Prognostic Implications of Associated Cardiac Abnormalities Detected on Echocardiography in Patients With Moderate Aortic Stenosis

This study aimed to evaluate the prevalence and prognostic value of the extent of extra-aortic valvular cardiac abnormalities in a large multicenter registry of patients with moderate AS. The prognostic significance of a new classification system that incorporates the extent of cardiac injury (beyon...

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Bibliographic Details
Published in:JACC. Cardiovascular imaging 2021-09, Vol.14 (9), p.1724-1737
Main Authors: Amanullah, Mohammed Rizwan, Pio, Stephan Milhorini, Ng, Arnold C.T., Sin, Kenny Y.K., Marsan, Nina Ajmone, Ding, Zee Pin, Leon, Martin B., Généreux, Philippe, Delgado, Victoria, Ewe, See Hooi, Bax, Jeroen J.
Format: Article
Language:English
Subjects:
aortic stenosis
classification
prognosis
valvular heart disease
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Summary:This study aimed to evaluate the prevalence and prognostic value of the extent of extra-aortic valvular cardiac abnormalities in a large multicenter registry of patients with moderate AS. The prognostic significance of a new classification system that incorporates the extent of cardiac injury (beyond the aortic valve) has been proposed in patients with severe aortic stenosis (AS). Whether this can be applied to patients with moderate AS is unclear. Based on the echocardiographic findings at the time of diagnosis of moderate AS (aortic valve area between 1.0 and 1.5 cm2 and dimensionless velocity index ratio of ≥0.25), a total of 1,245 patients were included and analyzed retrospectively. They were recategorized into 5 groups according to the extent of extra-aortic valvular cardiac abnormalities: none (Group 0), involving the left ventricle (Group 1), the left atrial or mitral valve (Group 2), the pulmonary artery vasculature or tricuspid valve (Group 3), or the right ventricle (Group 4). Patients were followed for all-cause mortality and combined endpoint (all-cause mortality, stroke, heart failure, or myocardial infarction). The distribution of patients according to the proposed classification was 13.1%, 26.8%, 42.6%, 10.6%, and 6.9% in Groups 0, 1, 2, 3, and 4, respectively. During a median follow-up of 4.3 (2.4 to 6.9) years, 564 (45.3%) patients died. There was a significant higher mortality rates with increasing extent of extra-aortic valvular cardiac abnormalities (log-rank p 
ISSN:1936-878X
1876-7591
DOI:10.1016/j.jcmg.2021.04.009