In severe aortic stenosis, cardiac damage stages 1-3/4 increased the risk of death or heart failure hospitalization up to HR 3.93 vs stage 0, independent of gradient, symptoms, or treatment.
Does advanced cardiac damage stage predict worse clinical outcomes in patients with severe aortic stenosis?
Cardiac damage staging provides useful prognostic stratification for patients with severe aortic stenosis, regardless of gradient pattern, symptoms, or initial treatment strategy.
Absolute Event Rate: 0% vs 0%
Abstract Background 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. Purpose 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. Methods This study included 3369 consecutive patients with severe AS (high-gradient HG AS, n = 1986; low-gradient LG AS, n = 1383) enrolled in the CURRENT AS Registry-2. Cardiac damage was categorized as stage 0 (no extra-aortic valve damage; HG AS, n = 147; LG AS, n = 147), 1 (left ventricular damage; HG AS, n = 484; LG AS, n = 253), 2 (left atrial and/or mitral valve damage; HG AS, n = 1185; LG AS, n = 778), or 3/4 (pulmonary artery or tricuspid valve damage/right ventricular damage; HG AS, n = 170; LG AS, n = 205). Results The cardiac damage stage was associated with patient characteristics such as age, sex, cardiovascular risk factors, coronary artery disease, atrial fibrillation, and renal failure. The cumulative incidence of the primary outcome (a composite of all-cause death and hospitalization for heart failure) was incrementally higher with increasing cardiac damage in both the HG (10.0%, 23.5%, 33.5%, and 46.3% in stages 0, 1, 2, and 3/4, respectively; P 0.001) and LG AS cohorts (20.2%, 39.0%, 46.5%, and 64.0% in stages 0, 1, 2, and 3/4, respectively; P 0.001). The incrementally higher adjusted risks for the primary outcome in stages 1, 2 and 3/4 versus stage 0 were significant (HG AS: hazard ratio HR = 2.46, 95% confidence interval CI = 1.23–4.95 stage 1; HR = 3.38, 95% CI = 1.72–6.63 stage 2; HR = 3.93, 95% CI = 1.97–8.07 stage 3/4; LG AS: HR = 1.73, 95% CI = 1.05–2.86 stage 1; HR = 2.29, 95% CI = 1.45–3.63 stage 2; HR = 2.95, 95% CI = 1.79–4.87 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. The summary of this study was showed in central figure. Conclusions Cardiac damage staging was useful for prognostic stratification regardless of the gradient patterns, presence of symptoms, and initial treatment strategies in patients with severe AS.central figure
Takeji et al. (Sat,) reported a other. In severe aortic stenosis, cardiac damage stages 1-3/4 increased the risk of death or heart failure hospitalization up to HR 3.93 vs stage 0, independent of gradient, symptoms, or treatment.