Staging Cardiac Damage in Patients With Asymptomatic Aortic Valve Stenosis

Lionel Tastet, Christophe Tribouilloy, Sylvestre Maréchaux, E. Mara Vollema, Victoria Delgado, Erwan Salaun, Mylène Shen, Romain Capoulade, Marie Annick Clavel, Marie Arsenault, Élisabeth Bédard, Mathieu Bernier, Jonathan Beaudoin, Jagat Narula, Patrizio Lancellotti, Jeroen J. Bax, Philippe Généreux, Philippe Pibarot

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: The optimal timing of intervention in patients with asymptomatic severe aortic stenosis (AS) remains controversial. Objectives: This multicenter study sought to test and validate the prognostic value of the staging of cardiac damage in patients with asymptomatic moderate to severe AS. Methods: This study retrospectively analyzed the clinical, Doppler echocardiographic, and outcome data that were prospectively collected in 735 asymptomatic patients (71 ± 14 years of age; 60% men) with at least moderate AS (aortic valve area <1.5 cm2) and preserved left ventricular ejection fraction (≥50%) followed in the heart valve clinics of 4 high-volume centers. Patients were classified according to the following staging classification: no cardiac damage associated with the valve stenosis (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 or subclinical heart failure (Stage 4). The primary endpoint was all-cause mortality. Results: At baseline, 89 (12%) patients were classified in Stage 0, 200 (27%) in Stage 1, 341 (46%) in Stage 2, and 105 (14%) in Stage 3 or 4. Median follow-up was 2.6 years (interquartile range: 1.1 to 5.2 years). There was a stepwise increase in mortality rates according to staging: 13% in Stage 0, 25% in Stage 1, 44% in Stage 2, and 58% in Stages 3 to 4 (p < 0.0001). The staging was significantly associated with excess mortality in multivariable analysis adjusted for aortic valve replacement as a time-dependent variable (hazard ratio: 1.31 per each increase in stage; 95% CI: 1.06 to 1.61; p = 0.01), and showed incremental value to several clinical variables (net reclassification index = 0.34; p = 0.003). Conclusions: The new staging system characterizing the extra-aortic valve cardiac damage provides incremental prognostic value in patients with asymptomatic moderate to severe AS. This staging classification may be helpful to identify asymptomatic AS patients who may benefit from elective aortic valve replacement.

Original languageEnglish (US)
Pages (from-to)550-563
Number of pages14
JournalJournal of the American College of Cardiology
Volume74
Issue number4
DOIs
StatePublished - Jul 30 2019

Fingerprint

Aortic Valve Stenosis
Aortic Valve
Mortality
Pulmonary Valve
Tricuspid Valve
Heart Valves
Mitral Valve
Stroke Volume
Multicenter Studies
Pathologic Constriction
Heart Failure

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Tastet, L., Tribouilloy, C., Maréchaux, S., Vollema, E. M., Delgado, V., Salaun, E., ... Pibarot, P. (2019). Staging Cardiac Damage in Patients With Asymptomatic Aortic Valve Stenosis. Journal of the American College of Cardiology, 74(4), 550-563. https://doi.org/10.1016/j.jacc.2019.04.065
Tastet, Lionel ; Tribouilloy, Christophe ; Maréchaux, Sylvestre ; Vollema, E. Mara ; Delgado, Victoria ; Salaun, Erwan ; Shen, Mylène ; Capoulade, Romain ; Clavel, Marie Annick ; Arsenault, Marie ; Bédard, Élisabeth ; Bernier, Mathieu ; Beaudoin, Jonathan ; Narula, Jagat ; Lancellotti, Patrizio ; Bax, Jeroen J. ; Généreux, Philippe ; Pibarot, Philippe. / Staging Cardiac Damage in Patients With Asymptomatic Aortic Valve Stenosis. In: Journal of the American College of Cardiology. 2019 ; Vol. 74, No. 4. pp. 550-563.
@article{faac98bcd0bf4d28b07ea25393daeb10,
title = "Staging Cardiac Damage in Patients With Asymptomatic Aortic Valve Stenosis",
abstract = "Background: The optimal timing of intervention in patients with asymptomatic severe aortic stenosis (AS) remains controversial. Objectives: This multicenter study sought to test and validate the prognostic value of the staging of cardiac damage in patients with asymptomatic moderate to severe AS. Methods: This study retrospectively analyzed the clinical, Doppler echocardiographic, and outcome data that were prospectively collected in 735 asymptomatic patients (71 ± 14 years of age; 60{\%} men) with at least moderate AS (aortic valve area <1.5 cm2) and preserved left ventricular ejection fraction (≥50{\%}) followed in the heart valve clinics of 4 high-volume centers. Patients were classified according to the following staging classification: no cardiac damage associated with the valve stenosis (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 or subclinical heart failure (Stage 4). The primary endpoint was all-cause mortality. Results: At baseline, 89 (12{\%}) patients were classified in Stage 0, 200 (27{\%}) in Stage 1, 341 (46{\%}) in Stage 2, and 105 (14{\%}) in Stage 3 or 4. Median follow-up was 2.6 years (interquartile range: 1.1 to 5.2 years). There was a stepwise increase in mortality rates according to staging: 13{\%} in Stage 0, 25{\%} in Stage 1, 44{\%} in Stage 2, and 58{\%} in Stages 3 to 4 (p < 0.0001). The staging was significantly associated with excess mortality in multivariable analysis adjusted for aortic valve replacement as a time-dependent variable (hazard ratio: 1.31 per each increase in stage; 95{\%} CI: 1.06 to 1.61; p = 0.01), and showed incremental value to several clinical variables (net reclassification index = 0.34; p = 0.003). Conclusions: The new staging system characterizing the extra-aortic valve cardiac damage provides incremental prognostic value in patients with asymptomatic moderate to severe AS. This staging classification may be helpful to identify asymptomatic AS patients who may benefit from elective aortic valve replacement.",
author = "Lionel Tastet and Christophe Tribouilloy and Sylvestre Mar{\'e}chaux and Vollema, {E. Mara} and Victoria Delgado and Erwan Salaun and Myl{\`e}ne Shen and Romain Capoulade and Clavel, {Marie Annick} and Marie Arsenault and {\'E}lisabeth B{\'e}dard and Mathieu Bernier and Jonathan Beaudoin and Jagat Narula and Patrizio Lancellotti and Bax, {Jeroen J.} and Philippe G{\'e}n{\'e}reux and Philippe Pibarot",
year = "2019",
month = "7",
day = "30",
doi = "10.1016/j.jacc.2019.04.065",
language = "English (US)",
volume = "74",
pages = "550--563",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "4",

}

Tastet, L, Tribouilloy, C, Maréchaux, S, Vollema, EM, Delgado, V, Salaun, E, Shen, M, Capoulade, R, Clavel, MA, Arsenault, M, Bédard, É, Bernier, M, Beaudoin, J, Narula, J, Lancellotti, P, Bax, JJ, Généreux, P & Pibarot, P 2019, 'Staging Cardiac Damage in Patients With Asymptomatic Aortic Valve Stenosis', Journal of the American College of Cardiology, vol. 74, no. 4, pp. 550-563. https://doi.org/10.1016/j.jacc.2019.04.065

Staging Cardiac Damage in Patients With Asymptomatic Aortic Valve Stenosis. / Tastet, Lionel; Tribouilloy, Christophe; Maréchaux, Sylvestre; Vollema, E. Mara; Delgado, Victoria; Salaun, Erwan; Shen, Mylène; Capoulade, Romain; Clavel, Marie Annick; Arsenault, Marie; Bédard, Élisabeth; Bernier, Mathieu; Beaudoin, Jonathan; Narula, Jagat; Lancellotti, Patrizio; Bax, Jeroen J.; Généreux, Philippe; Pibarot, Philippe.

In: Journal of the American College of Cardiology, Vol. 74, No. 4, 30.07.2019, p. 550-563.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Staging Cardiac Damage in Patients With Asymptomatic Aortic Valve Stenosis

AU - Tastet, Lionel

AU - Tribouilloy, Christophe

AU - Maréchaux, Sylvestre

AU - Vollema, E. Mara

AU - Delgado, Victoria

AU - Salaun, Erwan

AU - Shen, Mylène

AU - Capoulade, Romain

AU - Clavel, Marie Annick

AU - Arsenault, Marie

AU - Bédard, Élisabeth

AU - Bernier, Mathieu

AU - Beaudoin, Jonathan

AU - Narula, Jagat

AU - Lancellotti, Patrizio

AU - Bax, Jeroen J.

AU - Généreux, Philippe

AU - Pibarot, Philippe

PY - 2019/7/30

Y1 - 2019/7/30

N2 - Background: The optimal timing of intervention in patients with asymptomatic severe aortic stenosis (AS) remains controversial. Objectives: This multicenter study sought to test and validate the prognostic value of the staging of cardiac damage in patients with asymptomatic moderate to severe AS. Methods: This study retrospectively analyzed the clinical, Doppler echocardiographic, and outcome data that were prospectively collected in 735 asymptomatic patients (71 ± 14 years of age; 60% men) with at least moderate AS (aortic valve area <1.5 cm2) and preserved left ventricular ejection fraction (≥50%) followed in the heart valve clinics of 4 high-volume centers. Patients were classified according to the following staging classification: no cardiac damage associated with the valve stenosis (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 or subclinical heart failure (Stage 4). The primary endpoint was all-cause mortality. Results: At baseline, 89 (12%) patients were classified in Stage 0, 200 (27%) in Stage 1, 341 (46%) in Stage 2, and 105 (14%) in Stage 3 or 4. Median follow-up was 2.6 years (interquartile range: 1.1 to 5.2 years). There was a stepwise increase in mortality rates according to staging: 13% in Stage 0, 25% in Stage 1, 44% in Stage 2, and 58% in Stages 3 to 4 (p < 0.0001). The staging was significantly associated with excess mortality in multivariable analysis adjusted for aortic valve replacement as a time-dependent variable (hazard ratio: 1.31 per each increase in stage; 95% CI: 1.06 to 1.61; p = 0.01), and showed incremental value to several clinical variables (net reclassification index = 0.34; p = 0.003). Conclusions: The new staging system characterizing the extra-aortic valve cardiac damage provides incremental prognostic value in patients with asymptomatic moderate to severe AS. This staging classification may be helpful to identify asymptomatic AS patients who may benefit from elective aortic valve replacement.

AB - Background: The optimal timing of intervention in patients with asymptomatic severe aortic stenosis (AS) remains controversial. Objectives: This multicenter study sought to test and validate the prognostic value of the staging of cardiac damage in patients with asymptomatic moderate to severe AS. Methods: This study retrospectively analyzed the clinical, Doppler echocardiographic, and outcome data that were prospectively collected in 735 asymptomatic patients (71 ± 14 years of age; 60% men) with at least moderate AS (aortic valve area <1.5 cm2) and preserved left ventricular ejection fraction (≥50%) followed in the heart valve clinics of 4 high-volume centers. Patients were classified according to the following staging classification: no cardiac damage associated with the valve stenosis (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 or subclinical heart failure (Stage 4). The primary endpoint was all-cause mortality. Results: At baseline, 89 (12%) patients were classified in Stage 0, 200 (27%) in Stage 1, 341 (46%) in Stage 2, and 105 (14%) in Stage 3 or 4. Median follow-up was 2.6 years (interquartile range: 1.1 to 5.2 years). There was a stepwise increase in mortality rates according to staging: 13% in Stage 0, 25% in Stage 1, 44% in Stage 2, and 58% in Stages 3 to 4 (p < 0.0001). The staging was significantly associated with excess mortality in multivariable analysis adjusted for aortic valve replacement as a time-dependent variable (hazard ratio: 1.31 per each increase in stage; 95% CI: 1.06 to 1.61; p = 0.01), and showed incremental value to several clinical variables (net reclassification index = 0.34; p = 0.003). Conclusions: The new staging system characterizing the extra-aortic valve cardiac damage provides incremental prognostic value in patients with asymptomatic moderate to severe AS. This staging classification may be helpful to identify asymptomatic AS patients who may benefit from elective aortic valve replacement.

UR - http://www.scopus.com/inward/record.url?scp=85068900912&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85068900912&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2019.04.065

DO - 10.1016/j.jacc.2019.04.065

M3 - Article

C2 - 31345430

AN - SCOPUS:85068900912

VL - 74

SP - 550

EP - 563

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 4

ER -

Tastet L, Tribouilloy C, Maréchaux S, Vollema EM, Delgado V, Salaun E et al. Staging Cardiac Damage in Patients With Asymptomatic Aortic Valve Stenosis. Journal of the American College of Cardiology. 2019 Jul 30;74(4):550-563. https://doi.org/10.1016/j.jacc.2019.04.065