Survival of patients with moderate aortic stenosis: propensity score matching analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Itelman ◽  
O Vatury ◽  
S Ben-Zekry ◽  
R Kuperstein ◽  
P Fefer ◽  
...  
Keyword(s):  
Propensity Score ◽  
Aortic Stenosis ◽  
Propensity Score Matching ◽  
Interaction Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cumulative Probability ◽  
Current Analysis ◽  
Ventricular Ejection Fraction

Abstract Introduction and purpose Data on the survival of patients with moderate aortic stenosis (AS) is conflicting. The purpose of the current analysis was to assess survival of moderate AS patients. Methods SHARE is an historical retrospective cohort of all cardiovascular patients evaluated in an Israeli tertiary hospital between 2007 and 2019. The current analysis included all patients who underwent echocardiographic evaluation. Aortic stenosis severity was extracted for all patients from the echocardiographic reports. All-cause mortality and was available for all patients. Subjects with severe AS or aortic valve replacement were excluded from the analysis. Results Cohort included 97,561 subjects of whom 42,187 (43.2%) were outpatients. Final cohort included 93,889 patients with a mean age of 66±17 (58% men). There were 2,949 (3%) with moderate AS. During a median follow up of 52 [IQR 22–89] months 17,173 (18%) patients died. Kaplan-Meier survival analysis demonstrated worse cumulative probability of death of 51%±2% vs. 20%±0% at 5 years for patients with moderate AS vs. mild or no AS, respectively (p Log rank <0.001). Sub-analysis of 32,745 patients for whom clinical laboratory and medication data was available yielded consistent results in a comprehensive multivariate model such that patients with moderate AS (N=1,381) were 26% more likely to die (95% CI: 1.17–1.37, p<0.0001). Finally, a propensity score matching of patients with moderate AS and controls with no or mild AS (N=1,381) successfully demonstrated that patients with moderate AS were 40% more likely to die during follow up (95% CI 1.25–1.57, p<0.001; FIGURE). Four-years mortality rates were 2 fold higher for patients with moderate AS compared with controls (OR = 1.96, 95% CI 1.6–2.4, p<0.001). Interaction analysis demonstrated that the association of moderate AS with survival was not dependent on left ventricular ejection fraction. Conclusion Moderate AS is associated with worse survival. Our findings underscore the importance of careful clinical observation as well as the need for further studies. Figure 1 Funding Acknowledgement Type of funding source: None

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 (>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 <1.5 cm2), or severe stenosis (<1 cm2). Severe aortic stenosis was further classified by mean gradient (LGAS, mean <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.

The carotid arterial approach for balloon dilation of critical aortic stenosis in neonates—immediate results and follow-up

1995 ◽  
Vol 5 (2) ◽  
pp. 155-160 ◽  
Author(s):  
Sandra Giusti ◽  
Adele Borghi ◽  
Sofia Redaelli ◽  
Philipp Bonhoeffer ◽  
Isabella Spadoni ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Aortic Stenosis ◽  
Aortic Regurgitation ◽  
Balloon Dilation ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Critical Aortic Stenosis ◽  
The Right

SummaryBalloon dilation of the aortic valve was performed in 20 consecutive neonates with critical aortic stenosis using an approach achieved by cutting down on the right carotid artery. The age of the patients ranged from one to 25 days (mean seven days) and their weight from 2.1 to 4.0 kg (mean 3.16 kg). All patients were evaluated before cardiac catheterization with cross-sectional and Doppler echocardiography so as to keep the catheterization procedure as short as possible. Balloon dilation was accomplished in all patients. The only complication was an apical perforation by the guide wire in two cases. The ensuing pericardial effusion was immediately drained with pericardiocentesis and the subsequent course of the procedure was uneventful. Immediate results showed dramatic improvement in cardiovascular conditions. The transvalvar pressure gradient fell from 80±40 to 27±20 mm Hg (p<0.001). Left ventricular ejection fraction evaluated by echocardiography increased from 30±21% before dilation to 54±18% 24-48 hours after the procedure (p<0.001). In all patients, the procedure was free from vascular complications. Aortic regurgitation was documented after the procedure in 11 patients, being severe in one, moderate in five and trivial in five. Seven patients died, although in only one was the death related directly to the procedure itself. Six patients died because of associated lesions despite an immediate satisfactory result of the balloon valvoplasty. The 13 surviving patients are doing well, and are receiving no medications. During a mean follow-up of 25 months (range 2-54 months), four patients have developed restenosis. One underwent surgical valvotomy at one year of age. The second was successfully redilated through the same approach at two months of age. The other two have a significant gradient, as assessed by Doppler measurements (60 and 70 mm Hg), with normal systolic ventricular function. Two patients have moderate aortic regurgitation. Balloon dilation achieved through cutdown on the right carotid artery is a safe and effective alternative to surgery in neonates with isolated aortic stenosis. The unfavorable results are mainly due to associated anomalies.

scholarly journals Ventricular-arterial coupling in hypertensive patients after TAVR. It is not all about the valve

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
F Islas ◽  
R Bottino ◽  
P Jimenez ◽  
L Nombela ◽  
P Marcos Alberca ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Left Ventricular Ejection Fraction ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Hypertensive Patients

Abstract Background In severe aortic stenosis, the left ventricle faces the challenge of the valvular load and the arterial load caused by abnormalities in systemic arterial compliance and systemic vascular resistance. The aim of this study is to assess the effect of hypertension control on left ventricular performance in patients that underwent TAVR. Methods 68 consecutive patients who underwent TAVR were analyzed; all patients were evaluated to confirm severe aortic stenosis with transthoracic echo (TTE). Conventional echo parameters were assessed as well as left ventricular mechanics parameters and vascular parameters such as arterial elastance (Ea), ventricular elastance (Ees) and V/Ac; besides all patients underwent TTE prior to TAVR, at discharge and 90 days follow-up visit. Results Mean age was 82±5; mean aortic valve area was 0.69±0.19, mean left ventricular ejection fraction was 58.3±12.1 and mean ventricular-arterial coupling was 1.6±0.9. At 90 days follow up we observed a significant worsening in V/Ac in those patients with poor control of blood pressure (&gt;140/90mmHg), (1.8±0.5 vs 2.1±0.3, p=0.03). Aortic impedance was significantly higher (4.4±1.4 vs 3.5±1.2, p=0.05); Ea and Ees were also significantly higher in hypertensive patients (2.3±0.8 vs 1.7±0.6, p=0.05) and (1.4±0.7 vs 0.9±0.6, p=0.01) respectively. Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) showed a slightly reduction in hypertensive patients, although not statistically significant. Conclusions Control of blood pressure seems to be an important factor that contributes to a better or rather worse LV performance and could have a potential role in systolic function and clinical outcome of patients after TAVR. FUNDunding Acknowledgement Type of funding sources: None.

Abstract 9944: Bicuspid and Unicuspid Aortic Valve: Fate of Moderate/Severe Mixed Aortic Valve Disease

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Alexander Egbe ◽  
Joeseph Poterucha ◽  
Carole Warnes
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Disease ◽  
Left Ventricular ◽  
Valve Disease ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Aortic Replacement ◽  
Mechanical Prostheses

Objectives: There is paucity of data about mixed aortic valve disease (MAVD) in patients with bicuspid/unicuspid aortic valve (BAV). This study sought to describe the natural history of moderate/severe MAVD in this population. Methods: We queried our database for patients with BAV and moderate/severe MAVD from 1994-2013. We excluded patients with NYHA III/IV symptoms, left ventricular ejection fraction <50%, aortic dimension >50 mm, and significant disease of other valves. Primary endpoint was freedom from adverse events (AE) defined as aortic valve replacement (AVR) or death. Secondary endpoint was freedom from developing NYHA III/IV symptoms, and to identify predictors of AE. Cox proportional hazard model was used. Results: There were 138 patients (age 51±12 years, males 81%) who were followed for 8.5±4 years. Ninety-two patients (67%) underwent AVR at a mean follow-up duration of 3.7±2.5 years. Mechanical prostheses were implanted in 79% and 52% had concomitant CABG and/or aortic replacement during AVR. No early surgical mortality. Event-free survival was 51%, and 20% at 5 and 10 years. Predictors of AE were age at presentation (hazard ratio [HR] 5.22 Confidence interval [CI] 3.10 to 6.64) for every decade increase in age and having severe stenosis or regurgitation at the time of presentation (HR 1.32; CI 1.05 to 3.16). Conclusion: Time (age and duration of follow-up) was the strongest predictor of AE in BAV population unlike in patients with trileaflet aortic valve stenosis where peak aortic velocity was prognostic. Figure Legend: pVel: peak velocity group 1: moderate aortic stenosis and regurgitation Group ≥2: severe aortic stenosis or regurgitation

Peak Oxygen Consumption and Resting Left Ventricular Ejection Fraction Changes After Cardiomyoplasty at 6-Month Follow-up

Circulation ◽  
1995 ◽  
Vol 92 (9) ◽  
pp. 216-222 ◽  
Author(s):  
Edimar Alcides Bocchi ◽  
Guilherme Veiga Guimarães ◽  
Luiz Felipe P. Moreira ◽  
Fernando Bacal ◽  
Alvaro Vilela de Moraes ◽  
...  
Keyword(s):  
Oxygen Consumption ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Peak Oxygen Consumption ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

scholarly journals Biomarkers-based personalized follow-up in chronic heart failure improves patient’s outcomes and reduces care associate cost

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Antonio Leon-Justel ◽  
Jose I. Morgado Garcia-Polavieja ◽  
Ana Isabel Alvarez-Rios ◽  
Francisco Jose Caro Fernandez ◽  
Pedro Agustin Pajaro Merino ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Admissions ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Secondary Outcome ◽  
Ventricular Ejection Fraction ◽  
Number Of Patients ◽  
Ed Visits ◽  
The Impact

Abstract Background Heart failure (HF) is a major and growing medical and economic problem, with high prevalence and incidence rates worldwide. Cardiac Biomarker is emerging as a novel tool for improving management of patients with HF with a reduced left ventricular ejection fraction (HFrEF). Methods This is a before and after interventional study, that assesses the impact of a personalized follow-up procedure for HF on patient’s outcomes and care associated cost, based on a clinical model of risk stratification and personalized management according to that risk. A total of 192 patients were enrolled and studied before the intervention and again after the intervention. The primary objective was the rate of readmissions, due to a HF. Secondary outcome compared the rate of ED visits and quality of life improvement assessed by the number of patients who had reduced NYHA score. A cost-analysis was also performed on these data. Results Admission rates significantly decreased by 19.8% after the intervention (from 30.2 to 10.4), the total hospital admissions were reduced by 32 (from 78 to 46) and the total length of stay was reduced by 7 days (from 15 to 9 days). The rate of ED visits was reduced by 44% (from 64 to 20). Thirty-one percent of patients had an improved functional class score after the intervention, whereas only 7.8% got worse. The overall cost saving associated with the intervention was € 72,769 per patient (from € 201,189 to € 128,420) and €139,717.65 for the whole group over 1 year. Conclusions A personalized follow-up of HF patients led to important outcome benefits and resulted in cost savings, mainly due to the reduction of patient hospitalization readmissions and a significant reduction of care-associated costs, suggesting that greater attention should be given to this high-risk cohort to minimize the risk of hospitalization readmissions.

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.

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