scholarly journals Diagnostic and Prognostic Accuracy of Aortic Valve Calcium Scoring in Patients With Moderate-to-Severe Aortic Stenosis

2021 ◽  
Vol 8 ◽  
Author(s):  
Jamila Boulif ◽  
Alisson Slimani ◽  
Siham Lazam ◽  
Christophe de Meester ◽  
Sophie Piérard ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Multidetector Row Computed Tomography ◽  
Prognostic Impact ◽  
Prognostic Information ◽  
Free Survival ◽  
Prognostic Accuracy ◽  
Heterogenous Group ◽  
Prognostic Implications

Background: Assessing the true severity of aortic stenosis (AS) remains a challenge, particularly when echocardiography yields discordant results. Recent European and American guidelines recommend measuring aortic valve calcium (AVC) by multidetector row computed tomography (MDCT) to improve this assessment.Aim: To define, using a standardized MDCT scanning protocol, the optimal AVC load criteria for truly severe AS in patients with concordant echocardiographic findings, to establish the ability of these criteria to predict clinical outcomes, and to investigate their ability to delineate truly severe AS in patients with discordant echocardiographic AS grading.Methods and Results: Two hundred and sixty-six patients with moderate-to-severe AS and normal LVEF prospectively underwent MDCT and Doppler-echocardiography to assess AS severity. In patients with concordant AS grading, ROC analysis identified optimal cut-off values for diagnosing severe AS using different AVC load criteria. In these patients, 4-year event-free survival was better with low AVC load (60–63%) by these criteria than with high AVC load (23–26%, log rank p < 0.001). Patients with discordant AS grading had higher AVC load than those with moderate AS but lower AVC load than those with severe high-gradient AS. Between 36 and 55% of patients with severe LG-AS met AVC load criteria for severe AS. Although AVC load predicted outcome in these patients as well, its prognostic impact was less than in patients with concordant AS grading.Conclusions: Assessment of AVC load accurately identifies truly severe AS and provides powerful prognostic information. Our data further indicate that patients with discordant AS grading consist in a heterogenous group, as evidenced by their large range of AVC load. MDCT allows to differentiate between truly severe and pseudo-severe AS in this population as well, although the prognostic implications thereof are less pronounced than in patients with concordant AS grading.

Abstract 4290: Risk Factors and Prognostic Implications of Mitral Regurgitation in Severe Aortic Stenosis

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Padmini Varadarajan ◽  
Ramdas G Pai
Keyword(s):  
Risk Factors ◽  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Aortic Stenosis ◽  
Independent Predictor ◽  
Severe Aortic Stenosis ◽  
Aortic Valve Area ◽  
List Type ◽  
Prognostic Implications ◽  
Valve Area

Introduction: Mitral regurgitation (MR) is present in nearly half of the patients with severe aortic stenosis (AS). Risk factors for its development and its prognostic implications are not clear. Methods: Search of our echocardiographic database between 1993 to 2003 yielded 740 patients with severe AS defined as aortic valve area (AVA) ≤ 0.8cm2. Thorough chart reviews were conducted to collect clinical and pharmacological data. Mortality data was obtained from National death index. Results: Patient characteristics: age 74±13 years; females 60%, EF 54±20%, aortic valve area 0.67±0.17 cm2. MR grade ≥2+ were present in 339 (46%) patients: 2+ in 166 (22%), 3+ in 115 (16%) and 4+ in 58 (8%). There was a progressive decrease in survival with each grade of MR in the whole cohort as well as the surgically and medically treated subsets (p<0.0001, figure ). Presence of 3 and 4+ MR was associated with a larger LV (p<0.0001), lower EF (p<0.0001), greater age (p=0.0001), a smaller aortic valve area (p=0.001) and female gender (p=0.003). It remained an independent predictor of lower survival after adjusting for group differences using the Cox regression model. There was a lower AVR rate in those with 3 or 4+ MR compared to the rest (32 vs. 41%, p=0.03) despite a distinct independent survival advantage with AVR (RR 0.40, p<0.0001). Conclusion: Significant MR is present in nearly half of the patients with severe AS. The risk factors for its development include age, greater AS severity and LV dysfunction. It is an independent predictor of reduced survival.

scholarly journals Prognostic Impact of Aortic Valve Area in Conservatively Managed Patients With Asymptomatic Severe Aortic Stenosis With Preserved Ejection Fraction

2019 ◽  
Vol 8 (3) ◽  
Author(s):  
Norio Kanamori ◽  
Tomohiko Taniguchi ◽  
Takeshi Morimoto ◽  
Hirotoshi Watanabe ◽  
Hiroki Shiomi ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Severe Aortic Stenosis ◽  
Prognostic Impact ◽  
Aortic Valve Area ◽  
Preserved Ejection Fraction ◽  
Link Type ◽  
Valve Area

See Editorial by Tribouilloy et al

scholarly journals B-type natriuretic peptide in patients with asymptomatic severe aortic stenosis

Heart ◽  
2018 ◽  
pp. heartjnl-2018-313746 ◽  
Author(s):  
Kenji Nakatsuma ◽  
Tomohiko Taniguchi ◽  
Takeshi Morimoto ◽  
Hiroki Shiomi ◽  
Kenji Ando ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Natriuretic Peptide ◽  
Event Rate ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Prognostic Impact ◽  
Ventricular Ejection Fraction ◽  
Asymptomatic Patients

ObjectivesWe sought to evaluate the prognostic impact of the B-type natriuretic peptide (BNP) levels in patients with asymptomatic severe aortic stenosis (AS), who were not referred for aortic valve replacement (AVR).MethodsWe used data from a Japanese multicentre registry, the Contemporary outcomes after sURgery and medical tREatmeNT in patients with severe Aortic Stenosis Registry, which enrolled 3815 consecutive patients with severe AS. Of those, 387 asymptomatic patients who were not referred for AVR without left ventricular dysfunction and very severe AS were subdivided into four groups based on their BNP levels (BNP<100 pg/mL, n=201; 100≤BNP<200 pg/mL, n=94; 200≤BNP<300 pg/mL, n=42 and BNP>300 pg/mL, n=50).ResultsThe cumulative 5-year incidence of AS-related events (aortic valve-related death or heart failure hospitalisation) was incrementally higher with increasing BNP level (14.2%, 29.6%, 46.3% and 47.0%, p<0.001). After adjusting for confounders, the risk for AS-related events was incrementally greater with increasing BNP levels (HR: 1.97, 95% CI: 0.97 to 3.98, p=0.06; HR: 3.59, 95% CI: 1.55 to 8.32, p=0.03 and HR: 7.38, 95% CI: 3.21 to 16.9, p<0.001, respectively). Notably, asymptomatic patients with BNPlevels of <100 pg/mL had an event rate of only 2.1% at 1 year.ConclusionsIncreased BNP level was associated with a higher risk for AS-related adverse events in patients with asymptomatic severe AS with normal left ventricular ejection fraction who were not referred for AVR. Asymptomatic patients with BNP levels of <100 pg/mL had relatively low event rate, who might be safely followed with watchful waiting strategy.Trail registration numberUMIN000012140.

scholarly journals Impact of concomitant mitral regurgitation in severe aortic stenosis in Japan – from the CURRENT AS registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Murai ◽  
Y Kawase ◽  
T Taniguchi ◽  
T Morimoto ◽  
T Maruo ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Aortic Stenosis ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Severe Aortic Stenosis ◽  
Treatment Strategies ◽  
Primary Outcome Measure ◽  
Prognostic Impact ◽  
Conservative Strategy

Abstract Background Clinical significance of concomitant mitral regurgitation (MR) in patients with severe aortic stenosis (AS) has not been well-studied. Purpose The purpose of this study is to investigate the prognostic impact of concomitant MR in patients with severe AS. Method We used the data of 3815 patients from the CURRENT AS registry, a retrospective multicenter registry of severe AS in Japan. We compared the clinical outcomes between patients with moderate/severe MR and with none/mild MR according to the initial treatment strategies (initial aortic valve replacement [AVR] or conservative strategy). The primary outcome measure was a composite of aortic valve-related death and heart failure hospitalisation. Results Among the study population, moderate/severe MR were observed in 227/1197 (19%) patients with initial AVR strategy and in 536/2618 (20%) patients with conservative strategy. Among survivors with the initial AVR strategy, moderate/severe MR improved in 61/62 (98%) patients with concomitant mitral procedures. The crude cumulative 5-year incidence of the primary outcome measure was significantly higher in patients with moderate/severe MR than in those with none/mild MR regardless of the treatment strategies (25.2% vs. 14.4%, P&lt;0.001 in the initial AVR strategy; 63.3% vs 40.7%, P&lt;0.001 in the conservative strategy). Multivariate analysis revealed moderate/severe MR at index echocardiography was independently associated with higher risk for the primary outcome measure in conservative strategy (adjusted HR 1.20, 95% CI 1.03–1.40, P=0.023), but not associated in the initial AVR strategy (adjusted HR 1.20, 95% CI 0.82–1.80, P=0.339). Conclusion Moderate/severe MR was independently associated with poorer outcome in patients with severe AS who were managed conservatively, but not in those with initial AVR strategy. Funding Acknowledgement Type of funding source: None

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