Staging Cardiac Damage in Patients With Asymptomatic Aortic Valve Stenosis

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:74

Article

Tastet, Lionel¹  Tribouilloy, Christophe²  Marechaux, Sylvestre³  Vollema, E. Mara⁴  Delgado, Victoria⁴  Salaun, Erwan¹  Shen, Mylene¹  Capoulade, Romain⁵  Clavel, Marie-Annick¹  Arsenault, Marie¹  Bedard, Elisabeth¹  Bernier, Mathieu¹  Beaudoin, Jonathan¹  Narula, Jagat⁶  Lancellotti, Patrizio⁷  Bax, Jeroen J.⁴  Genereux, Philippe^8,9,10  Pibarot, Philippe¹ 

[1] Laval Univ, Quebec Heart & Lung Inst, Quebec City, PQ, Canada

[2] Amiens Univ Hosp Ctr, Dept Cardiol, Amiens, France

[3] Catholic Univ Lille, Catholic Inst Lille, GCS Hosp Grp, Dept Cardiol, Lille, France

[4] Leiden Univ, Heart & Lung Ctr, Dept Cardiol, Med Ctr, Leiden, Netherlands

[5] Univ Nantes, Univ Hosp Ctr Nantes, French Natl Ctr Sci Res CNRS, French Natl Inst Hlth & Med Res INSERM,Thorac Ins, Nantes, France

[6] Mt Sinai Hosp, Dept Cardiol, New York, NY 10029 USA

[7] Sart Tilman Univ Hosp Ctr, Univ Liege Hosp, Cardiooncol Clin, Dept Cardiol,GIGA Cardiovasc Sci, Liege, Belgium

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

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

[10] Sacre Coeur Hosp Montreal, Dept Cardiol, Montreal, PQ, Canada

关键词: aortic valve replacement;    aortic valve stenosis;    asymptomatic;    disease staging;    echocardiography;   

DOI  :  10.1016/j.jacc.2019.04.065

来源: Elsevier

【 摘 要 】

BACKGROUND The optimal timing of intervention in patients with asymptomatic severe aortic stenosis (AS) remains controversial. OBJECTIVES This multicenter study sought to test and validate the prognostic value of the staging of cardiac damage in patients with asymptomatic moderate to severe AS. METHODS This study retrospectively analyzed the clinical, Doppler echocardiographic, and outcome data that were prospectively collected in 735 asymptomatic patients (71 +/- 14 years of age; 60% men) with at least moderate AS (aortic valve area < 1.5 cm(2)) and preserved left ventricular ejection fraction (>= 50%) followed in the heart valve clinics of 4 high-volume centers. Patients were classified according to the following staging classification: no cardiac damage associated with the valve stenosis (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 or subclinical heart failure (Stage 4). The primary endpoint was all-cause mortality. RESULTS At baseline, 89 (12%) patients were classified in Stage 0, 200 (27%) in Stage 1, 341 (46%) in Stage 2, and 105 (14%) in Stage 3 or 4. Median follow-up was 2.6 years (interquartile range: 1.1 to 5.2 years). There was a stepwise increase in mortality rates according to staging: 13% in Stage 0, 25% in Stage 1, 44% in Stage 2, and 58% in Stages 3 to 4 (p < 0.0001). The staging was significantly associated with excess mortality in multivariable analysis adjusted for aortic valve replacement as a time-dependent variable (hazard ratio: 1.31 per each increase in stage; 95% CI: 1.06 to 1.61; p = 0.01), and showed incremental value to several clinical variables (net reclassification index = 0.34; p = 0.003). CONCLUSIONS The new staging system characterizing the extra-aortic valve cardiac damage provides incremental prognostic value in patients with asymptomatic moderate to severe AS. This staging classification may be helpful to identify asymptomatic AS patients who may benefit from elective aortic valve replacement. (C) 2019 by the American College of Cardiology Foundation.

【 授权许可】

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