scholarly journals Insights into aortic stenosis progression: factors affecting rate of progression and its impact on survival

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.R Amanullah ◽  
S.M Pio ◽  
K.Y Sin ◽  
N Ajmone Marsan ◽  
Z.P Ding ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Renal Impairment ◽  
Median Time ◽  
Left Ventricular ◽  
Factors Affecting ◽  
Proportional Analysis ◽  
All Cause Mortality ◽  
Rate Of Progression ◽  
Fast Progression

Abstract Background Severe aortic stenosis (AS) is associated with adverse clinical outcomes. Little is known about the rate of progression in patients with moderate AS. Purpose Risk factors affecting the rate of progression from moderate to severe AS, and their impact on all-cause mortality were studied in this multicentre registry. Methods Based on the echocardiographic diagnosis of moderate AS (valve area >1.0 and ≤1.5 cm2) at the time of first echocardiogram, 962 patients with follow-up were included. Follow-up echocardiograms were reviewed to identify those who developed severe AS (based on the current guidelines). Patients were divided into 2 groups: AS Progressors (progressed to severe AS) and Non-progressors (remained in moderate AS). Among those with AS progression, patients were subdivided into Slow versus Fast Progressors, according to the median time interval between the two echocardiograms. The clinical correlates of fast AS Progressors were analysed using the binary logistic regression. The association between rate of progression (slow versus fast) and all-cause mortality was assessed by the Kaplan-Meier method using log-rank test. A multivariate Cox proportional analysis was used to identify the independent associates of all-cause mortality, with interval of AS progression between the two echocardiograms (in years) included as a continuous variable. Results Of the 962 patients with moderate AS, AS progressed to severe in 62% (n=595), while 38% (n=367) remained in moderate AS, over a mean follow-up of 6.8 [IQR 4.2–9.3] years. Older age, renal impairment (eGFR<30ml/min/1.73 m2), hypertension and atrial fibrillation were significantly associated with higher risk of AS progression. Left ventricular (LV) hypertrophy and higher peak aortic velocity were more prevalent in AS Progressors at baseline. Among the AS Progressors (n=595), the median time of AS progression was 2.5 [IQR 1.3–3.9] years. Based on the median time of AS progression, patients were subdivided into: Slow (n=295) versus Fast Progressors (n=300). On multivariate analysis, age, renal impairment (eGFR<30ml/min/1.73 m2), betablocker use, impaired LV ejection fraction and peak aortic velocity were significantly associated with Fast progression of AS. Although the rates of AV intervention were similar between Fast versus Slow Progressors (60% vs. 54%, p=0.137), Fast AS Progressors had worse survival than Slow AS Progressors (Log rank p=0.045, Figure 1), over a mean follow-up of 4.0 [IQR 1.0–6.4] years. Importantly, on multivariable Cox proportional analysis, shorter time of progression from moderate to severe AS was independently associated with increased all-cause mortality (HR=0.92, 95% CI 0.88–0.99, p=0.047). Conclusion In a large real-world registry of patients with moderate AS, fast progression to severe AS is associated with worse survival. Close surveillance should be given to those patients who are at higher risk of AS progression. AS progression and all-cause mortality Funding Acknowledgement Type of funding source: None

P3779NT-proBNP adds incremental predictive information on incident atrial fibrillation in patients with asymptomatic aortic stenosis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C N Bang ◽  
A M Greve ◽  
K Boman ◽  
K Egstrup ◽  
M H Olsen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Aortic Stenosis ◽  
Left Atrial ◽  
Pressure Overload ◽  
Left Ventricular Pressure ◽  
Left Ventricular ◽  
Predictor Variables ◽  
All Cause Mortality ◽  
New Onset

Abstract Background Incident atrial fibrillation (AF) marks an adverse shift in the prognosis of patients with aortic stenosis (AS). Identifying risk factors for AF is therefore of paramount importance for timely intervention in patients with AS. In patients without AS, brain natriuretic peptides (BNP) is a well-established biomarker for left ventricular pressure overload on the pathway to heart failure and atrial fibrillation. However, a potential role of NT-proBNP to predict risk of new-onset AF in asymptomatic patients with mild to moderate AS is not well studied. Methods We included 1,434 patients with mild to moderate AS from the SEAS Study (Simvastatin and Ezetimibe in Aortic Stenosis) without AF or clinically overt heart failure at baseline. The primary endpoint for this substudy was time to incident AF, as determined by the first annual in-study 12-lead ECG with AF. Multivariable Cox model were adjusted for other important predictors of incident AF as selected by Bayesian statistics. Fine and Gray competing risk regression was used to evaluate the influence of all-cause mortality on selected predictor variables of incident AF. Results During a median follow-up of 4.3 years (range 0.1–6.9 years), incident AF occurred in 114 (6.1%) patients (13.8 per 1,000 person-years of follow-up), who at baseline were older (69±10 vs. 67±10 years, p<0.001), had larger systolic left atrial diameter (46±24 vs. 34±18 mm, p<0.001) and higher NT-proBNP level (286 [132; 613] vs. 154 [82; 297] pg/ml, p<0.001); but same left ventricular ejection fraction (66±6 mm vs. 67±6, p=0.4). In multivariable Cox regression, adjusted for age, circumferential end-systolic stress, left atrial volume and ECG PR interval, Ln(NT-proBNP) was associated with higher risk of new-onset AF (HR: 1.9 [95% CI: 1.6–2.3], p<0.001). Similar results were found when using Fine and Gray estimates with all-cause mortality (HR: 2.0 [95% CI: 1.7–2.4], p<0.001 (Figure, panel A). NT-proBNP level added incremental predictive information on incident AF over the other important, as selected by Bayesian statistics, predictor variables (C-index 0.81, p<0.001, Figure, panel B). There was no interaction with aortic valve area (p>0.05). Figure 1 Conclusions In patients with asymptomatic aortic stenosis and sinus rhythm at baseline, NT-proBNP levels were significantly higher in patients who subsequently developed AF. NT-proBNP significantly improved prognostic information of incident AF over other important predictor variables. This supports the notion that incident AF is a marker of left ventricular pressure overload and possibly a novel marker of timely intervention with aortic valve replacement.

scholarly journals P904 Impact of significant functional mitral regurgitation and aortic stenosis on outcome of HFrEF patients

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
K Hu ◽  
D Liu ◽  
M Kirch ◽  
F Liebner ◽  
C Scheffold ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Aortic Stenosis ◽  
Cox Regression ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Functional Mitral Regurgitation ◽  
Baseline Visit ◽  
All Cause Mortality ◽  
The Impact

Abstract Background Concomitant aortic stenosis (AS) and functional mitral regurgitation (FMR) are common in patients with left ventricular dysfunction. We evaluated the impact of significant valve diseases on outcome of patients with reduced left ventricular ejection fraction (HFrEF, LVEF &lt; 40%). Methods A total of 1264 consecutive HFrEF patients referred to our department between 2009 and 2017 were screened. Transthoracic echocardiography was performed at baseline visit in all patients. Patients with primary MR or received mitral valve operation before or after baseline visit (n = 64) as well as patients underwent aortic valve replacement (AVR) before baseline visit (n = 66) were excluded. Finally, 1134 HFrEF patients were included for final analysis, and all completed a median clinical follow-up of 26 (12-40) months by medical record review or telephone interview. The primary endpoint was all-cause mortality or heart transplantation (HTx). Results Moderate or severe FMR or AS was detected in 902 (79.5%) and in 119 (10.5%) patients by echocardiography, respectively. Of patients with significant AS, 47 patients underwent AVR shortly after baseline visit. In total, 353 (31.2%, including HTx n = 11) HFrEF patients died or underwent HTx during follow-up. Age, body mass index, diabetes, atrial fibrillation, coronary artery disease, chronic respiratory diseases, and renal dysfunction (all P &lt; 0.05) were defined as clinical covariates associated with all-cause mortality/HTx and served as potential confounders in the multivariable Cox regression models. All-cause mortality/HTx was significantly higher in HFrEF patients with significant FMR than patients without significant FMR (33.8% vs. 20.7%, P &lt; 0.001). Multivariable Cox regression analysis showed significant FMR remained as an independent determinant of all-cause mortality/HTx in patients with HFrEF after adjusted for above mentioned confounders (HR 1.39, 95% CI 1.02-1.90, P = 0.035). Patients with significant AS without AVR faced increased risk of all-cause mortality/HTx as compared to patients without significant AS (HR 2.34, P &lt; 0.001), while risk of all-cause mortality/HTx was significantly lower in patients with significant AS and underwent AVR as compared to patients without significant AS after adjustment for confounders (HR 0.36, P = 0.008). In the subgroup of HFrEF patients with significant FMR, significant AS without AVR was independently associated with increased all-cause mortality/HTx as compared to patients without significant AS (HR 2.30, P &lt; 0.001), while outcome is better in AS and FMR patients underwent AVR as compared to patients with significant FMR and without significant AS (survival: 85.4% vs. 67.5%, P &lt; 0.001; HR 0.34, P = 0.010) after adjustment for potential confounding factors. Conclusion Moderate to severe FMR and/or AS is incrementally related to higher all-cause mortality/HTx in HFrEF patients. AVR could significantly improve the survival of HFrEF patients with concomitant significant AS and FMR.

Comparison of Aortic Gradient and Ventricular Mass after Valve Replacement for Aortic Stenosis with Rapid Deployment, Sutureless, and Conventional Bioprostheses

Cardiology ◽  
2021 ◽  
pp. 1-11
Author(s):  
Rubén Taboada-Martín ◽  
José María Arribas-Leal ◽  
María Asunción Esteve-Pastor ◽  
José Abellán Alemán ◽  
Francisco Marín ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Ventricular Mass ◽  
Risk Of Mortality ◽  
Echocardiographic Parameters ◽  
Rapid Deployment ◽  
The Impact ◽  
Peak Gradient

<b><i>Background:</i></b> The use of rapid deployment and sutureless aortic prostheses is increasing. Previous reports have shown promising results on haemodynamic performance and mortality rates. However, the impact of these bioprostheses on left ventricular mass (LVM) regression remains unknown. We decided to study the changes in remodelling and LVM regression in isolated severe aortic stenosis treated with conventional or Perceval® or Intuity® valves. <b><i>Method and Results:</i></b> From January 2011 to January 2016, 324 bioprostheses were implanted in our centre. The collected characteristics were divided into 3 groups: conventional valves, Perceval®, and Intuity®, and they were analysed after 12 months. There were 183 conventional valves (56%), 72 Perceval® (22%), and 69 Intuity® (21.2%). The statistical analysis showed significant differences in transprosthetic postoperative peak gradient (23 [18–29] mm Hg vs. 21 [16–29] mm Hg and 18 [14–24] mm Hg, <i>p</i> &#x3c; 0.001), ventricular mass electrical criteria regression (Sokolow and Cornell products), and 1-year survival (90 vs. 93% and 97%, log rank <i>p</i> value = 0.04) in conventional, Perceval®, and Intuity® groups. <b><i>Conclusions:</i></b> We observed differences in haemodynamic, electrocardiographic, and echocardiographic parameters related to the different types of prosthesis. Patients with the Intuity® prosthesis had the highest reduction in peak aortic gradient and the higher ventricular mass regression. Besides, patients with the Intuity® prosthesis had less risk of mortality during follow-up than the other two groups. Further studies are needed to confirm these findings.

Sex differences in transaortic flow rate and association with all-cause mortality in patients with severe aortic stenosis

2021 ◽  
Author(s):  
Sahrai Saeed ◽  
Anastasia Vamvakidou ◽  
Spyridon Zidros ◽  
George Papasozomenos ◽  
Vegard Lysne ◽  
...  
Keyword(s):  
Sex Differences ◽  
Aortic Stenosis ◽  
Flow Rate ◽  
Cox Regression ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Cox Regression Analysis ◽  
Increased Risk ◽  
All Cause Mortality

Abstract Aims It is not known whether transaortic flow rate (FR) in aortic stenosis (AS) differs between men and women, and whether the commonly used cut-off of 200 mL/s is prognostic in females. We aimed to explore sex differences in the determinants of FR, and determine the best sex-specific cut-offs for prediction of all-cause mortality. Methods and results Between 2010 and 2017, a total of 1564 symptomatic patients (mean age 76 ± 13 years, 51% men) with severe AS were prospectively included. Mean follow-up was 35 ± 22 months. The prevalence of cardiovascular disease was significantly higher in men than women (63% vs. 42%, P &lt; 0.001). Men had higher left ventricular mass and lower left ventricular ejection fraction compared to women (both P &lt; 0.001). Men were more likely to undergo an aortic valve intervention (AVI) (54% vs. 45%, P = 0.001), while the death rates were similar (42.0% in men and 40.6% in women, P = 0.580). A total of 779 (49.8%) patients underwent an AVI in which 145 (18.6%) died. In a multivariate Cox regression analysis, each 10 mL/s decrease in FR was associated with a 7% increase in hazard ratio (HR) for all-cause mortality (HR 1.07; 95% CI 1.03–1.11, P &lt; 0.001). The best cut-off value of FR for prediction of all-cause mortality was 179 mL/s in women and 209 mL/s in men. Conclusion Transaortic FR was lower in women than men. In the group undergoing AVI, lower FR was associated with increased risk of all-cause mortality, and the optimal cut-off for prediction of all-cause mortality was lower in women than men.

scholarly journals Left ventricular fibrosis and hypertrophy are associated with mortality in heart failure with preserved ejection fraction

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Pankaj Garg ◽  
Hosamadin Assadi ◽  
Rachel Jones ◽  
Wei Bin Chan ◽  
Peter Metherall ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
T1 Mapping ◽  
Left Ventricular ◽  
Preserved Ejection Fraction ◽  
Native T1 ◽  
Lv Mass ◽  
All Cause Mortality ◽  
Ventricular Fibrosis

AbstractCardiac magnetic resonance (CMR) is emerging as an important tool in the assessment of heart failure with preserved ejection fraction (HFpEF). This study sought to investigate the prognostic value of multiparametric CMR, including left and right heart volumetric assessment, native T1-mapping and LGE in HFpEF. In this retrospective study, we identified patients with HFpEF who have undergone CMR. CMR protocol included: cines, native T1-mapping and late gadolinium enhancement (LGE). The mean follow-up period was 3.2 ± 2.4 years. We identified 86 patients with HFpEF who had CMR. Of the 86 patients (85% hypertensive; 61% males; 14% cardiac amyloidosis), 27 (31%) patients died during the follow up period. From all the CMR metrics, LV mass (area under curve [AUC] 0.66, SE 0.07, 95% CI 0.54–0.76, p = 0.02), LGE fibrosis (AUC 0.59, SE 0.15, 95% CI 0.41–0.75, p = 0.03) and native T1-values (AUC 0.76, SE 0.09, 95% CI 0.58–0.88, p < 0.01) were the strongest predictors of all-cause mortality. The optimum thresholds for these were: LV mass > 133.24 g (hazard ratio [HR] 1.58, 95% CI 1.1–2.2, p < 0.01); LGE-fibrosis > 34.86% (HR 1.77, 95% CI 1.1–2.8, p = 0.01) and native T1 > 1056.42 ms (HR 2.36, 95% CI 0.9–6.4, p = 0.07). In multivariate cox regression, CMR score model comprising these three variables independently predicted mortality in HFpEF when compared to NTproBNP (HR 4 vs HR 1.65). In non-amyloid HFpEF cases, only native T1 > 1056.42 ms demonstrated higher mortality (AUC 0.833, p < 0.01). In patients with HFpEF, multiparametric CMR aids prognostication. Our results show that left ventricular fibrosis and hypertrophy quantified by CMR are associated with all-cause mortality in patients with HFpEF.

scholarly journals Natural Progression of Low-Gradient Severe Aortic Stenosis with Preserved Ejection Fraction

2014 ◽  
Vol 41 (3) ◽  
pp. 273-279 ◽  
Author(s):  
Antony Leslie Innasimuthu ◽  
Sanjay Kumar ◽  
Jason Lazar ◽  
William E. Katz
Keyword(s):  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Aortic Valve Area ◽  
Ventricular Ejection Fraction ◽  
Mild Stenosis ◽  
Natural Progression

Because the natural progression of low-gradient aortic stenosis (LGAS) has not been well defined, we performed a retrospective study of 116 consecutive patients with aortic stenosis who had undergone follow-up echocardiography at a median interval of 698 days (range, 371–1,020 d). All patients had preserved left ventricular ejection fraction (&gt;0.50) during and after follow-up. At baseline, patients were classified by aortic valve area (AVA) as having mild stenosis (≥1.5 cm2), moderate stenosis (≥1 to &lt;1.5 cm2), or severe stenosis (&lt;1 cm2). Severe aortic stenosis was further classified by mean gradient (LGAS, mean &lt;40 mmHg; high-gradient aortic stenosis [HGAS], mean ≥40 mmHg). We compared baseline and follow-up values among 4 groups: patients with mild stenosis, moderate stenosis, LGAS, and HGAS. At baseline, 30 patients had mild stenosis, 54 had moderate stenosis, 24 had LGAS, and 8 had HGAS. Compared with the moderate group, the LGAS group had lower AVA but similar mean gradient. Yet the actuarial curves for progressing to HGAS were significantly different: 25% of patients in LGAS reached HGAS status significantly earlier than did 25% of patients in the moderate-AS group (713 vs 881 d; P=0.035). Because LGAS has a high propensity to progress to HGAS, we propose that low-gradient aortic stenosis patients be closely monitored as a distinct subgroup that warrants more frequent echocardiographic follow-up.

scholarly journals Clinical characteristics, one-year change in ejection fraction and long-term outcomes in patients with heart failure with mid-range ejection fraction: a multicentre prospective observational study in Catalonia (Spain)

BMJ Open ◽  
2017 ◽  
Vol 7 (12) ◽  
pp. e018719 ◽  
Author(s):  
Nuria Farré ◽  
Josep Lupon ◽  
Eulàlia Roig ◽  
Jose Gonzalez-Costello ◽  
Joan Vila ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Prospective Observational Study ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
End Point ◽  
Patients With Heart Failure ◽  
All Cause Mortality ◽  
Baseline Characteristics

ObjectivesThe aim of this study was to analyse baseline characteristics and outcome of patients with heart failure and mid-range left ventricular ejection fraction (HFmrEF, left ventricular ejection fraction (LVEF) 40%–49%) and the effect of 1-year change in LVEF in this group.SettingMulticentre prospective observational study of ambulatory patients with HF followed up at four university hospitals with dedicated HF units.ParticipantsFourteen per cent (n=504) of the 3580 patients included had HFmrEF.InterventionsBaseline characteristics, 1-year LVEF and outcomes were collected. All-cause death, HF hospitalisation and the composite end-point were the primary outcomes.ResultsMedian follow-up was 3.66 (1.69–6.04) years. All-cause death, HF hospitalisation and the composite end-point were 47%, 35% and 59%, respectively. Outcomes were worse in HF with preserved ejection fraction (HFpEF) (LVEF>50%), without differences between HF with reduced ejection fraction (HFrEF) (LVEF<40%) and HFmrEF (all-cause mortality 52.6% vs 45.8% and 43.8%, respectively, P=0.001). After multivariable Cox regression analyses, no differences in all-cause death and the composite end-point were seen between the three groups. HF hospitalisation and cardiovascular death were not statistically different between patients with HFmrEF and HFrEF. At 1-year follow-up, 62% of patients with HFmrEF had LVEF measured: 24% had LVEF<40%, 43% maintained LVEF 40%–49% and 33% had LVEF>50%. While change in LVEF as continuous variable was not associated with better outcomes, those patients who evolved from HFmrEF to HFpEF did have a better outcome. Those who remained in the HFmrEF and HFrEF groups had higher all-cause mortality after adjustment for age, sex and baseline LVEF (HR 1.96 (95% CI 1.08 to 3.54, P=0.027) and HR 2.01 (95% CI 1.04 to 3.86, P=0.037), respectively).ConclusionsPatients with HFmrEF have a clinical profile in-between HFpEF and HFrEF, without differences in all-cause mortality and the composite end-point between the three groups. At 1 year, patients with HFmrEF exhibited the greatest variability in LVEF and this change was associated with survival.

Abstract 15607: Right Atrial Reservoir Strain Predicts Survival in Patients With Cardiac Amyloidosis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Peter Huntjens ◽  
Kathleen Zhang ◽  
Yuko Soyama ◽  
Maria Karmpalioti ◽  
Daniel Lenihan ◽  
...  
Keyword(s):  
Cardiac Amyloidosis ◽  
Ventricular Hypertrophy ◽  
Cardiac Tissue ◽  
Fold Increase ◽  
Left Ventricular ◽  
Right Atrial ◽  
Chamber View ◽  
All Cause Mortality ◽  
And Function

Introduction: Myofibril deposition in amyloidosis diffusely may affect cardiac structure and function. Right ventricular involvement has been associated with adverse clinical outcome. However, the utility of right atrial (RA) function assessment by echocardiographic strain imaging is unclear. Hypothesis: We hypothesize that right atrial stain has prognostic value in cardiac amyloidosis. Methods: We studied 121 consecutive patients with cardiac amyloidosis: 18% had transthyretin and 79% had light chain amyloidosis. Cardiac amyloidosis was either confirmed by endocardial biopsy (36%) or by a combination of non-cardiac tissue biopsy and proof of left ventricular hypertrophy (64%). Speckle tracking peak RA reservoir strain was assessed based on 6 segments from the apical 4-chamber view. All-cause mortality was tracked over a median of 5 years. Results: Echocardiographic peak longitudinal RA strain was feasible in 109 patients (90%). 60 CA patients died during follow-up period. Peak longitudinal RA strain was reduced in cardiac amyloidosis non-survivors (8.1%) in comparison to survivors (18.3%, p<0.01), showing RA involvement in cardiac amyloidosis. Peak RA strain was significantly associated with survival (using median 12.5%) (p<0.001). Low peak longitudinal RA strain was associated with a 3.3-fold increase in mortality risk (95% confidence interval: 1.83 - 5.96). Conclusions: Reduced peak longitudinal RA strain was significantly associated with survival in patients with cardiac amyloidosis. RA reservoir function assessed by strain appears to be useful as a new means to predict prognosis in cardiac amyloidosis patients and has promise for clinical application.

scholarly journals P1522THE RELATIONSHIP BETWEEN AORTIC STENOSIS AND NORTALITY RATE: A PROSPECTIVE COHORT STUDY IN JAPANESE HEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Yuji Sasakawa ◽  
Daijo Inaguma
Keyword(s):  
Heart Failure ◽  
Risk Factor ◽  
Aortic Stenosis ◽  
Transthoracic Echocardiography ◽  
Prospective Cohort ◽  
Aortic Valve Area ◽  
Tumor Bearing ◽  
All Cause Mortality ◽  
Secondary Outcomes

Abstract Background and Aims Aortic stenosis (AS) in Japanese hemodialysis (HD) patients is sometimes pointed out by periodic transthoracic echocardiography. In general population, heart failure symptoms become severer with progress of AS. In HD patients, there is a possibility that AS cause blood pressure decline and congestive heart failure which are one of the reasons for censoring HD. There were no large-scale prospective observational studies relating to cardiovascular (CV) events and mortality in HD patients with AS, therefore we investigated whether AS was associated with incidence of CV events and mortality in HD patients. Method This study was a prospective cohort analysis which 4 facilities in Japan participated. The subjects who were over 20 years and underwent maintenance HD for at least 12 months were enrolled at timing of receiving transthoracic echocardiography. Patients were classified into following 2 group (AS group: mean pressure gradient (PG) ≥ 20 mmHg or aortic valve area (AVA) ≤ 1.0 cm2 or maximum blood velocity (Vmax) ≥ 2.0 m/s, no AS group: others). Four hundred sixty-four patients were followed up for 2 years. The primary outcome was defined as all-cause mortality. The secondary outcomes were incidences of CV events, stroke and hospitalization due to peripheral artery disease (PAD). Baseline was set at the time of transthoracic echocardiography examination. We compared the mortality and incidences of events between the 2 groups by a multivariate Cox proportional hazard model. In addition, we extracted risk factors relevant to AS by a multivariate logistic regression model. Results There were 79 patients (17.0 %) in the AS group among 464 patients. Older age and longer dialysis vintage were significantly associated with comorbidity of AS (multivariate-adjusted odds ratio [OR], 1.06; 95% confidence interval [CI], 1.03-1.10; p &lt; 0.001, OR, 1.05; 95% CI, 1.01-1.08; p = 0.01, respectively). Meanwhile, gender, diabetes mellitus and serum phosphate were not associated with comorbidity of AS. During follow up period (median, 2.3 years), 31 patients (6.7 %) died. There was no significant difference in all-cause mortality between the 2 groups (multivariate-adjusted hazard ratio [HR] for no AS group, 0.68; 95% CI, 0.24 – 1.91; p = 0.46). Furthermore, there were no significant associations between comorbidity of AS and the 3 secondary outcomes (HR, 0.25; 95% CI, 0.03 – 2.00; HR, 1.33; 95% CI, 0.34 – 5.21; HR, 1.50; 95%CI, 0.36 – 6.29, respectively). There were also no significant associations between comorbidity of severe AS defined as Vmax ≥ 2.0 m/s to ≥ 3.0 m/s and all the outcomes including all-cause mortality. On the other hand, tumor bearing was a risk factor for all-cause mortality (HR, 1.65; 95% CI, 1.04 - 2.61), and hypoalbuminemia was a risk factor for mortality from infection (HR, 0.13; 95% CI, 0.02-0.90). Conclusion This research showed that there were also no significant associations between comorbidity of AS and outcomes such as all-cause mortality, incidence of CV events, stroke, and PAD during the follow-up period of 2 years. The death caused by infection and malignant tumor accounted for more than 50 % of total all-cause death. It indicates that physical condition and tumor-bearing affect the mortality stronger than AS in a short term. We continue annual follow up and evaluate the impact of AS itself and vascular calcification causing AS after a long term like 5 years.

Sign in / Sign up

Export Citation Format

Share Document