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Eur Heart J. 2017 Dec 1;38(45):3351-3358. doi: 10.1093/eurheartj/ehx381.

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

Author information

1
Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA.
2
Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, USA.
3
Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Québec, Canada.
4
Pulmonary Hypertension and Vascular Biology Research Group, Laval University, Québec, Canada.
5
Sahlgrenska University Hospital, Gothenburg, Sweden.
6
Baylor Scott & White Health, Plano, TX, USA.
7
Interventional Technologies in the Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
8
Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
9
Emory University School of Medicine, Atlanta, GA, USA.
10
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
11
Saint Luke's Mid America Heart Institute, Kansas City, MO, USA.
12
Vanderbilt University Medical Center, Nashville, TN, USA.
13
Columbia University Medical Center, 161?Ft. Washington Avenue, 6th Floor, New York, NY 10032, USA.
14
Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
15
Columbia University Medical Center, 161 Ft. Washington Avenue, 6th Floor, New York, NY 10032, USA.
16
Stanford University, Stanford, CA, USA.
17
University of British Columbia/St. Paul's Hospital, Vancouver, British Columbia, Canada.

Abstract

Aims:

In patients with aortic stenosis (AS), risk stratification for aortic valve replacement (AVR) relies mainly on valve-related 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. One-year 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.

KEYWORDS:

Aortic stenosis; Aortic valve; Aortic valve replacement; Classification; Staging; Transcatheter aortic valve implantation; Transcatheter aortic valve replacement

PMID:
29020232
PMCID:
PMC5837727
DOI:
10.1093/eurheartj/ehx381
[Indexed for MEDLINE]
Free PMC Article

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