Association Between the Degree of Extravalvular Cardiac Damage and the Severity of Aortic Stenosis

Q: What are the key findings of this study?

Extravalvular cardiac damage (stage >0) was associated with a significantly higher risk of all-cause mortality compared to no cardiac damage (HR 1.75) across the spectrum of aortic stenosis.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Aortic stenosis (n=1747). Intervention: Extravalvular cardiac damage (stage >0) vs. No extravalvular cardiac damage (stage 0). Primary outcome: All-cause mortality (HR 1.75, 95% CI 1.44-2.11, p=<0.001).

Q: What does this research mean for the field?

Extravalvular cardiac damage stage >0 correlates with aortic stenosis severity and is associated with significantly higher all-cause and cardiovascular mortality compared to stage 0 across all stages of the disease. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To investigate the correlation between aortic stenosis severity and extravalvular cardiac damage staging, and to evaluate its clinical impact across the spectrum of aortic stenosis outpatients.

Augustin Coisne; Rubens Groulez; Camille Diharce; David Montaigne; Gilles Lemesle; Sandro Ninni; Samy Aghezzaf; Arnaud Sudre; Thomas Modine; André Vincentelli; Marie Jungling; Philippe Généreux; Sebastian Ludwig; Martin Leon; Juan Granada; Christophe Bauters

doi:10.1016/j.jacadv.2026.103227

September 10, 2026JACC AdvancesOpen Access

Association Between the Degree of Extravalvular Cardiac Damage and the Severity of Aortic Stenosis

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Key result

Extravalvular cardiac damage is linked to ~75% higher all-cause mortality in aortic stenosis.

HR 1.75
95% CI 1.44-2.11
P<0.001
n=1,747

Figures

Graphical abstract published by JACC Advances — Graphical abstract · Published by JACC Advances · CC BY

Why the study?

The relationship between the extent of extravalvular cardiac damage and valve disease severity remains uncertain in aortic stenosis patients.

Does the degree of extravalvular cardiac damage correlate with aortic stenosis severity and impact clinical outcomes in outpatients with aortic stenosis?

Key Points

To investigate the correlation between aortic stenosis severity and extravalvular cardiac damage staging, and to evaluate its clinical impact across the spectrum of aortic stenosis outpatients.
Consecutive outpatients with mild, moderate, and severe native aortic stenosis (N=1,747 with available cardiac damage staging) were recruited by 117 cardiologists between May 2016 and December 2017 in the VALVENOR cohort.
Extravalvular cardiac damage was categorized from stage 0 to stage 4 using echocardiographic evaluation, and patients were followed for 5 years.
Patients with cardiac damage stage >0 exhibited higher peak aortic jet velocity compared to stage 0 (3.35 ± 0.69 vs 3.11 ± 0.56 m/s; P < 0.001), remaining independently associated with stage >0 after multivariable adjustment (per m/s, P < 0.001).
Cardiac damage stage >0 was associated with significantly higher 5-year all-cause mortality (HR: 1.75; 95% CI: 1.44-2.11; P < 0.001) and cardiovascular mortality (HR: 2.52; 95% CI: 1.79-3.55; P < 0.001) compared with stage 0.

Study Design

Type

Cohort (n=1,747)

Multicenter

Yes

Structured PICO

Does the degree of extravalvular cardiac damage correlate with aortic stenosis severity and impact clinical outcomes in outpatients with aortic stenosis?

P

Population

1,747 outpatients ≥18 years old with mild to severe native aortic stenosis, followed for 5 years to assess the prognostic impact of extravalvular cardiac damage.

O

Outcome

All-cause mortality and cardiovascular mortality at 5 yearshard clinical

Main Result

Hazard Ratio: 1.75 (95% CI 1.44–2.11)

p-value: p=<0.001

The extent of extravalvular cardiac damage correlates with aortic stenosis severity and is independently associated with increased all-cause and cardiovascular mortality across all stages of the disease.

Limitations

Observational study cannot establish a causal relationship between AS severity and the extent of extravalvular CD.
CD staging was available in only 65% of the overall cohort.
The staging system is semiquantitative and relies largely on echocardiographic surrogates.
AS severity was categorized by Vmax alone, which may underestimate severity in low-flow states.
Serial echocardiographic assessments of CD staging after AVR were not systematically collected.
CD was dichotomized (stage 0 vs stage >0) for prognostic analyses, reducing the granularity of the original five-stage classification.
Observational study cannot establish a causal relationship between AS severity and the extent of extravalvular CD
CD staging was available in only 65% of the overall VALVENOR cohort
The staging system is semiquantitative and relies largely on echocardiographic surrogates
AS severity was categorized according to Vmax alone, which may underestimate severity in low-flow states
Serial echocardiographic assessment of CD staging after AVR were not systematically collected
CD was dichotomized (stage 0 vs stage >0) for prognostic analyses, reducing the granularity of the original five-stage classification

Implication

May refine risk stratification across AS severity; extends staging concepts but leaves open impact on management.

Abstract

BACKGROUND The relationship between the extent of extravalvular cardiac damage (CD) and valve disease severity remains uncertain in aortic stenosis (AS) patients. OBJECTIVES The objective of the study was to investigate the correlation between AS severity and CD staging and its clinical impact across the spectrum of AS outpatients. METHODS Consecutive patients with mild (peak aortic velocity = 2.5-2.9 m/s), moderate (3-3.9 m/s), and severe AS (≥4 m/s) native AS from a regionwide cohort were included by 117 cardiologists between May 2016 and December 2017 in the VALVENOR cohort. Patients were followed up for 5 years. RESULTS Among the 1,747 patients with available CD (65% of the overall cohort), 744 (42.6%) patients had mild AS, 714 (40.9%) patients moderate AS, and 289 (16.5%) severe AS. Of the 1747 patients, 524 patients (30%) demonstrated CD stage 0, 298 (17%) stage 1, 765 (44%) stage 2, 109 (6%) stage 3, and 51 (3%) stage 4. Patients in stage >0 had higher peak aortic jet velocity compared to patients in stage 0 (3.35 ± 0.69 vs 3.11 ± 0.56 m/s; P < 0.001). After adjustment, higher peak aortic jet velocity (per m/s, P < 0.001) remained independently associated with CD stage >0. Both all-cause mortality and cardiovascular mortality were higher in patients in stage >0 as compared with patients in stage 0 (HR: 1.75; 95% CI: 1.44-2.11; P < 0.001 and HR: 2.52: 95% CI: 1.79-3.55; P < 0.001, respectively). CONCLUSIONS The extent of extravalvular CD correlates with AS severity and is associated with poor clinical outcomes across all AS stages. Further research is warranted to determine whether assessing CD should be integrated in the management of patients with AS.

Discussion

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Cite This Study

Coisne et al. (2026) conducted a cohort in Aortic stenosis (n=1,747). Extravalvular cardiac damage (stage >0) vs. No extravalvular cardiac damage (stage 0) was evaluated on All-cause mortality (HR 1.75, 95% CI 1.44-2.11, p=<0.001). Extravalvular cardiac damage (stage >0) was associated with a significantly higher risk of all-cause mortality compared to no cardiac damage (HR 1.75) across the spectrum of aortic stenosis.

synapsesocial.com/papers/6aa555bb327956e4761fa096 https://doi.org/10.1016/j.jacadv.2026.103227

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Association Between the Degree of Extravalvular Cardiac Damage and the Severity of Aortic Stenosis

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Association Between the Degree of Extravalvular Cardiac Damage and the Severity of Aortic Stenosis

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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