Clinical and Echocardiographic Predictors of Outcomes in Patients With Moderate (Mean Transvalvular Gradient 20 to 40 mm Hg) Aortic Stenosis

• Published in: The American journal of cardiology Vol. 124; no. 12; pp. 1924 - 1931
• Main Authors: Murphy, Katie R., Khan, Omar A., Rassa, Allen C., Elman, Miriam R., Chadderdon, Scott M, Song, Howard K., Golwala, Harsh, Cigarroa, Joaquin E, Zahr, Firas E
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15.12.2019; Elsevier Limited
• Subjects: Aged; Aortic stenosis; Aortic valve; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - surgery; Cardiac arrhythmia; Cause of Death; Cohort Studies; Confidence intervals; Congestive heart failure; Death; Echocardiography, Doppler - methods; Electrocardiography; Female; Fibrillation; Heart failure; Heart Failure - diagnosis; Heart Failure - diagnostic imaging; Heart Failure - mortality; Heart Failure - surgery; Heart Valve Prosthesis; Hospitalization; Humans; Hypertrophy; Kaplan-Meier Estimate; Male; Middle Aged; Mortality; Multivariate Analysis; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Retrospective Studies; Risk analysis; Risk Assessment; Risk factors; Severity of Illness Index; Statistical models; Stenosis; Stroke Volume - physiology; Surgery; Survival Analysis; Transcatheter Aortic Valve Replacement - methods; Transcatheter Aortic Valve Replacement - mortality; Treatment Outcome; Ultrasonic imaging; United States; Velocity; Ventricle; United States
• ISSN: 0002-9149; 1879-1913; 1879-1913
• DOI: 10.1016/j.amjcard.2019.09.022

Risk factors for adverse clinical outcomes in patients with moderate aortic stenosis are not well defined. Previous studies have suggested that certain patients with moderate AS may be at an increased risk of heart failure (HF) or death. All patients with moderate AS seen in our institution during the study period (6/1/2014 to 6/30/2017) with a minimum 1-year follow-up were included. Clinical and echocardiographic data were collected retrospectively. End points were defined as HF hospitalization, aortic valve replacement (AVR), or death. Kaplan-Meier and multivariable Cox proportional hazard models analyses were conducted using composite outcomes of (1) HF hospitalization or AVR and (2) HF hospitalization, AVR, or all-cause death. A total of 151 subjects met the inclusion criteria. The most significant risk factors associated with the composite outcomes were an ejection fraction (EF) <50% ((1) hazard ratio [HR]: 4.1; 95% confidence interval [CI]: 2.34, 7.12; (2) HR: 3.8; 95% CI: 2.2, 6.6), atrial fibrillation ((1) HR: 2.0; 95% CI: 1.2, 3.2; (2) HR: 2.1; 95% CI: 1.43, 3.2), left ventricular hypertrophy ((1) HR: 5.85; 95% CI: 2.0, 15.8; (2) HR: 3.2; 95% CI: 1.4, 7.4), aortic valve area ((1) HR: 0.3; 95% CI: 0.1, 0.6; (2) HR: 0.32; 95% CI: 0.1, 0.65), and abnormal right ventricular function ((1) HR: 4.3; 95% CI: 2.5, 7.5; (2) HR: 5.5; 95% CI: 3.0, 9.8). In conclusion, presence of reduced ejection fraction, atrial fibrillation, left ventricular hypertrophy, and abnormal right ventricular function are associated with an increased risk of HF hospitalization, AVR, and death in patients with moderate aortic stenosis.