Staging Cardiac Damage in Patients With Symptomatic Aortic Valve Stenosis

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:74

Article

Vollema, E. Mara¹  Amanullah, Mohammed R.²  Ng, Arnold C. T.³  van der Bijl, Pieter¹  Prevedello, Francesca¹  Sin, Yoong Kong⁴  Prihadi, Edgard A.¹  Marsan, Nina Ajmone¹  Ding, Zee Pin²  Genereux, Philippe^5,6,7  Pibarot, Philippe⁸  Leon, Martin B.^5,9  Narula, Jagat¹⁰  Ewe, See Hooi²  Delgado, Victoria¹  Bax, Jeroen J.¹ 

[1] Leiden Univ, Dept Cardiol, Med Ctr, Albinusdreef 2, NL-2300 RC Leiden, Netherlands

[2] Natl Heart Ctr Singapore, Dept Cardiol, Singapore, Singapore

[3] Univ Queensland, Princess Alexandra Hosp, Dept Cardiol, Brisbane, Qld, Australia

[4] Natl Heart Ctr Singapore, Dept Cardiothorac Surg, Singapore, Singapore

[5] Cardiovasc Res Fdn, Clin Trials Ctr, New York, NY USA

[6] Morristown Med Ctr, Gagnon Cardiovasc Inst, Morristown, NJ USA

[7] Univ Montreal, Hop Sacre Coeur Montreal, Montreal, PQ, Canada

[8] Laval Univ, Inst Univ Cardiol & Pneumol Quebec, Quebec Heart & Lung Inst, Quebec City, PQ, Canada

[9] Columbia Univ, Med Ctr, New York Presbyterian Hosp, New York, NY USA

[10] Mt Sinai Hosp, New York, NY 10029 USA

关键词: aortic stenosis;    cardiac damage;    classification;    prognosis;    staging;   

DOI  :  10.1016/j.jacc.2019.05.048

来源: Elsevier

【 摘 要 】

BACKGROUND In severe aortic stenosis (AS), patients often show extra-aortic valvular injury. Recently, a new staging system for severe AS has been proposed on the basis of the extent of cardiac damage. OBJECTIVES The present study evaluated the prevalence and prognostic impact of these different stages of cardiac damage in a large, real-world, multicenter cohort of symptomatic severe AS patients. METHODS From the ongoing registries from 2 academic institutions, a total of 1,189 symptomatic severe AS patients were selected and retrospectively analyzed. 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). Patients were followed for all-cause mortality and combined endpoint (all-cause mortality, stroke, and cardiac-related hospitalization). RESULTS On the basis of the proposed classification, 8% of patients were classified as Stage 0, 24% as Stage 1, 49% as Stage 2, 7% as Stage 3, and 12% as Stage 4. On multivariable analysis, cardiac damage was independently associated with all-cause mortality and combined outcome, although this was mainly determined by Stages 3 and 4. CONCLUSIONS In this large multicenter cohort of symptomatic severe AS patients, stage of cardiac injury as classified by a novel staging system was independently associated with all-cause mortality and combined endpoint, although this seemed to be predominantly driven by tricuspid valve or pulmonary artery vasculature damage (Stage 3) and right ventricular dysfunction (Stage 4). (C) 2019 by the American College of Cardiology Foundation.

【 授权许可】

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