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Different clinical outcomes in patients with asymptomatic severe aortic stenosis according to the stage classification: Does the aortic valve area matter?
- Source :
-
International journal of cardiology [Int J Cardiol] 2017 Feb 01; Vol. 228, pp. 244-252. Date of Electronic Publication: 2016 Nov 11. - Publication Year :
- 2017
-
Abstract
- Background: The ACC/AHA guidelines introduced a new classification of severe aortic stenosis (AS) mainly based on maximum jet velocity (Vmax) and mean pressure gradient (mPG), but not on aortic valve area (AVA). However, prognostic value of this new classification has not yet been fully evaluated.<br />Methods and Results: We studied 1512 patients with asymptomatic severe AS enrolled in the CURRENT AS registry in whom surgery was not initially planned. Patients were divided into 2 groups: Group 1 (N=122) comprised patients who met the recommendation for surgery; high-gradient (HG)-AS (Vmax≥4.0m/s or mPG≥40mmHg) with ejection fraction (EF)<50%, or very HG-AS (Vmax≥5.0m/s or mPG≥60mmHg), and Group 2 (N=1390) comprised patients who did not meet this recommendation. Group 2 was further subdivided into HG-AS with preserved EF (HGpEF-AS, N=498) and low-gradient (LG)-AS, but AVA<1.0cm <superscript>2</superscript> (N=892). The excess risk of Group 1 relative to Group 2 for the primary outcome measure (a composite of aortic valve-related death or heart failure hospitalization) was significant (adjusted HR: 1.92, 95%CI: 1.37-2.68, P<0.001). The excess risk of HGpEF-AS relative to LG-AS for the primary outcome measure was also significant (adjusted HR: 1.45, 95%CI: 1.11-1.89, P=0.006). Among LG-AS patients, patients with reduced EF (<50%) (LGrEF-AS, N=103) had extremely high cumulative 5-year incidence of all-cause death (85.5%).<br />Conclusion: Trans-aortic valve gradient in combination with EF was a good prognostic marker in patients with asymptomatic AS. However, patients with LGrEF-AS had extremely poor prognosis when managed conservatively.<br /> (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)
- Subjects :
- Aged
Aged, 80 and over
Aortic Valve Stenosis mortality
Aortic Valve Stenosis physiopathology
Cohort Studies
Conservative Treatment methods
Echocardiography
Female
Heart Valve Prosthesis Implantation methods
Humans
Male
Middle Aged
Patient Selection
Predictive Value of Tests
Prognosis
Proportional Hazards Models
Retrospective Studies
Risk Assessment
Severity of Illness Index
Societies, Medical
Survival Rate
Treatment Outcome
Aortic Valve pathology
Aortic Valve Stenosis classification
Aortic Valve Stenosis therapy
Registries
Stroke Volume physiology
Subjects
Details
- Language :
- English
- ISSN :
- 1874-1754
- Volume :
- 228
- Database :
- MEDLINE
- Journal :
- International journal of cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 27865193
- Full Text :
- https://doi.org/10.1016/j.ijcard.2016.11.092