Cardiac Damage Stages and Clinical Outcomes in Patients With Severe Aortic Stenosis

The prognostic impact of cardiac damage staging in severe aortic stenosis (AS) based on gradient patterns, symptoms, and initial treatment strategies is not well understood. This study aimed to assess the differences in characteristics and clinical outcomes of AS patients according to cardiac damage stage, stratified by gradient patterns, symptoms, and treatment strategies. A total of 3,369 consecutive patients with severe AS (high-gradient HG AS, n = 1986; low-gradient LG AS, n = 1,383) from the CURRENT AS registry-2 were included. Cardiac damage was categorized into 4 groups (stage 0, stage 1, stage 2, and stage 3/4). The cumulative incidence of the primary outcome (all-cause death or heart failure hospitalization) increased with advancing cardiac damage stages in both HG and LG AS. Adjusted HRs for stages 1, 2, and 3/4 vs stage 0 were significantly higher in both HG and LG cohorts (HG AS: HR: 2.47; 95% CI: 1.23-4.96 stage 1; HR: 3.39; 95% CI: 1.72-6.67 stage 2; HR: 4.01; 95% CI: 1.95-8.25 stage 3/4; LG AS: HR: 1.72; 95% CI: 1.04-2.84 stage 1; HR: 2.28; 95% CI: 1.44-3.61 stage 2; HR: 2.95; 95% CI: 1.79-4.88 stage 3/4). The higher risk of the primary outcome with more advanced cardiac damage was consistent regardless of the presence of symptoms and the initial treatment strategies in both HG and LG AS. Cardiac damage staging is a useful tool for prognostic stratification in patients with severe AS, independent of gradient patterns, symptoms, and initial treatment strategies.