scholarly journals Impact of Early Surgery and Staging Classification on Survival in Asymptomatic Very Severe Aortic Stenosis

2021 ◽  
Vol 77 (4) ◽  
pp. 506-508
Author(s):  
Sung-Ji Park ◽  
Sahmin Lee ◽  
Seung-Ah Lee ◽  
Dae-Hee Kim ◽  
Hyung-Kwan Kim ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Early Surgery ◽  
Staging Classification

Abstract 12572: Early Surgical Treatment versus Initial Conservative Management for Asymptomatic Severe and Very Severe Aortic Stenosis: A Meta-analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yujiro Yokoyama ◽  
Hisato Takagi ◽  
Toshiki Kuno
Keyword(s):  
Aortic Stenosis ◽  
Cardiovascular Mortality ◽  
Severe Aortic Stenosis ◽  
Meta Analysis ◽  
Early Surgery ◽  
Optimal Timing ◽  
Aortic Valve Area ◽  
Conservative Strategy ◽  
Subgroup Analyses ◽  
All Cause Mortality

Background: Although current guidelines generally recommend watchful waiting strategy for patients with asymptomatic severe aortic stenosis (AS) until symptoms develop, the optimal timing of surgical intervention remains controversial. Objective: This study aimed to compare the outcomes of early surgery vs. conservative strategy for patients with asymptomatic severe AS. Methods: MEDLINE and EMBASE were searched through February, 2020 to identify clinical trials that investigatedearly surgery and conservative strategy for patients with asymptomatic severe AS. From each study, we extracted the hazard ratio (HR) of all-cause mortality and cardiovascular mortality. Subgroup analyses were conducted by dividing into severe AS (peak aortic jet velocity [Vmax] ≥4.0 m/s, mean aortic pressure gradient [PG] ≥40 mmHg, or aortic valve area [AVA] ≤1.0 cm 2 ) and very severe AS (Vmax ≥4.5 m/s, mean PG ≥50 mmHg, or AVA ≤0.75 cm 2 ) groups. Results: 1 randomized controlled, 7 observational trials were identified. Pooled analyses demonstrated that all-cause mortality and cardiovascular mortality for early surgery were significantly lower compared to conservative strategy (HR [95% Confidence Interval [CI]] =0.49 [0.36-0.68]; P <0.0001, HR [95% CI] =0.42 [0.22-0.82]; P =0.01, respectively). Subgroup analyses showed significant reduction for early surgery in all-cause mortality (severe AS: HR [95% CI] =0.52 [0.35-0.78]; P =0.001, very severe AS: HR [95% CI] =0.38 [0.17-0.85]; P =0.02). Conclusions: We demonstrated that early surgery was associated with significant reduction in all-cause and cardiovascular mortality in patients with severe AS. Further randomized trials are warranted to confirm our findings.

scholarly journals Serum Biomarkers of Cardiovascular Remodelling Reflect Extra-Valvular Cardiac Damage in Patients with Severe Aortic Stenosis

2020 ◽  
Vol 21 (11) ◽  
pp. 4174
Author(s):  
Laura Bäz ◽  
Gudrun Dannberg ◽  
Katja Grün ◽  
Julian Westphal ◽  
Sven Möbius-Winkler ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Serum Levels ◽  
Serum Biomarkers ◽  
Tissue Remodelling ◽  
Cardiac Damage ◽  
Right Heart ◽  
Cardiovascular Tissue ◽  
Left And Right ◽  
Staging Classification

In patients with aortic stenosis (AS), a novel staging classification of extra-valvular left and right heart damage with prognostic relevance was introduced in 2017. The aim of the study was to evaluate the biomarkers of cardiovascular tissue remodelling in relation to this novel staging classification. Patients were categorized according to the novel staging classification into stages 0 to 4. The levels of matrix metalloproteinase 9 (MMP-9), tissue inhibitor of metalloproteinases 1 (TIMP-1), B and C domain containing tenascin-C (B+ Tn-C, C+ Tn-C), the ED-A and ED-B domain containing fibronectin (ED-A+ Fn, ED-B+ Fn), endothelin 1 (ET-1) and neutrophil gelatinase-associated lipocalin (NGAL) were determined in serum by ELISA. There were significantly decreased serum levels of MMP-9 and increased levels of B+ Tn-C and C+ Tn-C when comparing stages 0 and 1 with stage 2, with no further dynamics in stages 3 and 4. In contrast, for TIMP-1, C+ Tn-C, ED-A+ Fn, ET-1 and NGAL, significantly increased serum levels could be detected in stages 3 and 4 compared to both stages 0 and 1 and stage 2. ED-A+ Fn and ET-1 could be identified as independent predictors of the presence of stage 3 and/or 4. To the best of our knowledge, this is the first study identifying novel serum biomarkers differentially reflecting the patterns of left and right heart extra-valvular damage in patients suffering from AS. Our findings might indicate a more precise initial diagnosis and risk stratification.

scholarly journals Early Surgery vs. Surgery After Watchful Waiting for Asymptomatic Severe Aortic Stenosis

2018 ◽  
Vol 82 (10) ◽  
pp. 2663-2671 ◽  
Author(s):  
Makoto Miyake ◽  
Chisato Izumi ◽  
Tomohiko Taniguchi ◽  
Takeshi Morimoto ◽  
Masashi Amano ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Watchful Waiting ◽  
Severe Aortic Stenosis ◽  
Early Surgery

scholarly journals Response to Letter Regarding Article, “Early Surgery Versus Conventional Treatment in Asymptomatic Very Severe Aortic Stenosis”

Circulation ◽  
2010 ◽  
Vol 122 (25) ◽  
Author(s):  
Duk-Hyun Kang ◽  
Ji Hye Rim ◽  
Sung-Cheol Yun ◽  
Dae-Hee Kim ◽  
Jong-Min Song ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Conventional Treatment ◽  
Severe Aortic Stenosis ◽  
Early Surgery

scholarly journals Incremental value of left ventricular global longitudinal strain in a newly proposed staging classification based on cardiac damage in patients with severe aortic stenosis

2020 ◽  
Vol 21 (11) ◽  
pp. 1248-1258 ◽  
Author(s):  
E Mara Vollema ◽  
Mohammed R Amanullah ◽  
Edgard A Prihadi ◽  
Arnold C T Ng ◽  
Pieter van der Bijl ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Prognostic Value ◽  
Longitudinal Strain ◽  
Severe Aortic Stenosis ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Cardiac Damage ◽  
All Cause Mortality ◽  
Incremental Prognostic Value ◽  
Staging Classification

Abstract Aims Cardiac damage in severe aortic stenosis (AS) can be classified according to a recently proposed staging classification. The present study investigated the incremental prognostic value of left ventricular (LV) global longitudinal strain (GLS) over stages of cardiac damage in patients with severe AS. Methods and results From an ongoing registry, a total of 616 severe symptomatic AS patients with available LV GLS by speckle tracking echocardiography were selected and retrospectively analysed. Patients were categorized according to cardiac damage on echocardiography: Stage 0 (no damage), Stage 1 (LV damage), Stage 2 (mitral valve or left atrial damage), Stage 3 (tricuspid valve or pulmonary artery vasculature damage), or Stage 4 (right ventricular damage). LV GLS was divided by quintiles and assigned to the different stages. The endpoint was all-cause mortality. Over a median follow-up of 44 [24–89] months, 234 (38%) patients died. LV GLS was associated with all-cause mortality independent of stage of cardiac damage. After incorporation of LV GLS by quintiles into the staging classification, Stages 2–4 were independently associated with outcome. LV GLS showed incremental prognostic value over clinical characteristics and stages of cardiac damage. Conclusion In this large single-centre cohort of severe AS patients, incorporation of LV GLS by quintiles in a novel proposed staging classification resulted in refinement of risk stratification by identifying patients with more advanced cardiac damage. LV GLS was shown to provide incremental prognostic value over the originally proposed staging classification.

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