In patients with moderate aortic stenosis and pulmonary hypertension or right ventricular dysfunction, mortality risk was similar to those with severe aortic stenosis (HR 0.96).
Does extra-aortic cardiac damage staging predict mortality risk in patients with moderate compared to asymptomatic severe aortic stenosis?
Extra-aortic cardiac damage staging identifies patients with moderate aortic stenosis who have a mortality risk comparable to those with severe aortic stenosis, particularly when pulmonary hypertension or RV dysfunction is present.
Absolute Event Rate: 0% vs 0%
Abstract Background Extra-aortic cardiac damage staging has been increasingly recognized for its prognostic value in aortic stenosis (AS). However, it is still unknown whether it might help identify high risk patients across moderate and severe AS. Aim of this study was therefore to investigate whether this staging is additionally associated with outcome in patients with moderate AS compared to asymptomatic severe AS. Methods Patients were included from a multicentre international registry and categorized into five extra-aortic cardiac damage stages: Stage 0-no cardiac damage; Stage 1-left ventricular (LV) damage:LV hypertrophy, or E/e′ 14, or LV ejection fraction 50%; Stage 2-left atrium (LA) or mitral valve damage:LA enlargement (34 mL/m²), atrial fibrillation (AF), or significant mitral regurgitation; Stage 3-pulmonary hypertension:systolic pulmonary artery pressure (SPAP) ≥60 mmHg or significant tricuspid regurgitation; Stage 4-right ventricular dysfunction:tricuspid annular plane systolic excursion 16 mm. Patients were further stratified based on AS severity and the specific stage, for which stages 1/2 and 3/4 were pooled respectively to reduce groups’ comparisons. Outcome was all-cause mortality at 5 years. Aortic valve replacement (AVR) was treated as a time-dependent covariate. Results A total of 2057 patients were included, of which 1645 were moderate AS (Stage 0/1/2/3/4: N=250/341/746/79/168), and 412 were asymptomatic severe AS (Stage 0/1/2/3/4: N=51/150/139/11/56). Baseline characteristics are detailed in Figure 1. Within the same stage, severe AS was associated with lower comorbidity burden (including AF), smaller LA volume and SPAP, but greater LV thickness. Cox models adjusting for age, sex, comorbidities, renal function, symptoms, and AVR showed that as compared to Stage 0, each group showed higher mortality risk (all P0.01). In addition, while moderate AS at Stage 1/2 was associated with lower risk than severe AS at stage1/2 (HR 0.73, 95%CI 0.54-0.98, P= 0.036), moderate AS at Stage 3/4 showed comparable risk as severe AS at Stage 1/2 (HR 0.96, 95%CI 0.68-1.36, P= 0.819) and severe AS at Stage 3/4 (HR 1.22, 95%CI 0.77-1.93, P= 0.387). These differences were consistently observed in the adjusted survival curves censored at 5 years or AVR (Figure 2). Conclusion In patients with moderate or asymptomatic severe AS, extra-aortic cardiac damage was associated with mortality beyond AS severity. While at early-stage moderate AS had better outcomes than severe AS, development of pulmonary hypertension or RV dysfunction identified patients at similar high risk, even if with only moderate AS, highlighting the importance of timely diagnosis and potential treatment for these patients.
He et al. (Thu,) reported a other. In patients with moderate aortic stenosis and pulmonary hypertension or right ventricular dysfunction, mortality risk was similar to those with severe aortic stenosis (HR 0.96).