About this item:

201 Views | 361 Downloads

Author Notes:

Corresponding author. Tel: þ1 212 342 3617, Fax: þ1 212 342 5375, Email: ml2398@columbia.edu

P.G. has received consultant fees and speaker fees from Edwards Lifesciences.

P.P. holds the Canada research Chair in Valvular Heart Diseases, Canadian Institutes of Health research, Ottawa, ON, Canada, has Core Lab contracts with Edwards Lifesciences for which he receives no direct compensation, and is a consultant for St Jude Medical.

M.J.M. is a member of the PARTNER Trial Executive Committee for which he receives no direct compensation.

R.R.M. has received grants from Edwards Lifesciences and St Jude Medical, is a consultant for Abbott Vascular, Cordis, and Medtronic, and holds equity in Entourage Medical.

W.A.J. has Core Lab contracts with Edwards Lifesciences for which he receives no direct compensation.

L.G.S. holds equity in Cardiosolution and Valvexchange, intellectual property with Postthorax, and is a member of the PARTNER Trial Executive Committee for which he receives no direct compensation.

E.M.T. is a member of the PARTNER Trial Executive Committee for which he receives no direct compensation.

V.H.T. is a consultant for Edwards Lifesciences, Abbott, Sorin Medical, St Jude Medical, and DirectFlow.

V.B. is a consultant for Edwards Lifesciences and Abbott Vascular.

H.C.H. has received grants from Edwards Lifesciences, St Jude Medical, Medtronic, Boston Scientific, Abbott Vascular, Gore, Siemens, Cardiokinetix, and Mitraspan, is a consultant for Edwards Lifesciences and Siemens, and holds equity in Microinterventional Devices.

W.Y.S. is a consultant for Microinterventional Devices.

D.J.C. has received research support from Edwards Lifesciences, Medtronic, and Boston Scientific and is a consultant for Edwards Lifesciences and Medtronic.

B.R.L. was supported by K23 HL116660, serves on the advisory board of Roche Diagnostics, and has received grants from Edwards Lifesciences and Roche Diagnostics.

M.C.A. is a consultant for Claret Medical.

P.S.D. has Core Lab contracts with Edwards Lifesciences for which she receives no direct compensation.

R.T.H. has Core Lab contracts with Edwards Lifesciences for which she receives no direct compensation and is a consultant for Philips Healthcare, St Jude Medical and Boston Scientific.

S.K.K. is a consultant for Edwards Lifesciences and holds equity in Thubrikar Aortic Valve, Inc.

C.R.S. is a member of the PARTNER Trial Executive Committee for which he receives no direct compensation.

D.C.M. is supported by research grant R01 NHLBI #HL67025, has received consulting fees from Abbott Vascular, St Jude Medical, and Medtronic, and is a member of the PARTNER Trial Executive Committee for which he receives no direct compensation.

J.G.W. is a consultant for Edwards Lifesciences and a member of the PARTNER Trial Executive Committee, for which he receives no direct compensation.

M.B.L. is a member of the PARTNER Trial Executive Committee for which he receives no direct compensation.

The other authors report no relevant relationships with industry to disclose.

Subjects:

Research Funding:

The PARTNER 2 Trial was funded by Edwards Lifesciences.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Cardiac & Cardiovascular Systems
  • Cardiovascular System & Cardiology
  • Aortic stenosis
  • Aortic valve
  • Aortic valve replacement
  • Transcatheter aortic valve replacement
  • Transcatheter aortic valve implantation
  • Classification
  • Staging
  • PRESERVED EJECTION FRACTION
  • RIGHT-VENTRICULAR DYSFUNCTION
  • VALVE-REPLACEMENT
  • PROGNOSTIC VALUE
  • LONGITUDINAL STRAIN
  • RISK STRATIFICATION
  • LOW-FLOW
  • TRANSCATHETER
  • ECHOCARDIOGRAPHY
  • SEVERITY

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

Show all authors Show less authors

Journal Title:

EHJ Cardiovascular Imaging / European Heart Journal - Cardiovascular Imaging

Volume:

Volume 38, Number 45

Publisher:

, Pages 3351-+

Type of Work:

Article | Final Publisher PDF

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.

Copyright information:

© 2017 The Author.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/).

Creative Commons License

Export to EndNote