Eri Minamino-Muta1, Takao Kato1, Takeshi Morimoto2, Tomohiko Taniguchi1, Kenji Ando3, Norio Kanamori4, Koichiro Murata5, Takeshi Kitai6, Yuichi Kawase7, Makoto Miyake8, Chisato Izumi9, Hirokazu Mitsuoka10, Masashi Kato11, Yutaka Hirano12, Shintaro Matsuda1, Kazuya Nagao13, Tomoyuki Murakami14, Yasuyo Takeuchi15, Keiichiro Yamane16, Mamoru Toyofuku17, Mitsuru Ishii18, Moriaki Inoko19, Tomoyuki Ikeda20, Katsuhisa Ishii21, Kozo Hotta22, Toshikazu Jinnai23, Yoshihiro Kato24, Yasutaka Inuzuka25, Chiyo Maeda26, Yuko Morikami27, Naritatsu Saito1, Kenji Minatoya28, Takeshi Kimura1. 1. Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan. 2. Department of Clinical Epidemiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan. 3. Department of Cardiology, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-ku, Kokura, Fukuoka 802-8555, Japan. 4. Division of Cardiology, Shimada Municipal Hospital, 1200-5 Noda, Shimada, Shizuoka 427-8502, Japan. 5. Department of Cardiology, Shizuoka City Shizuoka Hospital, 10-93 Otemachi, Aoi-ku, Shizuoka 420-8630, Japan. 6. Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamimachi, Chuo-ku, Kobe-City, Hyogo 650-0047, Japan. 7. Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan. 8. Department of Cardiology, Tenri Hospital, Tenri, Japan. 9. Division of Heart Failure, National Cerebral and Cardiovascular Center, 200 Mishima-cho, Tenri, Nara 632-8555, Japan. 10. Division of Cardiology, Nara Hospital, Kinki University Faculty of Medicine, 1248-1 Otoda-cho, Ikoma, Nara 630-0293, Japan. 11. Department of Cardiology, Mitsubishi Kyoto Hospital, 1 Katsuragosho-cho, Nishigyo-ku, Kyoto 615-8087, Japan. 12. Department of Cardiology, Kinki University Hospital, 377-2 Ohno-higashi, Sayama, Osaka 589-8511, Japan. 13. Department of Cardiovascular Center, Osaka Red Cross Hospital, 5-30 Hudegasaki, Tennoji-Ku, Osaka 543-8555, Japan. 14. Department of Cardiology, Koto Memorial Hospital, 2-1 Hiramatsu-cho, Higashioumi, Shiga 527-0134, Japan. 15. Department of Cardiology, Shizuoka General Hospital, 4-27-1 Kitaando-cho, Aoi-ku, Shizuoka 420-8257, Japan. 16. Department of Cardiology, Nishikobe Medical Center, 5-7-1 Kojida-, Nishi-ku, Kobe 651-2273, Japan. 17. Department of Cardiology, Japanese Red Cross Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama 640-8558, Japan. 18. Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto 612-8555, Japan. 19. Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, 2-4-20 Ohgimachi, Kita-ku, Osaka 530-8480, Japan. 20. Department of Cardiology, Hikone Municipal Hospital, 1882 Yasaka-cho, Hikone, Shiga 522-8539, Japan. 21. Department of Cardiology, Kansai Electric Power Hospital, 2-1-7 Fukushima, Fukushima-ku, Osaka 553-0003, Japan. 22. Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashi-naniwa-cho, Amagasaki, Hyogo 660-8550, Japan. 23. Department of Cardiology, Japanese Red Cross Otsu Hospital, 1-1-35 Nagara, Otsu, Shiga 520-0046, Japan. 24. Department of Cardiology, Saiseikai Noe Hospital, 1-3-25 Furuichi, Joto-ku, Osaka 536-0001, Japan. 25. Department of Cardiology, Shiga Medical Center for Adults, 5-4-3 Moriyama, Moriyama, Shiga 524-8524, Japan. 26. Department of Cardiology, Hamamatsu Rosai Hospital, 25 Shogen-cho, Higashi-ku, Hamamatsu, Shizuoka 430-8525, Japan. 27. Department of Cardiology, Hirakata Kohsai Hospital, 1-2-2-1 Hujisakahigashi-cho, Hirakata, Osaka 573-0153, Japan. 28. Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
Abstract
AIMS: Early aortic valve replacement (AVR) might be beneficial in selected high-risk asymptomatic patients with severe aortic stenosis (AS), considering their poor prognosis when managed conservatively. This study aimed to develop and validate a clinical scoring system to predict AS-related events within 1 year after diagnosis in asymptomatic severe AS patients. METHODS AND RESULTS: We analysed 1274 asymptomatic severe AS patients derived from a retrospective multicentre registry enrolling consecutive patients with severe AS in Japan (CURRENT AS registry), who were managed conservatively and completed 1-year follow-up without AVR. From a randomly assigned derivation set (N = 849), we developed CURRENT AS risk score for the AS-related event (a composite of AS-related death and heart failure hospitalization) within 1 year using a multivariable logistic regression model. The risk score comprised independent risk predictors including left ventricular ejection fraction <60%, haemoglobin ≤11.0 g/dL, chronic lung disease (2 points), diabetes mellitus, haemodialysis, and any concomitant valve disease (1 point). The predictive accuracy of the model was good with the area under the curve of 0.79 and 0.77 in the derivation and validation sets (N = 425). In the validation set, the 1-year incidence of AS-related events was much higher in patients with score ≥2 than in patients with score ≤1 (Score 0: 2.2%, Score 1: 1.9%, Score 2: 13.4%, Score 3: 14.3%, and Score ≥4: 22.7%, P < 0.001). CONCLUSION: The CURRENT-AS risk score integrating clinical and echocardiographic factors well-predicted the risk of AS-related events at 1 year in asymptomatic patients with severe AS and was validated internally. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Early aortic valve replacement (AVR) might be beneficial in selected high-risk asymptomatic patients with severe aortic stenosis (AS), considering their poor prognosis when managed conservatively. This study aimed to develop and validate a clinical scoring system to predict AS-related events within 1 year after diagnosis in asymptomatic severe AS patients. METHODS AND RESULTS: We analysed 1274 asymptomatic severe AS patients derived from a retrospective multicentre registry enrolling consecutive patients with severe AS in Japan (CURRENT AS registry), who were managed conservatively and completed 1-year follow-up without AVR. From a randomly assigned derivation set (N = 849), we developed CURRENT AS risk score for the AS-related event (a composite of AS-related death and heart failure hospitalization) within 1 year using a multivariable logistic regression model. The risk score comprised independent risk predictors including left ventricular ejection fraction <60%, haemoglobin ≤11.0 g/dL, chronic lung disease (2 points), diabetes mellitus, haemodialysis, and any concomitant valve disease (1 point). The predictive accuracy of the model was good with the area under the curve of 0.79 and 0.77 in the derivation and validation sets (N = 425). In the validation set, the 1-year incidence of AS-related events was much higher in patients with score ≥2 than in patients with score ≤1 (Score 0: 2.2%, Score 1: 1.9%, Score 2: 13.4%, Score 3: 14.3%, and Score ≥4: 22.7%, P < 0.001). CONCLUSION: The CURRENT-AS risk score integrating clinical and echocardiographic factors well-predicted the risk of AS-related events at 1 year in asymptomatic patients with severe AS and was validated internally. Published on behalf of the European Society of Cardiology. All rights reserved.