E Mara Vollema1, Mohammed R Amanullah2, Arnold C T Ng3, Pieter van der Bijl1, Francesca Prevedello1, Yoong Kong Sin4, Edgard A Prihadi1, Nina Ajmone Marsan1, Zee Pin Ding2, Philippe Généreux5, Philippe Pibarot6, Martin B Leon7, Jagat Narula8, See Hooi Ewe2, Victoria Delgado1, Jeroen J Bax9. 1. Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands. 2. Department of Cardiology, National Heart Centre Singapore, Singapore. 3. Department of Cardiology, Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland, Australia. 4. Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore. 5. Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey; Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada. 6. Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada. 7. Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; New York-Presbyterian Hospital/Columbia University, Medical Center, New York, New York. 8. Mount Sinai Hospital, New York, New York. 9. Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: j.j.bax@lumc.nl.
Abstract
BACKGROUND: In severe aortic stenosis (AS), patients often show extra-aortic valvular injury. Recently, a new staging system for severe AS has been proposed on the basis of the extent of cardiac damage. OBJECTIVES: The present study evaluated the prevalence and prognostic impact of these different stages of cardiac damage in a large, real-world, multicenter cohort of symptomatic severe AS patients. METHODS: From the ongoing registries from 2 academic institutions, a total of 1,189 symptomatic severe AS patients were selected and retrospectively analyzed. According to the extent of cardiac damage on echocardiography, patients were classified as Stage 0 (no cardiac damage), Stage 1 (left ventricular damage), Stage 2 (mitral valve or left atrial damage), Stage 3 (tricuspid valve or pulmonary artery vasculature damage), or Stage 4 (right ventricular damage). Patients were followed for all-cause mortality and combined endpoint (all-cause mortality, stroke, and cardiac-related hospitalization). RESULTS: On the basis of the proposed classification, 8% of patients were classified as Stage 0, 24% as Stage 1, 49% as Stage 2, 7% as Stage 3, and 12% as Stage 4. On multivariable analysis, cardiac damage was independently associated with all-cause mortality and combined outcome, although this was mainly determined by Stages 3 and 4. CONCLUSIONS: In this large multicenter cohort of symptomatic severe AS patients, stage of cardiac injury as classified by a novel staging system was independently associated with all-cause mortality and combined endpoint, although this seemed to be predominantly driven by tricuspid valve or pulmonary artery vasculature damage (Stage 3) and right ventricular dysfunction (Stage 4).
BACKGROUND: In severe aortic stenosis (AS), patients often show extra-aortic valvular injury. Recently, a new staging system for severe AS has been proposed on the basis of the extent of cardiac damage. OBJECTIVES: The present study evaluated the prevalence and prognostic impact of these different stages of cardiac damage in a large, real-world, multicenter cohort of symptomatic severe AS patients. METHODS: From the ongoing registries from 2 academic institutions, a total of 1,189 symptomatic severe AS patients were selected and retrospectively analyzed. According to the extent of cardiac damage on echocardiography, patients were classified as Stage 0 (no cardiac damage), Stage 1 (left ventricular damage), Stage 2 (mitral valve or left atrial damage), Stage 3 (tricuspid valve or pulmonary artery vasculature damage), or Stage 4 (right ventricular damage). Patients were followed for all-cause mortality and combined endpoint (all-cause mortality, stroke, and cardiac-related hospitalization). RESULTS: On the basis of the proposed classification, 8% of patients were classified as Stage 0, 24% as Stage 1, 49% as Stage 2, 7% as Stage 3, and 12% as Stage 4. On multivariable analysis, cardiac damage was independently associated with all-cause mortality and combined outcome, although this was mainly determined by Stages 3 and 4. CONCLUSIONS: In this large multicenter cohort of symptomatic severe AS patients, stage of cardiac injury as classified by a novel staging system was independently associated with all-cause mortality and combined endpoint, although this seemed to be predominantly driven by tricuspid valve or pulmonary artery vasculature damage (Stage 3) and right ventricular dysfunction (Stage 4).
Authors: Taishi Okuno; Dik Heg; Jonas Lanz; Stefan Stortecky; Fabien Praz; Stephan Windecker; Thomas Pilgrim Journal: Int J Cardiol Heart Vasc Date: 2021-04-01
Authors: Christopher J Allen; Jubin Joseph; Tiffany Patterson; Matthew Hammond-Haley; Hannah Z R McConkey; Bernard D Prendergast; Michael Marber; Simon R Redwood Journal: J Am Heart Assoc Date: 2020-11-26 Impact factor: 5.501