Staging classification of aortic stenosis based on the extent of cardiac damage

• Type of Material: Article
• Authors: Philippe Genereux, Cardiovascular Research Foundation; Philippe Pibarot, Laval University; Bjorn Redfors, Cardiovascular Research Foundation; Michael J. Mack, Baylor Scott & White Health; Raj R. Makkar, Cedars-Sinai Medical Center; Wael A. Jaber, Cleveland Clinic; Lars G. Svensson, Cleveland Clinic; Samir Kapadia, Cleveland Clinic; E. Murat Tuzcu, Cleveland Clinic; Vinod Thourani, Emory University; Vasilis Babaliaros, Emory University; Howard C. Herrmann, University of Pennsylvania; Wilson Y. Szeto, University of Pennsylvania; David Jay Cohen, Emory University; Brian R. Lindman, Vanderbilt University; Thomas McAndrew, Cardiovascular Research Foundation; Maria C. Alu, Columbia University; Pamela S. Douglas, Duke University; Rebecca T. Hahn, Cardiovascular Research Foundation; Susheel K. Kodali, Cardiovascular Research Foundation; Craig R. Smith, Columbia University; D. Craig Miller, Stanford University; John G. Webb, University of British Columbia; Martin B. Leon, Cardiovascular Research Foundation
• Language: English
• Date: 2017-12-01
• Publisher: Oxford University Press (OUP): Policy B - Oxford Open Option B
• Publication Version: Final Published Version
• Copyright Statement: © 2017 The Author.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/eurheartj/ehx381
• Title of Journal or Parent Work: EHJ Cardiovascular Imaging / European Heart Journal - Cardiovascular Imaging
• ISSN: 2047-2404
• Volume: 38
• Issue: 45
• Start Page: 3351
• End Page: +
• Grant/Funding Information: The PARTNER 2 Trial was funded by Edwards Lifesciences.
• Keywords: Transcatheter aortic valve implantation; ECHOCARDIOGRAPHY; RIGHT-VENTRICULAR DYSFUNCTION; Aortic valve; Staging; Life Sciences & Biomedicine; Aortic stenosis; PROGNOSTIC VALUE; Cardiovascular System & Cardiology; Aortic valve replacement; RISK STRATIFICATION; LOW-FLOW; TRANSCATHETER; VALVE-REPLACEMENT; PRESERVED EJECTION FRACTION; SEVERITY; LONGITUDINAL STRAIN; Science & Technology; Transcatheter aortic valve replacement; Cardiac & Cardiovascular Systems; Classification
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, General

Abstract

Aims In patients with aortic stenosis (AS), risk stratification for aortic valve replacement (AVR) relies mainly on valverelated factors, symptoms and co-morbidities. We sought to evaluate the prognostic impact of a newly-defined staging classification characterizing the extent of extravalvular (extra-aortic valve) cardiac damage among patients with severe AS undergoing AVR. Methods and results Patients with severe AS from the PARTNER 2 trials were pooled and classified according to the presence or absence of cardiac damage as detected by echocardiography prior to AVR: no extravalvular cardiac damage (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 (Stage 4). One-year outcomes were compared using Kaplan- Meier techniques and multivariable Cox proportional hazards models were used to identify 1-year predictors of mortality. In 1661 patients with sufficient echocardiographic data to allow staging, 47 (2.8%) patients were classified as Stage 0, 212 (12.8%) as Stage 1, 844 (50.8%) as Stage 2, 413 (24.9%) as Stage 3, and 145 (8.7%) as Stage 4. Oneyear mortality was 4.4% in Stage 0, 9.2% in Stage 1, 14.4% in Stage 2, 21.3% in Stage 3, and 24.5% in Stage 4 (Ptrend < 0.0001). The extent of cardiac damage was independently associated with increased mortality after AVR (HR 1.46 per each increment in stage, 95% confidence interval 1.27-1.67, P < 0.0001). Conclusion This newly described staging classification objectively characterizes the extent of cardiac damage associated with AS and has important prognostic implications for clinical outcomes after AVR.