Association between short physical performance battery and mortality after transcatheter aortic valve implantation
T Nakade, Y Matsue, J Cao, E Sato, S Moriya, R Nishio, Y Nozaki, N Takahashi, S Doi, N Kagiyama, T Kaneko, S Miyazaki, H Iwata, S Okazaki, T MinaminoAbstract
Background
Older adults undergoing transcatheter aortic valve implantation (TAVI) often have impaired functional reserve that is not fully captured by conventional risk scores. In contemporary practice, frailty is frequently assessed using the Clinical Frailty Scale (CFS); however, CFS is inherently subjective and may not quantify lower-extremity performance. The Short Physical Performance Battery (SPPB) provides an objective, multidomain assessment of physical function, yet its prognostic utility after TAVI, particularly beyond CFS, remains unclear.
Purpose
To assess whether preprocedural SPPB is independently associated with long-term all-cause mortality after TAVI. We also examined whether SPPB provides incremental prognostic information beyond established clinical variables and the CFS.
Methods
We conducted a retrospective cohort study of consecutive patients undergoing TAVI between February 2016 and May 2025 at a single centre. SPPB was assessed preprocedurally and categorised as low (≤9) vs high (>9). The primary outcome was all-cause mortality. Time-to-event analyses were administratively censored at 5 years. Multivariable Cox models adjusted for age, Society of Thoracic Surgeons risk score, access route, haemoglobin, and NT-proBNP. Sensitivity analyses additionally adjusted for the CFS. In addition, we constructed three prespecified risk models to evaluate the incremental prognostic value of SPPB. Model 1 included age, the STS risk score, access route, haemoglobin, and NT-proBNP. Model 2 added the CFS to Model 1. Model 3 further added SPPB category to Model 2. Model discrimination was assessed using the area under the receiver operating characteristic curve (AUC), and reclassification was assessed using continuous net reclassification improvement (NRI).
Results
Among 968 patients with available SPPB (median age 84 years; 60.2% women), 415 (42.9%) had low SPPB. Over a median follow-up of 2.61 years, 118 deaths occurred. Low SPPB was associated with higher mortality (log-rank P<0.001) and remained independently associated after multivariable adjustment (adjusted HR 2.62, 95% CI 1.74–3.96; P<0.001). The association was robust to additional adjustment for CFS (adjusted HR 1.99, 95% CI 1.28–3.09; P=0.002). When modelled as a continuous variable, lower SPPB was similarly associated with higher mortality (per 1-point lower SPPB: adjusted HR 1.14, 95% CI 1.08–1.19; P<0.001), including after additional adjustment for CFS (adjusted HR 1.09, 95% CI 1.04–1.16; P=0.001). Adding SPPB to a model including conventional variables plus CFS improved discrimination (AUC 0.704 vs 0.679; P=0.029) and risk reclassification (NRI 0.288, 95% CI 0.092–0.485; P=0.004).
Conclusion
Low preprocedural SPPB is common and independently associated with higher post-TAVI mortality. Incorporating SPPB into preprocedural assessment provides incremental, clinically interpretable prognostic information beyond standard risk variables and clinician-rated frailty.Figure_1Figure_2