scholarly journals Progression of Aortic Stenosis and Long-term Follow-Up in Women

2021 ◽  
Vol 4 (8) ◽  
pp. 01-08
Author(s):  
Ezra Amsterdam
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Rapid Progression ◽  
Aortic Valve Area ◽  
Event Free Survival ◽  
Free Survival ◽  
Entire Cohort ◽  
Rapid Progressors ◽  
Group 2

Data on the rate of progression of aortic stenosis (AS) in women are limited. We retrospectively studied 95 female patients (age 75 ± 13 yrs) with aortic valve area (AVA) <2.0 cm2 (mild AS 1.5-1.9 cm2, moderate AS 1.0-1.4 cm2, severe AS <1.0 cm2). All patients underwent serial transthoracic echocardiography. We determined annual AVA decrease (rate of AS progression) by 3 approaches, each of which was applied to the entire cohort: 1) as a single group; 2) in the 3 subgroups of mild, moderate and severe AS; and 3) in the rapid and slower progressors. Study endpoints were aortic valve replacement (AVR) and all-cause mortality. The mean duration of follow-up was 4.5 ± 2.9 years. Mean rate of reduction in AVA for the total study group was 0.14 ± 0.16 cm2/yr and was directly related to presence of hypertension and baseline AVA, and inversely related to follow-up duration (all p<0.05). The annualized decrease in AVA for each of the subgroups of mild, moderate and severe AS at baseline was 0.21±0.31 cm2, 0.13±0.11 cm2, 0.11±0.09 cm2, respectively (p<0.0001). Rapid progression of AS (decrease in AVA ≥0.20 cm2/yr) occurred in 21% of patients (n=20) and was associated with baseline hypertension (p=0.03) and inversely related to follow-up duration (p=0.0007). Rapid progressors had shorter follow-up than slower progressors (20 vs. 42 mos, p=0.002). Event-free survival with end-points of death (n=65) or surgical/transcatheter AVR (n=24) at 1, 3, and 5 years, respectively, was 93%, 66% and 40% for mild AS; 96%, 72% and 48% for moderate AS; and 93%, 38% and 24% for severe AS. Thus, event-free survival at 5 years in patients with baseline severe AS was approximately half that of patients with AS of mild or moderate severity. In addition, event-free survival at 1 year in slower progressors was 92% and in rapid progressors was 70%.

scholarly journals P289 Aortic valve resistance risk-stratifies low-gradient aortic stenosis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
J Cho ◽  
T Uejima ◽  
H Nishikawa ◽  
J Yajima ◽  
T Yamashita
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Stroke Volume ◽  
Clinical Decision Making ◽  
Stroke Volume Index ◽  
Low Flow ◽  
Volume Index ◽  
Aortic Valve Area ◽  
Event Free Survival ◽  
Free Survival

Abstract Background Grading the severity of aortic stenosis (AS) is challenging, since there is a discrepancy between aortic valve area (AVA) and mean pressure gradient (mPG). Arotic valve resistance (RES) has been proposed as a usuful descriptor of AS severity, but it is not commonly used for clinical decision-making, because its robust validation of clinical-outcome efficacy is lacking. This study aimed to investigate whether RES holds an incremental value for risk-stratifying AS. Methods This study recuited 565 AS patients (AVA &lt; 1.5cm²) referred to echocardiography for valve assessment. The patients were divided into three different groups, according to the guidelines: high-gradient AS (HG-AS, mPG≥40mmHg, n = 157), low-gradient AS (LG-AS, mPG &lt; 40mmHg + AVA ≤ 1.0cm², n = 155) and moderate AS (Mod-AS, mPG &lt; 40mmHg + AVA &gt; 1.0cm², n = 253). RES was calculated from Doppler measurement of mPG and stoke volume. The diagnositic cutoff point for RES was determined at 190 dynes × s×cm-5 by substituting AVA = 1.0cm² and mPG = 40mmHg into the definition formula of RES and Gorlin formula. The patients were followed up for 2 years. The endpoint was a composite of cardiac death, hospitalization for heart failure and aortic valve replacement necessitated by the development of AS-related symptoms. Result Kaplan-Meier analyses showed that LG-AS exhibited an intermediate outcome between HG-AS and Mod-AS (event-free survival at 2 years = 20.9% for HG-AS, 59.7% for LG-AS, 89.9% for Mod-AS, p &lt; 0.001, figure A). When LG-AS was stratified by RES, the survival curves showed a significant separation (event-free survival at 2 years = 35.3% for high RES, 70.7% for low RES, p &lt; 0.001, figure B). This trend persisted even when analysed separately for norml (stroke volume index &gt; 35ml/m²) and low (stroke volume index ≤ 35ml/m²) flow state ((normal flow) event-free survival at 2 years = 38.7% for high RES, 70.4% for low RES, p = 0.023, figure C; (low flow) event-free survival at 2 years = 26.7% for high RES, 74.6% for low RES, p &lt; 0.001, figure D). Conclusion This study confirmed the clinical efficacy of RES for risk-stratifying LG-AS patients. Abstract P289 Figure.

Abstract 3388: Usefulness Of The Valvulo-arterial Impedance To Predict Adverse Outcome In Aortic Stenosis

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Zeineb Hachicha ◽  
Jean G Dumesnil ◽  
Philippe Pibarot
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Adverse Outcome ◽  
Event Free Survival ◽  
Free Survival ◽  
A Value ◽  
Arterial Impedance

Background . We recently proposed a new index: the valvulo-arterial impedance (Z va ), which represents the valvular and arterial hemodynamic factors that oppose ventricular ejection. This index is calculated by dividing the estimated left ventricule (LV) systolic pressure (systolic arterial pressure + mean transvalvular gradient) by the stroke volume indexed for the body surface area. We previously demonstrated that Z va is superior to standard indices of aortic stenosis (AS) severity in estimating the global LV afterload and predicting the occurrence of LV dysfunction. Objective : to assess the usefulness of Z va to predict adverse outcome in AS. Methods . We retrospectively analyzed clinical and echocardiographic data of 544 consecutive patients (320 men and 224 women; mean age: 70±14 years) having at least moderate AS (aortic jet velocity ≥2.5m/s) and no symptoms at baseline. The primary end-point for this study was the occurrence of aortic valve replacement (AVR) or death. Results . The mean follow-up time was 2.5±1.8 years. Ninety one patients (17%) died and 176 (32%) had aortic valve replacement (AVR) during follow-up. The 3-year event-free survival was significantly lower in patients (n=180, 33%) with Z va ≥ 4.5 mmHg.ml −1 .m −2 compared to those (n=192, 35%) with Z va between 3.5 and 4.5, and those (n=172, 32%) with Z va ≥ 3.5: respectively 33±5% vs 51±4% and 56±5%, p<0.001. A value of Z va ≥ 4.5 was associated with an age-adjusted risk of adverse event of 1.3 (95% confidence interval: 1.1–1.6, p=0.0015). On multivariate analysis, the independent predictors of the event-free survival were: peak aortic jet velocity (p<0.001), coronary artery disease (p=0.001) and Z va (p=0.03). Two-year overall survival was also significantly (p=0.001) lower in the patients with a baseline Zva ≥ 4.5 (70±5%) compared to those with Zva between 3.5 and 4.5 (80±3 %) and those with Z va ≤ 3.5 (88±3 %). Conclusion . A value of valvulo-arterial impedance ≥ 4.5 mmHg.ml −1 .m −2 identifies patients with a poor outcome. These findings suggest that beyond standard indices of stenosis severity, the consideration of valvulo-arterial impedance may be useful to improve risk stratification and clinical decision making in patients with AS.

scholarly journals Comparison of the results in Normal Flow High Gradient and Low Flow Low Gradient patients after correction of pronounced aortic stenosis with Ozaki procedure in the long-term observation

2020 ◽  
Vol 11 (2) ◽  
pp. 28-34
Author(s):  
Vladlen V. Bazylev ◽  
Dmitrii S. Tungusov ◽  
Ruslan M. Babukov ◽  
Fedor L. Bartosh ◽  
Artur I. Mikulyаk ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Odds Ratio ◽  
Low Flow ◽  
Normal Flow ◽  
Long Term Follow Up ◽  
Group 2 ◽  
Long Term Mortality

Relevance.It has been proven that patients with Low Flow Low Gradient (LFLG) after aortic valve replacement with biological or mechanical prostheses have a higher mortality rate and the number of adverse events compared with patients with Normal Flow High Gradient (NFHG). However, there are currently no comparative studies of patients with NFHG and LFLG after the Ozaki procedure. The better hemodynamic properties of autopericardial cusps compared with biological prostheses can more favorably influence the results in patients with LFLG in the short and long-term follow-up periods. Aim.1. Compare the hospit and long-term results of patients of the LFLG group with the results of patients of the NFHG group after the Ozaki procedure. 2. Identify predictors of hospital and long-term mortality in patients with LFLG. Materials and methods.All patients have been divided into two groups. Group 1: 137 patients with NFHG and signs of classic aortic stenosis: AVA1 cm2, Gmean40, SV index 35 ml/m2and normal left ventricle (LV) ejection fraction. Group 2. 71 patients with LFLG and underestimation of the average gradient indices (Gmean40) despite a decrease in the aortic valve aperture AVA1 cm2amid a decrease in the index of stroke volume 35 ml/m2and LV systolic function. Results.Hospital mortality after surgical correction of AV stenosis was significantly higher in patients of group 2: 3 (4.2%) patients and 1 (0.7%) patients, respectively (p=0.002). Survival at the maximum follow-up period for patients with LFLG was significantly lower than in the group of patients with NFHG 88.6 (95% confidence interval CI 4449.6) and 97.8 (95% CI 48.951), respectively (p=0.009). According to the results of the Cox regression analysis, the independent predictors of mortality in the long-term follow-up of patients with LFLG are the SV odds ratio 0.8 (95% CI 0.91.1);p=0.008 and the global longitudinal LV deformation (GLS) odds ratio 0.56 (95% CI 0.471.1);p=0.01. Conclusions.1. After the Ozaki procedure, patients with the LFLG group have higher risks of adverse events, both at the hospital stage and in the long-term follow-up, compared to patients with NFHG. 2. The duration of ischemia and LV mass are predictors of hospital mortality in the LFLG group of patients. 3. Predictors of long-term mortality in patients with LFLG are LV stroke volume index and global longitudinal LV deformation.

scholarly journals Risk Adapted Treatment in Childhood Hodgkin's Lymphoma: Outcome and Changing Epidemiologic Features in 25 Years

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4158-4158 ◽  
Author(s):  
Rejin Kebudi ◽  
Sema Bay Buyukkapu ◽  
Omer Gorgun ◽  
Fulya Yaman Agaoglu ◽  
Bulent Zulfikar ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Risk Group ◽  
Event Free Survival ◽  
Mixed Cellularity ◽  
Free Survival ◽  
Institutional Risk ◽  
Group 2 ◽  
Epidemiologic Features ◽  
Nodular Sclerosing

Abstract IntroductionThe survival of children with Hodgkin lymphoma have increased significantly raising the issue of decreasing late effects by using risk adapted treatment. Hodgkin lymphoma has different epidemiologic features in developed and developing countries. In this study the epidemiologic, clinical characteristics and outcome of children with Hodgkin disease treated with a risk adapted treatment over a 25 year period are evaluated. MethodsThis retrospective study evaluates the clinical characteristics and outcome of 122 children treated with the same institutional risk-adapted protocol in the Istanbul University, Oncology Institute between 1991-2016. Clinical staging was done according to Ann-Arbor staging, all patients had biopsy confirmation and the WHO histopathological classification was used. Imaging (ultrasound, CT/MRI and/or PET-CT since 2004) was done in all patients. Bone marrow aspiration and biopsy was done for all with B symptoms or risk group 2 and 3. Risk group 1 (clinical group IA/B and IIA) recieved 2 courses of ABVD (adriamycin 25 mg/m2, bleomycin 10 U/m2, vinblastin 6 mg/m2 and dacarbazine 375 mg/m2 , day 1 and 15) chemotherapy, risk group 2 (stage IIB and IIIA) 4 courses of ABVD, risk group 3 patients (IIIB,IVA/B) 6 courses of COPP/ABV (cyclophosphamide 600 mg/m2, vincristine 1.4 mg/m2 on day 1, procarbazine 100 mg/m2 day1-7, prednisolone 40 mg/m2 day1-14; adriamycine 35 mg/m2, bleomycin 10 U/m2, vinblastine 6 mg/m2 day 8) chemotherapy, each course administered every 28 days. All patients recieved involved field radiotherapy 15-25 Gy adjusted to age (15 Gy for < 5, 20 Gy for 5-10, 25 Gy for >10 years old), + 5 Gy for bulky disease and/or partial response to chemotherapy. Results There were 83 males and 39 females (M/F: 2.1) with a median age of 10 (2-18) years. The most frequent histological subtypes were mixed cellularity (41%) and nodular sclerosing (41%). The most common involved site was the neck (cervical and supraclavicular lymph nodes) (%85). The median follow up period was 6 1/12 years (1-25 years). The 5 year event free survival and survival were 82% and 97% for all patients; they were 86% and 97% for risk 1 (48 patients), 80% and 96% for risk 2 (29 patients), 79% and 97% for risk 3 (45 patients) . B symptoms were present in 46%; %54 were staged as I-II; 46% as stage III-IV. When classified according to two time periods: before and after 2000, the median age increased [9 (2-17) vs 11 (3-18) years], M/F ratio decreased [2.7 (36/13) vs 1.8 (47/26)] and the most common histological subtype were mixed cellularity (51%) vs nodular sclerosing (49%) respectively. The 5 year event free survival and survival were 79% and 95% before 2000 and 83,5% and 98% after 2000 respectively. Ebstein Barr Virus-Latent membrane Protein (EBV-LMP1) was found to be positive by immunohistochemistry in all tumor samples of 21 patients analyzed, all were treated before 2000. During follow-up no clinically evident cardiotoxicity or pulmonary toxicity has been observed. Three patients developed secondary tumors (Langerhans cell histiocytosis, schwannoma, non-Hodgkin's lymphoma). ConclusionThe epidemiologic features of HL is related to socioeconomic status. In our cohort, the oberved change in epidemiologic features within 25 years, such as the increase in median age, decrease in the M/F ratio and increase in nodular sclerosing subtype, is thought to be related to the socioeconomic development. A high survival rate has been achieved with the institutional risk-adapted protocol for all risk groups. The use of risk adapted protocols providing efficient and least toxic treatment is very important in pediatric Hodgkin lymphoma. Disclosures No relevant conflicts of interest to declare.

Abstract 13349: Long Term (4 Years) Clinical and Echocardiographic Results of Transcatheter Self-expanding Medtronic Corevalve Device in Patients With Aortic Stenosis

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Vassilis Voudris ◽  
Sofia Thomopoulou ◽  
Manolis Vavuranakis ◽  
Maria Kariori ◽  
Christos Stefopoulos ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
The Self ◽  
Paravalvular Leak ◽  
Categorical Variables ◽  
Aortic Valve Area ◽  
Medtronic Corevalve

Introduction: Transcatheter aortic valve implantation (TAVI) has emerged as an alternative to surgical aortic valve replacement for patients (pts) with severe aortic stenosis considered inoperable or at high operative risk. However, little is known about long-term outcomes following TAVI. In this study we assessed the 4-year clinical and echocardiographic outcomes of pts undergoing TAVI with the self expanding Medtronic CoreValve prosthesis. Methods: The 4-year outcomes following successful TAVI with the self-expanding aortic valve device (Medtronic CoreValve) were evaluated in 60 pts (mean age 79+6 years, male 47 %, Logistic Euroscore 28.43+10.93%). Principal outcome measures were death from any cause. An echocardiograpic examination was performed at prespecified intervals of 6 and 12 months, and every year afterwards. Categorical variables were compared using X2 test, and continuous variables using t test. Survival curves were also constructed. Results: All cause mortality at 1, 2, 3, and 4 years was 16.7%, 28.3%, 30%, and 40% respectively. Mean aortic valve gradient decreased from 50.96+18.6 mm Hg pre to 9.22+ 4.6 mm Hg after TAVI (P<0.001) and remained at 15.69+6.3 mm Hg at 4 years (p for post-TAVI trend <0.01). Mean aortic valve area increased from 0.66+ 0.14 cm2 pre to 1.87+0.33 cm2 after TAVI (p<0.001) and remained at 1.23+ 0.25 cm2 at 4 years (p for post-TAVI trend <0.01). Paravalvular leak (minimal to moderate) was observed in 61% of pts post-TAVI; however, there was no case of progression to severe regurgitation at 4 years follow-up. Conclusions: TAVI with the Medtronic CoreValve prosthesis is associated with sustained clinical and functional cardiovascular benefits in inoperable or high-risk patients with symptomatic aortic stenosis up to 4-year follow-up.

Clinical features and prognosis of patients with isolated severe aortic stenosis and valve area less than 1.0 cm2

Heart ◽  
2017 ◽  
Vol 104 (3) ◽  
pp. 222-229 ◽  
Author(s):  
Praveen Mehrotra ◽  
Katrijn Jansen ◽  
Timothy C Tan ◽  
Aidan Flynn ◽  
Judy W Hung
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Clinical Features ◽  
Severe Aortic Stenosis ◽  
Low Flow ◽  
Aortic Valve Area ◽  
High Gradients ◽  
Current Guidelines ◽  
Valve Area

ObjectiveCurrent guidelines define severe aortic stenosis (AS) as an aortic valve area (AVA)≤1.0 cm2, but some authors have suggested that the AVA cut-off be decreased to 0.8 cm2. The aim of this study was, therefore, to better describe the clinical features and prognosis of patients with an AVA of 0.8–0.99 cm2.MethodsPatients with isolated, severe AS and ejection fraction ≥55% with an AVA of 0.8–0.99 cm2 (n=105) were compared with those with an AVA<0.8 cm2 (n=155) and 1.0–1.3 cm2 (n=81). The endpoint of this study was a combination of death from any cause or aortic valve replacement at or before 3 years.ResultsPatients with an AVA of 0.8–0.99 cm2 group comprised predominantly normal-flow, low-gradient (NFLG) AS, while high gradients and low flow were more often observed with an AVA<0.8 cm2. The frequency of symptoms was not significantly different between an AVA of 0.8–0.99 cm2 and 1.0–1.3 cm2. The combined endpoint was achieved in 71%, 52% and 21% of patients with an AVA of 0.8 cm2, 0.8–0.99 cm2and 1.0–1.3 cm2, respectively (p<0.001). Among patients with an AVA of 0.8–0.99 cm2, NFLG AS was associated with a lower hazard (HR=0.40, 95% CI 0.23 to 0.68, p=0.001) of achieving the combined endpoint with outcomes similar to moderate AS in the first 1.5 years of follow-up. Patients with high-gradient or low-flow AS with an AVA of 0.8–0.99 cm2 had outcomes similar to those with an AVA<0.8 cm2. The sensitivity for the combined endpoint was 61% for an AVA cut-off of 0.8 cm2 and 91% for a cut-off of 1.0 cm2.ConclusionsThe outcomes of patients with AS with an AVA of 0.8–0.99 cm2 are variable and are more precisely defined by flow-gradient status. Our findings support the current AVA cut-off of 1.0 cm2.

scholarly journals Asymptomatic Patients with Severe Aortic Stenosis and the Impact of Intervention

2021 ◽  
Vol 8 (4) ◽  
pp. 35
Author(s):  
Mevlüt Çelik ◽  
Milan Milojevic ◽  
Andras P. Durko ◽  
Frans B. S. Oei ◽  
Edris A. F. Mahtab ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Survival Rates ◽  
Aortic Valve Area ◽  
Term Survival ◽  
Asymptomatic Patients ◽  
History Of ◽  
The Impact

Objectives the exact timing of aortic valve replacement (AVR) in asymptomatic patients with severe aortic stenosis (AS) remains a matter of debate. Therefore, we described the natural history of asymptomatic patients with severe AS, and the effect of AVR on long-term survival. Methods: Asymptomatic patients who were found to have severe AS between June 2006 and May 2009 were included. Severe aortic stenosis was defined as peak aortic jet velocity Vmax ≥ 4.0 m/s or aortic valve area (AVA) ≤ 1 cm2. Development of symptoms, the incidence of AVR, and all-cause mortality were assessed. Results: A total of 59 asymptomatic patients with severe AS were followed, with a mean follow-up of 8.9 ± 0.4 years. A total of 51 (86.4%) patients developed AS related symptoms, and subsequently 46 patients underwent AVR. The mean 1-year, 2-year, 5-year, and 10-year overall survival rates were higher in patients receiving AVR compared to those who did not undergo AVR during follow-up (100%, 93.5%, 89.1%, and 69.4%, versus 92.3%, 84.6%, 65.8%, and 28.2%, respectively; p < 0.001). Asymptomatic patients with severe AS receiving AVR during follow-up showed an incremental benefit in survival of up to 31.9 months compared to conservatively managed patients (p = 0.002). Conclusions: The majority of asymptomatic patients turn symptomatic during follow-up. AVR during follow-up is associated with better survival in asymptomatic severe AS patients.

scholarly journals Progression of Aortic Stenosis in Patients with Bicuspid Aortic Valve

2021 ◽  
Author(s):  
Michael Shang ◽  
Arianna Kahler-Quesada ◽  
Makoto Mori ◽  
Sameh Yousef ◽  
Arnar Geirsson ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Bicuspid Aortic Valve ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards Model ◽  
Rapid Progression ◽  
Progression Rate

Background: Bicuspid aortic valve is the most common congenital heart defect and predisposes patients to developing aortic stenosis more frequently and at a younger age than the general population. However, the influence of bicuspid aortic valve on the rate of progression of aortic stenosis remains unclear. Methods: In 236 patients (177 tricuspid aortic valve, 59 bicuspid aortic valve) matched by initial severity of mild or moderate aortic stenosis, we retrospectively analyzed baseline echocardiogram at diagnosis with latest available follow-up echocardiogram. Baseline comorbidities, annualized progression rate of hemodynamic parameters, and hazard of aortic valve replacement were compared between valve phenotypes. Results: Median echocardiographic follow-up was 2.6 (IQR 1.6-4.2) years. Patients with tricuspid aortic stenosis were significantly older with more frequent comorbid hypertension and congestive heart failure. Median annualized progression rate of mean gradient was 2.3 (IQR 0.6-5.0) mmHg/year vs. 1.5 (IQR 0.5-4.1) mmHg/year (p=0.5), and that of peak velocity was 0.14 (IQR 0-0.31) m/s/year vs. 0.10 (IQR 0.04-0.26) m/s/year (p=0.7) for tricuspid vs. bicuspid aortic valve, respectively. On multivariate analyses, bicuspid aortic valve was not significantly associated with more rapid progression of aortic stenosis. In a stepwise Cox proportional hazards model adjusted for baseline mean gradient, bicuspid aortic valve was associated with increased hazard of aortic valve replacement (HR: 1.7, 95% CI [1.0, 3.0], p=0.049). Conclusion: Bicuspid aortic valve may not significantly predispose patients to more rapid progression of mild or moderate aortic stenosis. Guidelines for echocardiographic surveillance of aortic stenosis need not be influenced by valve phenotype.

Frequency and clinical impact of different definitions of moderate aortic stenosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y.U Du ◽  
G.O Hashimoto ◽  
J Cavalcante ◽  
M Goessl ◽  
S Garcia ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Stroke Volume Index ◽  
High Rate ◽  
Volume Index ◽  
Funding Source ◽  
Aortic Valve Area ◽  
Mortality And Morbidity ◽  
Patient Demographics

Abstract Background Current echocardiographic guidelines recommend five parameters to define severity of aortic stenosis (AS): peak velocity (PV), mean gradient (MG), aortic valve area (AVA), index AVA (AVAi), and dimensionless index (DI). However, the clinical utility of these parameters for patients with moderate AS largely remain unknown. Objective To investigate the clinical profiles and outcomes of patients with moderate AS according to five different definitions for severity. Methods Using standard echocardiographic definitions, we identified patients with moderate AS who were evaluated in our health care system from 2011 to 2012. Patient demographics, morbidities, and adverse events were reviewed, including death, heart failure (HF) admission, and aortic valve replacement (AVR). Results We enrolled 1,042 patients (age, 75±12 yrs; 40% women). Very few patients (4%) met all five criteria for moderate AS, while 49% had only one or two criteria met. DI was the most common parameter for defining moderate AS, employed in 93% of patients. Patients with area-based indices (i.e., AVA, AVAi, DI) had lower stroke volume index, lower mean gradients, lower peak velocities, and more morbidities in comparison to those flow-based definitions of severity (i.e., PV, MG). During a median follow-up of 5.7 years, overall survival was poor with all-cause mortality of 62.8%. Notably, there was no difference in the rates of mortality (range, 56.4 to 63.3%) or HF hospitalization (range, 28.9 to 32.2%) for groups defined by the five parameters, though patients with flow-based definitions more likely had AVR in follow-up. Conclusions Most patients with moderate AS meet the definition for severity with one or few criteria. Regardless of the method of definition for severity, a high rate of mortality and morbidity can occur in patients with moderate AS. Further study to optimize the clinical outcomes of patients with moderate AS is warranted. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Minneapolis Heart Institute Foundation

Sign in / Sign up

Export Citation Format

Share Document