0.008). CONCLUSIONS: Patients with HDS-R ≤23 were sicker and more frail and had greater cognitive impairment. Additionally, HDS-R could independently predict mid-term outcomes following TAVR.