Increasing risk of mortality across the spectrum of aortic stenosis is independent of comorbidity & treatment: An international, parallel cohort study of 248,464 patients

Figures

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  Fig 1. Study flowchart. This flowchart shows the parallel points of inclusion and exclusion across the two study cohort–including 1,081 (US) / 184,405 (Australia) cases with evidence of prior aortic valve replacement excluded from study analyses.

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  Fig 2. Adjusted all-cause mortality according to AS stage. These adjusted Kaplan-Meier curves evaluate the risk of all-cause mortality over 10-years from the last echocardiogram according to AS severity in Australian (2A; left) and US (2B; right) cohorts when adjusting for age, sex, left ventricular ejection fraction, and presence of left heart disease.

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  Fig 3. Fully adjusted all-cause mortality according to AS stage. These adjusted Kaplan-Meier curves evaluate the risk of all-cause mortality over 10-years from the last echocardiogram according to AS severity in Australian (A) and US (B) cohorts when fully adjusting for all confounders (based on available data for each cohort.

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  Fig 4. Risk of all-cause mortality according to clinical factors. The forest plot denotes the risk of all-cause mortality occurring within 10 years across the full spectrum of AS when further adjusting for a comprehensive list of clinical factors.

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  Fig 5. Actual 5-year rates and odds ratios for all-cause mortality by AS stage stratified by left ventricular ejection fraction category. This graph compares actual 5-year mortality (all-cause) associated with moderate AS versus the rest of the cohort when excluding all severe AS cases, according to LVEF quantified at the same time-point (last echocardiogram). Age and sex-adjusted odd ratios (95% CI) for mortality per group are shown above the bars (moderate AS group versus rest with *p<0.05, ** p<0.01 and ***p<0.001 for that group comparison) derived from multiple logistic regression. Actual 5-year mortality rates across the four LVEF subgroups (moderate AS versus rest) were—110/187 (58.8%) vs. 1427/4083 (34.9%), 81/211 (38.4%) vs. 851/3208 (26.5%), 171/585 (29.2%) vs. 1667/8038 (20.7%) and 452/1998 (22.6%) vs. 3230/19,599 (16.5%).

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  Fig 6. Actual 5-year rates and odds ratios for cardiovascular-related mortality by AS stage stratified by left ventricular ejection fraction category. This graph compares actual 5-year mortality (cardiovascular-related) associated with moderate AS versus the rest of the cohort when excluding all severe AS cases, according to LVEF quantified at the same time-point (last echocardiogram). Age and sex-adjusted odd ratios (95% CI) for mortality per group are shown above the bars (moderate AS group versus rest with *p<0.05, ** p<0.01 and ***p<0.001 for that group comparison) derived from multiple logistic regression. Actual 5-year cardiovascular-related mortality rates across the four LVEF subgroups (moderate AS versus rest) were—70/187 (21%) vs. 755/4083 (16%), 46/211 (21.8%) vs. 366/3208 (11.4%), 85/585 (14.5%) vs. 611/8038 (7.6%) and 191/1998 (9.6%) vs. 1049/19,599 (15.4%).