Key result
Advanced 1-year cardiac damage linked to ~544% higher death or HF risk without initial AVR.
Why the study?
Do higher cardiac damage stages at 1-year follow-up echocardiography predict the composite of all-cause death or heart failure hospitalization in patients with severe aortic stenosis?
Observational (n=1,991)
Do higher cardiac damage stages at 1-year follow-up echocardiography predict the composite of all-cause death or heart failure hospitalization in patients with severe aortic stenosis?
Effect estimate: HR 6.44 (95% CI 2.62-15)
p-value: p=0.003 for interaction
Cardiac damage staging at 1-year follow-up echocardiography is a useful prognostic tool for patients with severe aortic stenosis managed conservatively, but its prognostic value is attenuated in those who undergo initial AVR.
May aid 1-year cardiac damage staging for prognostication in conservatively managed severe AS; leaves open its value post-AVR and requires prospective validation.
Data on the impact of cardiac damage based on follow-up echocardiography at 1 year in patients with severe aortic stenosis (AS) are insufficient. The current study included 1991 patients with severe AS who underwent follow-up echocardiography at 1 year after the initial AVR strategy (n = 1211) and conservative management (n = 780) in the CURRENT AS Registry-2. In the initial AVR group, the higher adjusted risk for stage 1, 2, and 3 or 4 relative to stage 0 was not significant for the primary outcome (a composite of all-cause death or hospitalization for heart failure) (hazard ratio [HR] = 0.51, 95% confidence interval [CI] = 0.25–1.04; HR = 0.71, 95% CI = 0.39–1.29; and HR = 0.57, 95% CI = 0.22–1.48). Meanwhile, in the conservative management group, it was significant for the primary outcome (HR = 2.33, 95% CI = 0.99–5.52; HR = 2.89, 95% CI = 1.30–6.40; and HR = 6.44, 95% CI = 2.62–15). A significant association was observed between the initial treatment strategies and effects of cardiac damage stages at 1 year on the primary outcome (P interaction = 0.003). Cardiac damage stages based on follow-up echocardiography at 1 year were useful for prognostic stratification in patients who received conservative management, but not in those who underwent initial AVR. UMINID: UMIN000034169.
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Takeji et al. (2026) conducted an observational in severe aortic stenosis (n=1,991). Cardiac damage stages (1, 2, 3 or 4) vs. Stage 0 was evaluated on composite of all-cause death or hospitalization for heart failure (HR 6.44, 95% CI 2.62-15, p=0.003 for interaction). Cardiac damage stages at 1-year echocardiography predicted death or heart failure hospitalization in patients managed conservatively (stage 3/4 vs 0 HR 6.44; 95% CI 2.62-15) but not after initial AVR.
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