scholarly journals Prognostic implications of cardiac damage classification based on computed tomography in severe aortic stenosis

2021 ◽  
Author(s):  
Kensuke Hirasawa ◽  
Philippe J vanRosendael ◽  
Federico Fortuni ◽  
Gurpreet K Singh ◽  
Jurrien H Kuneman ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Staging System ◽  
Left Ventricular ◽  
Right Atrial ◽  
Cardiac Damage ◽  
Stage 4 ◽  
Prognostic Implications ◽  
Stage 1

Abstract Aims An echocardiographic staging system of severe aortic stenosis (AS) based on additional extra-valvular cardiac damage has been associated with prognosis after transcatheter aortic valve implantation (TAVI). Multidetector row computed tomography (MDCT) is key in the evaluation of AS patients undergoing TAVI and can potentially detect extra-valvular cardiac damage. This study aimed at evaluating the prognostic implications of an MDCT staging system of severe AS in patients undergoing TAVI. Methods and results A total of 405 patients (80 ± 7 years, 52% men) who underwent full-beat MDCT prior to TAVI were included. The extent of cardiac damage was assessed by MDCT and classified in five categories; Stage 0 (no cardiac damage), Stage 1 (left ventricular damage), Stage 2 (left atrium and mitral valve damage), Stage 3 (right atrial damage), and Stage 4 (right ventricular damage). Twenty-seven (7%) patients were stratified as Stage 0, 96 (24%) as Stage 1, 152 (38%) as Stage 2, 78 (19%) as Stage 3, and 52 (13%) as Stage 4. During a median follow-up of 3.7 (IQR 1.7–5.5) years, 150 (37%) died. On multivariable Cox regression analysis, cardiac damage Stage 3 (HR vs. Stage 0: 4.496, P = 0.039) and Stage 4 (HR vs. Stage 0: 5.565, P = 0.020) were independently associated with all-cause mortality. Conclusion The MDCT-based staging system of cardiac damage in severe AS effectively identifies the patients who are at higher risk of death after TAVI.

scholarly journals Staging cardiac damage in aortic valve disease: one size fits all?

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
G Silva ◽  
F Sampaio ◽  
C Espada Guerreiro ◽  
P Goncalves Teixeira ◽  
P Ribeiro Queiros ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Regurgitation ◽  
Severe Aortic Stenosis ◽  
Multivariable Analysis ◽  
Staging System ◽  
Left Ventricular ◽  
Cardiac Damage ◽  
Stage 4 ◽  
Stage 1

Abstract Background Nowadays, in patients with aortic regurgitation (AR), aortic valve surgery is indicated when severe and symptomatic or those with depressed LVEF. However, clinical outcomes of patients with significant aortic regurgitation are not influenced by these factors only. Recently, a new staging system for severe aortic stenosis has been proposed by Généreux on the basis of the extent of anatomic and functional cardiac damage. If this model could be applicable to an unselected significant AR population has not been tested. Purpose The aim of our study was to evaluate the prevalence of the different stages of extra-aortic valvular cardiac damage by the application of Généreux staging and its impact on prognosis in a large, real world cohort of significant AR patients. Methods This study retrospectively analysed the clinical, Doppler echocardiographic and outcome data in patients with grade III or greater AR between January 2014 and September 2019. According to the extent of cardiac damage on echocardiography, patients were classified as Stage 0 (no cardiac damage), Stage 1 (left ventricular damage), Stage 2 (mitral valve or left atrial damage), Stage 3 (tricuspid valve or pulmonary artery vasculature damage) or Stage 4 (right ventricular damage). Exclusion criteria were severe aortic stenosis and previous valve repair or replacement. The primary end-point was all-cause mortality. Results A total of 572 patients, aged 70.1±13.9 years, 294 (51.3%) men were enrolled. One third of patients were in NYHA I. Based on the proposed classification, 82 patients (14.3%) were classified in stage 0, 130 (22.7%) in stage 1, 276 (48.2%) in stage 2, 68 (11.8%) in stage 3 and 17 (3.0%) in stage 4. Median follow-up time was 3.3±1.9 years. There was a progressive increase in mortality rates according to staging: 8.5% in stage 0, 10.8% in stage 1, 24.9% in stage 2, 42.6% in stage 3 and 52.9% in stage 4 (p<0.001). On multivariable analysis, the extent of cardiac damage was independently associated with excess mortality (HR 1.69, 95% CI 1.29 to 2.21) Conclusion Our study demonstrated that this new staging system studied for aortic stenosis also provides increased prognostic value to patients with significant aortic regurgitation. This staging system can be helpful to identify the degree of extra-aortic valvular cardiac damage and to optimize the time of valvular intervention. Further prospective studies are needed to confirm the benefit of the applicability of this model in clinical practice. FUNDunding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Centro Hospitalar Vila Nova de Gaia / Espinho Distribution of stages of cardiac damage Survival analysis according to stage

P3364Cardiac damage in a real-world severe aortic stenosis population

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Ventura Gomes ◽  
J Pais ◽  
A R Pereira ◽  
D Sebaiti ◽  
I Cruz ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Aortic Stenosis ◽  
Real World ◽  
Primary Outcome ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cardiac Damage ◽  
Stage 4 ◽  
Stage 1

Abstract Introduction The cardiac consequences of aortic stenosis, besides left ventricular ejection fraction and systolic pulmonary artery pressure, aren't considered in the recommendations for surgical intervention in patients (pts) with severe aortic stenosis (SAS). In 2017, a new staging echo classification was presented to accurately describe them. Purpose To evaluate this new echo classification in risk stratification of pts with SAS with or without AVR, in a real–world setting. Methods Retrospective cohort study of pts with SAS (mean transvalvular pressure gradient (MG) ≥40 mmHg or a peak transvalvular velocity (PTV) ≥4.0 m/s), examined between January 2014 and December 2016. Pts were classified according to the new staging echo classification (no extravalvular cardiac damage - Stage 0, left ventricular damage - Stage 1, left atrial or mitral valve damage - Stage 2, pulmonary vasculature or tricuspid valve damage - Stage 3, or right ventricular damage - Stage 4). Follow-up (FU) was 2.6±1.0 years. The primary outcome was a composite of cardiovascular death or heart failure hospitalization. Results 212 pts with SAS were included (age 76.1±9.1 years, 31.6% men; aortic valve area 0.69±0.21cm2; PTV 4.5±0.4m/s; MG 48.5±11.6mmHg; LVEF 58.8±12.2%). 19 (9.0%) pts were classified as Stage 0, 29 (13.7%) as Stage 1, 129 (60.8%) as Stage 2, 12 (5.7%) as Stage 3 and 23 (10.8%) as Stage 4. Pts with more advanced stages had more events (stage 0: 5.3%; stage 1: 10.3%; stage 2: 17.1%; stage 3: 50.0%; stage 4: 52.2%; p<0.0001). In the multivariate analysis, the classification system was also a predictor of the outcome, even when including the AVR in the model (table 1). Similar findings in the uni and multivariate analysis were identified when analyzing only the pts with SAS and no aortic intervention (events in stage 0: 16.7%; stage 1: 18.2%; stage 2: 29.3%; stage 3: 75.0%; stage 4: 64.7%, p<0.005; Figure 1). Table 1. Predictors of the outcome Variables Adjusted HR (95% CI) p-value Sex* 1.86 (1.01–3.44) 0.047 eGFR* 0.99 (0.98–1.01) 0.201 AVR* 8.97 (3.85–20.90) 0.0001 Classification* – 0.031   Stage 0 0.19 (0.02–1.537) 0.120   Stage 1 0.28 (0.08–1.01) 0.052   Stage 2 0.36 (0.17–0.74) 0,006   Stage 3 0.81 (0.30–2.19) 0.675   Stage 4 1 – *Variables with p<0.05 in univariate analysis. Figure 1. Survival of SAS pts with no AVR Conclusion In a real-world experience, the new staging echo classification showed a significant relationship between the extent of cardiac damage at baseline and the primary outcome in pts with SAS, even after controlling for AVR. This classification was also able to identify the SAS pts who did not perform AVR and had a significant risk of adverse events.

scholarly journals Cardiac damage grading in patients with aortic stenosis using multi-detector computed tomography and the impact on prognosis after transcatheter aortic valve intervention

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Hirasawa ◽  
P.J Rosendael ◽  
F Fortuni ◽  
G.K Singh ◽  
J Kuneman ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Staging System ◽  
Funding Source ◽  
Cardiac Damage ◽  
Transcatheter Aortic Valve ◽  
Stage 4 ◽  
All Cause Mortality ◽  
Stage 1

Abstract Introduction A staging of severe aortic stenosis (AS) based on additional extra-valvular cardiac damage has been associated with prognosis after transcatheter aortic valve implantation (TAVI). Multi-detector row computed tomography (MDCT) has a central role in the evaluation of AS patients undergoing TAVI and can detect extra-valvular cardiac damage. Purpose To evaluate the prognostic implications of an MDCT staging system of severe AS in patients undergoing TAVI. Methods Patients who underwent full-beat MDCT prior to TAVI were included. Patients with intra-cardiac devices, prior valvular surgery, and insufficient image quality were excluded. The extent of cardiac damage was assessed by MDCT and classified into following 5 groups; stage 0 (no cardiac damage), stage 1 (left ventricular damage), stage 2 (left atrium and mitral valve damage), stage 3 (right atrial damage), stage 4 (right ventricular damage). The primary end-point was all-cause mortality. Results A total of 405 patients (80±7 years, 52% men) were stratified according to the MDCT staging system: 27 (7%) were in stage 0, 96 (24%) in stage 1, 152 (38%) in stage 2, 78 (19%) in stage 3, and 52 (13%) in stage 4 (left panel). During follow-up (median 3.7 years, IQR: 1.7–5.5 years), 150 (37%) died (right panel). On multivariable analysis, cardiac damage stage, presence of chronic obstructive pulmonary disease, NYHA ≥3, eGFR, and transapical approach were independently associated with all-cause mortality. When evaluating each stage, stage 3 (HR: 4.725, P=0.033) and stage 4 (HR 5.678, P=0.018) were independently associated with worse outcomes as compared to the other stages. Conclusion MDCT-based staging system of severe AS identifies the patients who are at higher risk of death after TAVI. MDCT staging and the mortality Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): ESC research grant

scholarly journals The signifi cance of global longitudinal strain of left ventricular in the classifi cation of stages of aortic stenosis based on the extravalvular cardiac damage

2021 ◽  
Vol 99 (3) ◽  
pp. 187-191
Author(s):  
M. G. Matveeva ◽  
M. N. Alekhin
Keyword(s):  
Aortic Stenosis ◽  
Longitudinal Strain ◽  
Severe Aortic Stenosis ◽  
Systolic Dysfunction ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Cardiac Damage ◽  
Stage 4 ◽  
The Right ◽  
Stage 1

Severe aortic stenosis (AS) is characterized not only by degenerative changes in the aortic valve but also by extravalvular cardiac damage. Recently, a new staging classifi cation of AS has been proposed based on the extent of cardiac damage, as well as its modifi ed variants with the addition of a measure of global longitudinal strain of the left ventricular (GLS LV), as an earlier predictor of preclinical LV systolic dysfunction.Aim. To evaluate the signifi cance of GLS LV in the staging classifi cation of AS based on the extent of cardiac damage according to a multidisciplinary hospital.Мaterials and methods. 66 patients with severe AS with available GLS LV by speckle tracking echocardiography were selected and analyzed retrospectively.Results. Patients were categorized according to cardiac damage on ECHO: stage 0 was determined in 2 (3%) patients; stage 1 — 10 (15%), stage 2 — 41 (62%), stage 3 — 13 (20%). The use of staging classifi cation of AS with addition of GLS LV quintiles led to patient reclassifi cation. Thus, stage 4 included patients from stage 2 and stage 3 cardiac damage.Conclusions. In patients with severe AS, the adding the GLS LV to the routine ECHO can help to more accurately determine the stages of AS and make the right decision on the management tactics of such patients.

scholarly journals External validation of a new staging system for severe aortic stenosis in a Portuguese cohort

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Silva ◽  
S Maltes ◽  
P Freitas ◽  
A.M Ferreira ◽  
R.C Teles ◽  
...  
Keyword(s):  
Survival Analysis ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Real World ◽  
Cox Regression ◽  
Severe Aortic Stenosis ◽  
Staging System ◽  
Cardiac Damage ◽  
All Cause Mortality ◽  
Stage 1

Abstract Background Recently, a new staging system for severe aortic stenosis (AS) based upon the extent of extra-aortic-valve cardiac damage has been developed (Genereux et al. Eur Heart J 2017). The present study aimed to: 1) determine the prevalence of the different stages of extra-aortic valvular cardiac damage and its impact on prognosis in a real-world Portuguese cohort and; 2) evaluate the distribution of aortic valve calcium score (AV-CaSc) and its prognostic value. Methods Consecutive patients evaluated at a single-centre TAVI-programme between Nov/2015 and Nov/2018 were retrospective selected. The extent of extra-aortic valve cardiac damage was defined by echocardiography as stage 0 (no cardiac damage), stage 1 (left ventricular damage), stage 2 (mitral valve or left atrial damage), stage 3 (tricuspid valve or pulmonary artery vasculature damage) or stage 4 (right ventricular damage). AV-CaSc was estimated routinely at CT-angiography as per TAVI-programme protocol. The primary endpoint was 1-year all-cause mortality after CT-angiography. Survival analysis (Cox-regression hazards model and Kaplan-Meier) was performed. To account for the effect of aortic valve replacement (AVR), this variable entered the Cox-regression model as a time-dependent covariate. Results A total of 443 patients (mean age 82±7 years, 44% men, median euroSCORE II 4% [IQR 2.4–5.8]) were identified. After Heart Team discussion, 79% (n=349) underwent AVR (TAVI=307; surgical valve repair=42); 9% (n=42) await intervention; 6% (n=25) remain under medical treatment; 4% (n=19) died during the period of evaluation; and 2% (n=8) underwent palliative aortic balloon valvuloplasty. According to the proposed classification, the distribution of patients from stages 0 through 4 was: 0.2% (n=1), 7.5% (n=34), 67.8% (n=306), 14% (n=63), and 10.4% (n=47). Additionally, for each increasing stage of cardiac damage, the burden of AV-CaSc was higher (from stage 1 through 4: 1776 [IQR 1217–2448]; 2448 [1796–3442]; 2448 [1832–3622]; 2960 [1936–4878] units; p for trend = 0.002). All-cause mortality at 1-year was 14% (n=63). Mortality increased alongside with increasing extent of cardiac damage (from stage 0 through 4: 0% [n=0], 6% [n=2], 12% [n=36], 20% [n=12], and 30% [n=13]) – Fig. Multivariable analysis revealed chronic renal disease (HR 1.37 per stage [1.15–1.64], p&lt;0.001), AV-CaSc (HR 1.02 per 100 units [1.01–1.03], p=0.007), AVR (HR 0.46 [0.26–0.81], p=0.007) and stage of cardiac damage (HR 1.54 per stage [1.15–2.05], p=0.004) as independent predictors of 1-year mortality. Conclusion In a real-world Portuguese cohort of severe AS patients, the extent of cardiac damage was associated with 1-year mortality. AV- CaSc grants additional prognostic information to this classification. Incorporation of this staging system into patient evaluation may be useful in the risk assessment of severe AS. Survival analysis Funding Acknowledgement Type of funding source: None

Novel staging classification of primary mitral regurgitation based on the presence of cardiac damage

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.L Van Wijngaarden ◽  
Y.L Hiemstra ◽  
P Van Der Bijl ◽  
V Delgado ◽  
N Ajmone Marsan ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Kidney Function ◽  
Left Ventricular ◽  
Prognostic Impact ◽  
Cardiac Damage ◽  
Stage 4 ◽  
All Cause Mortality ◽  
Primary Mitral Regurgitation ◽  
Stage 1 ◽  
Staging Classification

Abstract Background The indication for surgery in patients with severe primary mitral regurgitation (MR) is currently based on the presence of symptoms, left ventricular (LV) dilatation and dysfunction, atrial fibrillation and pulmonary hypertension. The aim of this study was to evaluate the prognostic impact of a new staging classification based on cardiac damage including the known risk factors but also including global longitudinal strain (GLS), severe left atrial (LA) dilatation and right ventricular (RV) dysfunction. Methods In total 614 patients who underwent surgery for severe primary MR with available baseline transthoracic echocardiograms were included. Patients were classified according to the extent of cardiac damage (Figure): Stage 0-no cardiac damage, Stage 1-LV damage, Stage 2-LA damage, Stage 3-pulmonary vasculature or tricuspid valve damage and Stage 4-RV damage. Patients were followed for all-cause mortality. Results Based on the proposed classification, 172 (28%) patients were classified as Stage 0, 102 (17%) as Stage 1, 134 (21%) as Stage 2, 135 (22%) as Stage 3 and 71 (11%) as Stage 4. The more advanced the stage, the older the patients were with worse kidney function, more symptoms and higher EuroScore. Kaplan-Meier curve analysis revealed that patients with more advanced stages of cardiac damage had a significantly worse survival (log-rank chi-square 35.2; p&lt;0.001) (Figure). On multivariable analysis, age, male, chronic obstructive pulmonary disease, kidney function, and stage of cardiac damage were independently associated with all-cause mortality. For each stage increase, a 22% higher risk for all-cause mortality was observed (95% CI: 1.064–1.395; p=0.004). Conclusion In patients with severe primary MR, a novel staging classification based on the extent of cardiac damage, may help refining risk stratification, particularly including also GLS, LA dilatation and RV dysfunction in the assessment. Funding Acknowledgement Type of funding source: None

scholarly journals Prognosis and clinical outcomes after TAVI, regarding the extravalvular cardiac damage defined by echocardiography prior the procedural

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Borrego Rodriguez ◽  
J.C Echarte Morales ◽  
C Minguito Carazo ◽  
P.L Cepas-Guillen ◽  
C Garrote Coloma ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Clinical Outcomes ◽  
Left Ventricular ◽  
Aortic Valve Area ◽  
Cardiac Damage ◽  
Stage 4 ◽  
Transvalvular Gradient ◽  
Stage 1 ◽  
Staging Classification ◽  
Valve Area

Abstract Background Recent studies have shown that the extent of extravalvular (extra-aortic valve) cardiac damage in patients with severe aortic stenosis (AS) have important prognostic implications for clinical outcomes after aortic valve replacement (AVR). Aims The aim of the present study is to evaluate the prognostic impact of a defined staging classification (“Généreux Staging Classification”) (GSC) characterizing the extent of extravalvular cardiac damage in patients with severe AS undergoing percutaneous transcatheter aortic valve implantation (TAVI). Methods A total of 102 consecutive patients, admitted in our institution between 2011–2017, with severe AS (echo-defined by peak aortic velocity, mean transvalvular gradient or aortic valve area) and symptoms related to AS (dyspnea, heart failure, angina or syncope) undergoing TAVI, were included. These patients were pooled and classified according to the presence or absence of cardiac damage as detected by echocardiography prior to TAVI, regarding the GSC: no extravalvular cardiac damage (Stage 0), left ventricular damage (Stage 1), left atrial or mitral valve damage (Stage 2), pulmonary vasculature or tricuspid valve damage (Stage 3), or right ventricular damage (Stage 4). Two-year outcomes were compared using Kaplan– Meier techniques and multivariable Cox proportional hazards models were used to identify 2-year predictors of mortality. Results Out of 102 patients, 57 were male (55.9%). Mean age was 83.46±4.23 years. 2 patients (2.1%) were classified as Stage 0; 20 patients (20.3%) as Stage 1; 55 patients (54.2%) as Stage 2; 22 (21.6%) as Stage 3; and 3 patients (2.9%) as Stage 4. Two-year mortality was 0.0% in Stage 0, 5.0% in Stage 1, 5.5% in Stage 2, and 44.0% in Stages 3–4. After multivariable and univariate analysis, stage of cardiac damage was independently associated as predictor for all-cause mortality at 2-years, after TAVI (HR 2.8 [1.3±6.2], p&lt;0.01). There were not another identificable predictors of 2-years death (age, sex, hypertension [78.5% of total patients], dislipemia [64.7%], diabetes [30.3%], smoking [78.5%], O2-chronic obstructive pulmonary disease [27.5% of total patients], renal insufficiency [78.5%], previous coronary artery disease [37.3%], peak aortic velocity, mean transvalvular gradient, and aortic valve area). Conclusions Given the strong association demonstrated in this study between advanced staging of cardiac damage and worse clinical outcomes after TAVI in short-middle term survival, consideration of the GSC in patients with severe AS in future recommendations for risk stratification might be useful. Two-year all-cause death in TAVI by GSC. Funding Acknowledgement Type of funding source: None

Abstract 15604: Staging Cardiac Damage in Patients With Secondary Mitral Regurgitation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Gurpreet Singh ◽  
Farnaz Namazi ◽  
Kensuke Hirasawa ◽  
Nina A Ajmone Marsan ◽  
Victoria Delgado ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Censored Data ◽  
Significant Risk ◽  
Left Ventricular ◽  
Cardiac Damage ◽  
Stage 4 ◽  
All Cause Mortality ◽  
Secondary Mitral Regurgitation ◽  
Stage 1

Introduction: Patients with secondary mitral regurgitation (SMR) often show extra-mitral valvular cardiac damage which can influence the prognosis. SMR can be defined according to stages of extra-mitral valvular cardiac damage. The present study evaluated the prevalence of different stages of extra-mitral valvular cardiac damage and the prognostic implications in moderate and severe SMR patients. Methods: A total of 648 patients with moderate and severe SMR were classified according to the extent of cardiac damage on echocardiography: left ventricular damage (Stage 1), left atrial damage (Stage 2), pulmonary artery vasculature damage (Stage 3) or right ventricular damage (Stage 4). Cox proportional hazards analyses were performed, both on, non-censored and censored data (included till the occurrence of mitral valve intervention). The primary endpoint was all-cause mortality. Results: The prevalence of each stage of the proposed classification was, 10% in Stage 1, 7% in Stage 2, 16% in Stage 3 and 67% in Stage 4. In the censored data, cardiac damage classification was independently associated with all-cause mortality (HR: 1.182, CI :1.019-1.370; P=0.027), and this was mainly driven by Stage 4 (HR: 1.726 CI: 1.034-2.881; p=0.037, Figure 1A). The non-censored data, showed that Stage 3 was independently associated with all-cause mortality (HR: 1.795 CI:1.121-2.876; P= 0.015), whereas Stage 4 showed an increased non-significant risk for all-cause mortality (HR: 1.472 CI:0.973-2.227; P=0.067, Figure 1B). Conclusions: A new proposed staging classification for moderate and severe SMR showed, that cardiac damage staging was independently associated with all-cause mortality in patients censored for mitral valve intervention, and this was mainly determined by RV dysfunction.

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.

scholarly journals Effect of the Extent of Cardiac Damage on Transcatheter Aortic Valve Replacement Outcome: A New Aortic Stenosis Staging System

2020 ◽  
Vol 13 (2) ◽  
pp. 69-73
Author(s):  
Miho Fukui ◽  
João L Cavalcante
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Staging System ◽  
Cardiac Damage ◽  
Transcatheter Aortic Valve ◽  
Staging Classification

Severe aortic stenosis (AS) causes chronic pressure overload of the left ventricle (LV), resulting in progressive cardiac change that can extend beyond the LV. A new AS staging classification has been recently proposed encompassing the extent of cardiac changes in AS. The AS staging classification has important prognostic implications for clinical outcomes after aortic valve replacement. This article introduces the AS staging system and demonstrates the association of the extent of cardiac change with outcomes after transcatheter aortic valve replacement.

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