Lionel Tastet1, Christophe Tribouilloy2, Sylvestre Maréchaux3, E Mara Vollema4, Victoria Delgado4, Erwan Salaun1, Mylène Shen1, Romain Capoulade5, Marie-Annick Clavel1, Marie Arsenault1, Élisabeth Bédard1, Mathieu Bernier1, Jonathan Beaudoin1, Jagat Narula6, Patrizio Lancellotti7, Jeroen J Bax4, Philippe Généreux8, Philippe Pibarot9. 1. Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada. 2. Department of Cardiology, Amiens University Hospital Center, Amiens, France. 3. Department of Cardiology, GCS-Hospital Group of the Catholic Institute of Lille, Catholic University of Lille, Lille, France. 4. Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, Leiden, the Netherlands. 5. Thoracic Institute, French National Institute of Health and Medical Research (INSERM), French National Center for Scientific Research (CNRS), University Hospital Center of Nantes, University of Nantes, Nantes, France. 6. Department of Cardiology, Mount Sinai Hospital, New York, New York. 7. Department of Cardiology, GIGA Cardiovascular Sciences, Cardio-Oncology Clinic, University of Liège Hospital, Sart Tilman University Hospital Center, Liège, Belgium. 8. Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Department of Cardiology, Sacré-Coeur Hospital of Montréal, Montréal, Québec, Canada. 9. Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada. Electronic address: philippe.pibarot@med.ulaval.ca.
Abstract
BACKGROUND: The optimal timing of intervention in patients with asymptomatic severe aortic stenosis (AS) remains controversial. OBJECTIVES: This multicenter study sought to test and validate the prognostic value of the staging of cardiac damage in patients with asymptomatic moderate to severe AS. METHODS: This study retrospectively analyzed the clinical, Doppler echocardiographic, and outcome data that were prospectively collected in 735 asymptomatic patients (71 ± 14 years of age; 60% men) with at least moderate AS (aortic valve area <1.5 cm2) and preserved left ventricular ejection fraction (≥50%) followed in the heart valve clinics of 4 high-volume centers. Patients were classified according to the following staging classification: no cardiac damage associated with the valve stenosis (Stage 0), left ventricular damage (Stage 1), left atrial or mitral valve damage (Stage 2), pulmonary vasculature or tricuspid valve damage (Stage 3), or right ventricular damage or subclinical heart failure (Stage 4). The primary endpoint was all-cause mortality. RESULTS: At baseline, 89 (12%) patients were classified in Stage 0, 200 (27%) in Stage 1, 341 (46%) in Stage 2, and 105 (14%) in Stage 3 or 4. Median follow-up was 2.6 years (interquartile range: 1.1 to 5.2 years). There was a stepwise increase in mortality rates according to staging: 13% in Stage 0, 25% in Stage 1, 44% in Stage 2, and 58% in Stages 3 to 4 (p < 0.0001). The staging was significantly associated with excess mortality in multivariable analysis adjusted for aortic valve replacement as a time-dependent variable (hazard ratio: 1.31 per each increase in stage; 95% CI: 1.06 to 1.61; p = 0.01), and showed incremental value to several clinical variables (net reclassification index = 0.34; p = 0.003). CONCLUSIONS: The new staging system characterizing the extra-aortic valve cardiac damage provides incremental prognostic value in patients with asymptomatic moderate to severe AS. This staging classification may be helpful to identify asymptomatic AS patients who may benefit from elective aortic valve replacement.
BACKGROUND: The optimal timing of intervention in patients with asymptomatic severe aortic stenosis (AS) remains controversial. OBJECTIVES: This multicenter study sought to test and validate the prognostic value of the staging of cardiac damage in patients with asymptomatic moderate to severe AS. METHODS: This study retrospectively analyzed the clinical, Doppler echocardiographic, and outcome data that were prospectively collected in 735 asymptomatic patients (71 ± 14 years of age; 60% men) with at least moderate AS (aortic valve area <1.5 cm2) and preserved left ventricular ejection fraction (≥50%) followed in the heart valve clinics of 4 high-volume centers. Patients were classified according to the following staging classification: no cardiac damage associated with the valve stenosis (Stage 0), left ventricular damage (Stage 1), left atrial or mitral valve damage (Stage 2), pulmonary vasculature or tricuspid valve damage (Stage 3), or right ventricular damage or subclinical heart failure (Stage 4). The primary endpoint was all-cause mortality. RESULTS: At baseline, 89 (12%) patients were classified in Stage 0, 200 (27%) in Stage 1, 341 (46%) in Stage 2, and 105 (14%) in Stage 3 or 4. Median follow-up was 2.6 years (interquartile range: 1.1 to 5.2 years). There was a stepwise increase in mortality rates according to staging: 13% in Stage 0, 25% in Stage 1, 44% in Stage 2, and 58% in Stages 3 to 4 (p < 0.0001). The staging was significantly associated with excess mortality in multivariable analysis adjusted for aortic valve replacement as a time-dependent variable (hazard ratio: 1.31 per each increase in stage; 95% CI: 1.06 to 1.61; p = 0.01), and showed incremental value to several clinical variables (net reclassification index = 0.34; p = 0.003). CONCLUSIONS: The new staging system characterizing the extra-aortic valve cardiac damage provides incremental prognostic value in patients with asymptomatic moderate to severe AS. This staging classification may be helpful to identify asymptomatic AS patients who may benefit from elective aortic valve replacement.
Authors: Andreea Calin; Anca D Mateescu; Andreea C Popescu; Rong Bing; Marc R Dweck; Bogdan A Popescu Journal: Heart Date: 2020-03-16 Impact factor: 5.994
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