Decline in Functional Performance Predicts Later Increased Mobility Loss and Mortality in Peripheral Arterial Disease
Decline in Functional Performance Predicts Later Increased Mobility Loss and Mortality in Peripheral Arterial Disease
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DOI：
10.1016/j.jacc.2010.09.053
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发表时间：
2011-02-22
影响因子：
24
通讯作者：
Criqui, Michael H.
中科院分区：
文献类型：
--
作者：
McDermott, Mary M.;Liu, Kiang;Criqui, Michael H.
目的我们假设，在外周动脉疾病（PAD）患者中，2年内基于办公室的功能表现指标的下降与更大的活动能力丧失和死亡率相关。背景PAD患者功能表现下降与临床重要结局的关系尚不清楚。方法共有440名PAD男性和女性完成了6项研究，基线时和2年内每年进行一次最小步行试验和步行速度测量。参与者根据基线和2年随访之间的功能下降分为三分之一，并在功能变化评估后每年进行随访。考克斯比例风险模型被用来评估2年的功能性能与以后的死亡率和流动性损失的变化之间的关系，调整年龄，性别，种族，踝肱指数，合并症，和其他confronters.Results共102名参与者（23.2%）在44.5个月的中位随访后功能变化进行了评估。在319名没有基线移动残疾的参与者中，60名（18.8%）在评估功能变化后发生了移动丧失。在三分位数中，6分钟步行下降最大的参与者随后的活动能力丧失最高（风险比[HR]：3.50; 95%置信区间[CI]：1.56 - 7.85; p = 0.002），全因死亡率（HR：2.16; 95% CI：1.28 - 3.64; p = 0.004）和心血管疾病死亡率（HR：2.45; 95% CI：1.08 - 5.54; p = 0.031）。最快起搏的4米步行速度的下降与更高的活动能力丧失（p趋势= 0.018）、全因死亡率（p趋势= 0.01）和心血管死亡率（p趋势= 0.004.Conclusions PAD患者的功能表现下降，其后期活动能力丧失和死亡的风险增加。（J Am科尔心脏病学杂志2011;57：962-70）（C）美国心脏病学会基金会2011年
Objectives We hypothesized that a greater 2-year decline in office-based functional performance measures would be associated with greater mobility loss and mortality in people with peripheral arterial disease (PAD).Background Associations of decline in functional performance with clinically important outcomes in patients with PAD are unknown.Methods A total of 440 men and women with PAD completed the 6-min walk test and measures of walking velocity at baseline and annually for 2 years. Participants were categorized into tertiles according to their functional decline between baseline and 2-year follow-up and were followed annually after the functional change assessment. Cox proportional hazard models were used to assess relations between the 2-year change in functional performance with later mortality and mobility loss, with adjustments for age, sex, race, ankle brachial index, comorbidities, and other confounders.Results A total of 102 participants (23.2%) died during a median follow-up of 44.5 months after functional change was assessed. Of 319 participants without baseline mobility disability, 60 (18.8%) developed mobility loss after functional change was assessed. Participants in the tertile with the greatest 6-min walk decline had the highest subsequent mobility loss (hazard ratio [HR]: 3.50; 95% confidence interval [CI]: 1.56 to 7.85; p = 0.002), all-cause mortality (HR: 2.16; 95% CI: 1.28 to 3.64; p = 0.004), and cardiovascular disease mortality (HR: 2.45; 95% CI: 1.08 to 5.54; p = 0.031), compared with those with the smallest 6-min walk decline. Greater declines in fastest-paced 4-m walking velocity were associated with higher mobility loss (p trend = 0.018), all-cause mortality (p trend = 0.01), and cardiovascular mortality (p trend = 0.004).Conclusions Participants with PAD with declining functional performance are at increased risk for later mobility loss and mortality. (J Am Coll Cardiol 2011;57:962-70) (C) 2011 by the American College of Cardiology Foundation