New TAVR risk score could help predict poor functional outcomes among older patients
Researchers have developed a new risk score that can help anticipate poor functional outcomes when older patients undergo transcatheter aortic valve replacement (TAVR), sharing their findings in Clinical Interventions in Aging.[1]
“Identifying patients at high risk for poor functional recovery pre-procedurally is a critical unmet need,” wrote first author Hang Zhang, with the department of cardiac surgery at The Second Hospital of Hebei Medical University in Hebei, China, and colleagues. “While research has identified predictors for procedural and anatomical complications … these factors are less effective at forecasting longer-term, patient-centered functional outcomes. Factors like frailty, malnutrition, and specific cardiac parameters are increasingly recognized as crucial determinants of post-TAVR recovery, yet they are not fully integrated into routine risk stratification”
Zhang et al. performed retrospective review of data from more than 200 TAVR patients treated at a single facility from 2021 to 2024. The mean age was 78.6 years old, and 52% were men.
The goal was to identify TAVR cases that resulted in a poor functional outcome. Poor functional outcomes were defined as TAVR cases where, after six months, the patient failed to see an absolute increase in left ventricular ejection fraction (LVEF) of >10% and failed to see an improvement of at least 50 meters in six-minute walk test distance.
Overall, the authors determined that 39.2% of patients experienced a poor functional outcome. They then reviewed those cases and focused on five independent predictors of a poor functional outcome six months after TAVR:
- Advanced age (80 years old or older)
- NT-proBNP > 3,000 pg/mL
- A clinical frailty score > 4
- Coronary artery disease
- Chronic kidney disease
“We did not find a significant association between conduction disturbances and poor functional outcomes in our cohort,” the authors noted. “While conduction issues are a known complication of TAVR, recent advances in valve design and implantation techniques may have mitigated their long-term functional impact compared to earlier studies. The primary drivers of poor functional recovery in our study appear to be baseline patient reserves and comorbidities rather than procedural complications.”
The team’s TAVR-PRO risk score was then developed with these five independent predictors in mind. When that risk score was put to the test, it was associated with an area under the ROC curve of 0.88. Higher TAVR-PRO scores were linked to a significantly higher risk of a poor functional outcome or all-cause mortality after one year.
“The TAVR-PRO score, a simple five-variable tool, effectively predicts poor six-month functional outcomes and one-year mortality after TAVR in elderly patients without cardiogenic shock or emergent surgery requirements,” the authors concluded. “Its implementation in clinical practice could enhance patient selection, inform shared decision-making, and help tailor peri-procedural care for high-risk individuals, ultimately optimizing the overall benefit of the TAVR procedure.”
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Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.