Geoff Strange1, Simon Stewart2, David Celermajer3, David Prior4, Gregory M Scalia5, Thomas Marwick6, Marcus Ilton7, Majo Joseph8, Jim Codde9, David Playford10. 1. School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia. Electronic address: gstrange@neda.net.au. 2. Torrens University Australia, Adelaide, South Australia, Australia. 3. Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia. 4. University of Melbourne, St. Vincent's Hospital, Melbourne, Victoria, Australia. 5. University of Queensland, The Prince Charles Hospital, Brisbane, Queensland, Australia. 6. Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia. 7. Menzies School of Health Research, Royal Darwin Hospital, Darwin, Northern Territory, Australia. 8. Flinders University, Adelaide, South Australia, Australia. 9. University of Notre Dame, Fremantle, Western Australia, Australia. 10. School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia.
Abstract
BACKGROUND: Historical data suggesting poor survival in patients with aortic stenosis (AS) who do not undergo treatment are largely confined to patients with severe AS. OBJECTIVES: This study sought to determine the prognostic impact of all levels of native valvular AS. METHODS: Severity of AS was characterized by convention and by statistical distribution in 122,809 male patients (mean age 61 ± 17 years) and 118,494 female patients (mean age 62 ± 19 years), with measured aortic valve (AV) mean gradient, peak velocity, and/or area. The relationship between AS severity and survival was then examined during median 1,208 days (interquartile range: 598 to 2,177 days) of follow-up. Patients with previous aortic valve intervention were excluded. RESULTS: Overall, 16,129 (6.7%), 3,315 (1.4%), and 6,383 (2.6%) patients had mild, moderate, and severe AS, respectively. On an adjusted basis (vs. no AS; 5-year mortality 19%), patients with mild to severe AS had an increasing risk of long-term mortality (adjusted hazard ratio: 1.44 to 2.09; p < 0.001 for all comparisons). The 5-year mortality was 56% and 67%, respectively, in those with moderate AS (mean gradient 20.0 to 39.0 mm Hg/peak velocity 3.0 to 3.9 m/s) and severe AS (≥40.0 mm Hg, ≥4.0 m/s, or AV area <1.0 cm2 in low-flow, low-gradient severe AS). A markedly increased risk of death from all causes (5-year mortality >50%) and cardiovascular disease was evident from a mean AV gradient >20.0 mm Hg (moderate AS) after adjusting for age, sex, left ventricular systolic or diastolic dysfunction, and aortic regurgitation. CONCLUSIONS: These data confirm that when left untreated, severe AS is associated with poor long-term survival. Moreover, they also suggest poor survival rates in patients with moderate AS. (National Echocardiographic Database of Australia [NEDA]; ACTRN12617001387314).
BACKGROUND: Historical data suggesting poor survival in patients with aortic stenosis (AS) who do not undergo treatment are largely confined to patients with severe AS. OBJECTIVES: This study sought to determine the prognostic impact of all levels of native valvular AS. METHODS: Severity of AS was characterized by convention and by statistical distribution in 122,809 male patients (mean age 61 ± 17 years) and 118,494 female patients (mean age 62 ± 19 years), with measured aortic valve (AV) mean gradient, peak velocity, and/or area. The relationship between AS severity and survival was then examined during median 1,208 days (interquartile range: 598 to 2,177 days) of follow-up. Patients with previous aortic valve intervention were excluded. RESULTS: Overall, 16,129 (6.7%), 3,315 (1.4%), and 6,383 (2.6%) patients had mild, moderate, and severe AS, respectively. On an adjusted basis (vs. no AS; 5-year mortality 19%), patients with mild to severe AS had an increasing risk of long-term mortality (adjusted hazard ratio: 1.44 to 2.09; p < 0.001 for all comparisons). The 5-year mortality was 56% and 67%, respectively, in those with moderate AS (mean gradient 20.0 to 39.0 mm Hg/peak velocity 3.0 to 3.9 m/s) and severe AS (≥40.0 mm Hg, ≥4.0 m/s, or AV area <1.0 cm2 in low-flow, low-gradient severe AS). A markedly increased risk of death from all causes (5-year mortality >50%) and cardiovascular disease was evident from a mean AV gradient >20.0 mm Hg (moderate AS) after adjusting for age, sex, left ventricular systolic or diastolic dysfunction, and aortic regurgitation. CONCLUSIONS: These data confirm that when left untreated, severe AS is associated with poor long-term survival. Moreover, they also suggest poor survival rates in patients with moderate AS. (National Echocardiographic Database of Australia [NEDA]; ACTRN12617001387314).
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