Dataset Information

Natural history observations in moderate aortic stenosis.

ABSTRACT:

Background

The natural history of patients with moderate aortic stenosis (AS) is poorly understood. We aimed to determine the long-term outcomes of patients with moderate AS.

Methods

We examined patients with moderate AS defined by echocardiography in our healthcare system, and performed survival analyses for occurrence of death, heart failure (HF) hospitalization, and progression of AS, with accounting for symptoms, left ventricular dysfunction, and comorbidities.

Results

We examined 729 patients with moderate AS (median age, 76 years; 59.9?% men) with a median follow-up of 5.0 years (interquartile range: 2.0 to 8.1 years). The 5-year overall survival was 52.3?% (95?% confidence interval [CI]: 48.6?% to 56.0?%) and survival free of death or HF hospitalization was 43.2?% (95?% CI: 39.5?% to 46.9?%). Worse New York Heart Association (NYHA) functional class was associated with poor long-term survival, with mortality rates ranging from 7.9?% (95?% CI: 6.6-9.2?%) to 25.2?% (95?% CI: 20.2-30.3?%) per year. Among patients with minimal or no symptoms, no futility markers, and preserved left ventricular function, 5-year overall survival was 71.9?% (95?% CI: 66.4-77.4?%) and survival free of death or HF hospitalization was 61.4?% (95?% CI: 55.5-67.3?%). Risk factors associated with adverse events were age, NYHA class, low ejection fraction and high aortic valve velocity (all p?ConclusionsPatients with moderate AS are at significant risk of death. Our findings highlight the need for more study into appropriate therapeutic interventions to improve the prognosis of these patients.

SUBMITTER: Du Y

PROVIDER: S-EPMC7893941 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Natural history observations in moderate aortic stenosis.

Du Yu Y Gössl Mario M Garcia Santiago S Enriquez-Sarano Maurice M Cavalcante Joao L JL Bae Richard R Hashimoto Go G Fukui Miho M Lopes Bernardo B Ahmed Aisha A Schmidt Christian C Stanberry Larissa L Garberich Ross R Bradley Steven M SM Steffen Robert R Sorajja Paul P

BMC cardiovascular disorders 20210219 1

<h4>Background</h4>The natural history of patients with moderate aortic stenosis (AS) is poorly understood. We aimed to determine the long-term outcomes of patients with moderate AS.<h4>Methods</h4>We examined patients with moderate AS defined by echocardiography in our healthcare system, and performed survival analyses for occurrence of death, heart failure (HF) hospitalization, and progression of AS, with accounting for symptoms, left ventricular dysfunction, and comorbidities.<h4>Results</h4> ...[more]

PMID: 33607944

Similar Datasets

Project description:OBJECTIVE Minimal aortic injuries (MAIs) are being recognized more frequently due to the increasing use of high-resolution diagnostic techniques. The objective of this case series review was to report the clinical and radiological characteristics and outcomes of a series of patients with MAI. METHODS From January 2000 to December 2011, 54 major blunt trauma patients were admitted to our institution with traumatic aortic injuries. Nine of them presented with MAI, whereas the remaining 45 patients suffered a significant aortic injury (SAI). RESULTS MAIs accounted for 17% of the overall traumatic aortic injuries in our series. Major trauma patients with MAI and SAI were similar regarding the presence of severe associated non-aortic injuries and the expected mortality calculated by injury severity score, revised trauma score and trauma injury severity score. There were no statistically significant differences in in-hospital mortality between MAI (22.2%) and SAI (30.2%). No death in the MAI group was aortic related, whereas five deaths in the SAI group were caused by an aortic complication. The survival of MAI patients was 77.8% at 1 and 5 years. There was no late mortality among MAI patients. The survival of SAI patients was 69.7% at 1 year and 63.6% at 5 and 10 years. None of the seven surviving patients with MAI presented a progression of the aortic injury. In six patients, the intimal tear completely healed in imaging controls, whereas one patient developed a small saccular pseudoaneurysm. CONCLUSIONS Blunt traumas presenting MAI are as severe as traumas that associate SAI and present similar in-hospital mortality. In contrast to SAI traumas, in-hospital mortality due to MAI is not usually related to the aortic injury, so these injuries are more amenable to a conservative management. It is mandatory to perform a close imaging surveillance to detect early any potential adverse evolution of an MAI. Nevertheless, a balance must be struck between a close serial imaging surveillance and the potentially detrimental effects of obtaining high-resolution additional images.

Project description:ImportanceWhether intervention should be performed in patients with asymptomatic severe aortic stenosis (AS) remains debated.ObjectiveTo meta-analyze the natural history of asymptomatic severe AS and examine the association of early intervention with survival.Data sourcesPubMed, Embase, and Cochrane databases were searched from inception to February 1, 2020.Study selectionObservational studies of adult patients with asymptomatic severe AS.Data extraction and synthesisTwo investigators independently extracted study and patient characteristics, follow-up time, events, and prognostic indicators of events. Random-effects models were used to derive pooled estimates.Main outcomes and measuresThe meta-analysis on natural history was performed on the primary end point of all-cause death occurring during a conservative treatment period, with secondary end points consisting of cardiac death, death due to heart failure, sudden death, development of symptoms, development of an indication for aortic valve intervention, and aortic valve intervention. The primary end point for the meta-analysis of early intervention vs a conservative strategy was all-cause death during long-term follow-up. Finally, meta-analysis was performed on the association of prognostic indicators with the composite of death or aortic valve intervention found in multivariable models.ResultsA total of 29 studies with 4075 patients with 11 901 years of follow-up were included. Pooled rates per 100 patients per year were 4.8 (95% CI, 3.6-6.4) for all-cause death, 3.0 (95% CI, 2.2-4.1) for cardiac death, 2.0 (95% CI, 1.3-3.1) for death due to heart failure, 1.1 (95% CI, 0.6-2.1) for sudden death, 18.1 (95% CI, 12.8-25.4) for an indication for aortic valve intervention, 18.5 (95% CI, 13.4-25.5) for development of symptoms, and 19.2 (95% CI, 15.5-23.8) for aortic valve intervention. Early intervention was associated with a significant reduction in long-term mortality (hazard ratio, 0.38; 95% CI, 0.25-0.58). Factors associated with worse prognosis were severity of AS, low-flow AS, left ventricular damage, and atherosclerotic risk factors.Conclusions and relevanceData from observational studies and a recent randomized clinical trial suggest that many patients with asymptomatic severe AS develop an indication for aortic valve intervention, and their deaths are mostly cardiac but not only sudden. Other end points besides sudden death should be considered during the decision to perform early intervention that are associated with improved survival.

Dataset Information

Natural history observations in moderate aortic stenosis.

Background

Methods

Results

Publications

Natural history observations in moderate aortic stenosis.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets