Staging Cardiac Damage in Patients With Symptomatic Aortic Valve Stenosis

E. Mara Vollema, Mohammed R. Amanullah, Arnold C.T. Ng, Pieter van der Bijl, Francesca Prevedello, Yoong Kong Sin, Edgard A. Prihadi, Nina Ajmone Marsan, Zee Pin Ding, Philippe Généreux, Philippe Pibarot, Martin B. Leon, Jagat Narula, See Hooi Ewe, Victoria Delgado, Jeroen J. Bax

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: In severe aortic stenosis (AS), patients often show extra-aortic valvular injury. Recently, a new staging system for severe AS has been proposed on the basis of the extent of cardiac damage. Objectives: The present study evaluated the prevalence and prognostic impact of these different stages of cardiac damage in a large, real-world, multicenter cohort of symptomatic severe AS patients. Methods: From the ongoing registries from 2 academic institutions, a total of 1,189 symptomatic severe AS patients were selected and retrospectively analyzed. According to the extent of cardiac damage on echocardiography, patients were classified as Stage 0 (no cardiac damage), Stage 1 (left ventricular damage), Stage 2 (mitral valve or left atrial damage), Stage 3 (tricuspid valve or pulmonary artery vasculature damage), or Stage 4 (right ventricular damage). Patients were followed for all-cause mortality and combined endpoint (all-cause mortality, stroke, and cardiac-related hospitalization). Results: On the basis of the proposed classification, 8% of patients were classified as Stage 0, 24% as Stage 1, 49% as Stage 2, 7% as Stage 3, and 12% as Stage 4. On multivariable analysis, cardiac damage was independently associated with all-cause mortality and combined outcome, although this was mainly determined by Stages 3 and 4. Conclusions: In this large multicenter cohort of symptomatic severe AS patients, stage of cardiac injury as classified by a novel staging system was independently associated with all-cause mortality and combined endpoint, although this seemed to be predominantly driven by tricuspid valve or pulmonary artery vasculature damage (Stage 3) and right ventricular dysfunction (Stage 4).

Original languageEnglish (US)
Pages (from-to)538-549
Number of pages12
JournalJournal of the American College of Cardiology
Volume74
Issue number4
DOIs
StatePublished - Jul 30 2019
Externally publishedYes

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Aortic Valve Stenosis
Tricuspid Valve
Mortality
Pulmonary Artery
Right Ventricular Dysfunction
Wounds and Injuries
Mitral Valve
Registries
Echocardiography
Hospitalization
Cross-Sectional Studies
Stroke

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Vollema, E. M., Amanullah, M. R., Ng, A. C. T., van der Bijl, P., Prevedello, F., Sin, Y. K., ... Bax, J. J. (2019). Staging Cardiac Damage in Patients With Symptomatic Aortic Valve Stenosis. Journal of the American College of Cardiology, 74(4), 538-549. https://doi.org/10.1016/j.jacc.2019.05.048
Vollema, E. Mara ; Amanullah, Mohammed R. ; Ng, Arnold C.T. ; van der Bijl, Pieter ; Prevedello, Francesca ; Sin, Yoong Kong ; Prihadi, Edgard A. ; Marsan, Nina Ajmone ; Ding, Zee Pin ; Généreux, Philippe ; Pibarot, Philippe ; Leon, Martin B. ; Narula, Jagat ; Ewe, See Hooi ; Delgado, Victoria ; Bax, Jeroen J. / Staging Cardiac Damage in Patients With Symptomatic Aortic Valve Stenosis. In: Journal of the American College of Cardiology. 2019 ; Vol. 74, No. 4. pp. 538-549.
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abstract = "Background: In severe aortic stenosis (AS), patients often show extra-aortic valvular injury. Recently, a new staging system for severe AS has been proposed on the basis of the extent of cardiac damage. Objectives: The present study evaluated the prevalence and prognostic impact of these different stages of cardiac damage in a large, real-world, multicenter cohort of symptomatic severe AS patients. Methods: From the ongoing registries from 2 academic institutions, a total of 1,189 symptomatic severe AS patients were selected and retrospectively analyzed. According to the extent of cardiac damage on echocardiography, patients were classified as Stage 0 (no cardiac damage), Stage 1 (left ventricular damage), Stage 2 (mitral valve or left atrial damage), Stage 3 (tricuspid valve or pulmonary artery vasculature damage), or Stage 4 (right ventricular damage). Patients were followed for all-cause mortality and combined endpoint (all-cause mortality, stroke, and cardiac-related hospitalization). Results: On the basis of the proposed classification, 8{\%} of patients were classified as Stage 0, 24{\%} as Stage 1, 49{\%} as Stage 2, 7{\%} as Stage 3, and 12{\%} as Stage 4. On multivariable analysis, cardiac damage was independently associated with all-cause mortality and combined outcome, although this was mainly determined by Stages 3 and 4. Conclusions: In this large multicenter cohort of symptomatic severe AS patients, stage of cardiac injury as classified by a novel staging system was independently associated with all-cause mortality and combined endpoint, although this seemed to be predominantly driven by tricuspid valve or pulmonary artery vasculature damage (Stage 3) and right ventricular dysfunction (Stage 4).",
author = "Vollema, {E. Mara} and Amanullah, {Mohammed R.} and Ng, {Arnold C.T.} and {van der Bijl}, Pieter and Francesca Prevedello and Sin, {Yoong Kong} and Prihadi, {Edgard A.} and Marsan, {Nina Ajmone} and Ding, {Zee Pin} and Philippe G{\'e}n{\'e}reux and Philippe Pibarot and Leon, {Martin B.} and Jagat Narula and Ewe, {See Hooi} and Victoria Delgado and Bax, {Jeroen J.}",
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Vollema, EM, Amanullah, MR, Ng, ACT, van der Bijl, P, Prevedello, F, Sin, YK, Prihadi, EA, Marsan, NA, Ding, ZP, Généreux, P, Pibarot, P, Leon, MB, Narula, J, Ewe, SH, Delgado, V & Bax, JJ 2019, 'Staging Cardiac Damage in Patients With Symptomatic Aortic Valve Stenosis', Journal of the American College of Cardiology, vol. 74, no. 4, pp. 538-549. https://doi.org/10.1016/j.jacc.2019.05.048

Staging Cardiac Damage in Patients With Symptomatic Aortic Valve Stenosis. / Vollema, E. Mara; Amanullah, Mohammed R.; Ng, Arnold C.T.; van der Bijl, Pieter; Prevedello, Francesca; Sin, Yoong Kong; Prihadi, Edgard A.; Marsan, Nina Ajmone; Ding, Zee Pin; Généreux, Philippe; Pibarot, Philippe; Leon, Martin B.; Narula, Jagat; Ewe, See Hooi; Delgado, Victoria; Bax, Jeroen J.

In: Journal of the American College of Cardiology, Vol. 74, No. 4, 30.07.2019, p. 538-549.

Research output: Contribution to journalArticle

TY - JOUR

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

AU - Vollema, E. Mara

AU - Amanullah, Mohammed R.

AU - Ng, Arnold C.T.

AU - van der Bijl, Pieter

AU - Prevedello, Francesca

AU - Sin, Yoong Kong

AU - Prihadi, Edgard A.

AU - Marsan, Nina Ajmone

AU - Ding, Zee Pin

AU - Généreux, Philippe

AU - Pibarot, Philippe

AU - Leon, Martin B.

AU - Narula, Jagat

AU - Ewe, See Hooi

AU - Delgado, Victoria

AU - Bax, Jeroen J.

PY - 2019/7/30

Y1 - 2019/7/30

N2 - Background: In severe aortic stenosis (AS), patients often show extra-aortic valvular injury. Recently, a new staging system for severe AS has been proposed on the basis of the extent of cardiac damage. Objectives: The present study evaluated the prevalence and prognostic impact of these different stages of cardiac damage in a large, real-world, multicenter cohort of symptomatic severe AS patients. Methods: From the ongoing registries from 2 academic institutions, a total of 1,189 symptomatic severe AS patients were selected and retrospectively analyzed. According to the extent of cardiac damage on echocardiography, patients were classified as Stage 0 (no cardiac damage), Stage 1 (left ventricular damage), Stage 2 (mitral valve or left atrial damage), Stage 3 (tricuspid valve or pulmonary artery vasculature damage), or Stage 4 (right ventricular damage). Patients were followed for all-cause mortality and combined endpoint (all-cause mortality, stroke, and cardiac-related hospitalization). Results: On the basis of the proposed classification, 8% of patients were classified as Stage 0, 24% as Stage 1, 49% as Stage 2, 7% as Stage 3, and 12% as Stage 4. On multivariable analysis, cardiac damage was independently associated with all-cause mortality and combined outcome, although this was mainly determined by Stages 3 and 4. Conclusions: In this large multicenter cohort of symptomatic severe AS patients, stage of cardiac injury as classified by a novel staging system was independently associated with all-cause mortality and combined endpoint, although this seemed to be predominantly driven by tricuspid valve or pulmonary artery vasculature damage (Stage 3) and right ventricular dysfunction (Stage 4).

AB - Background: In severe aortic stenosis (AS), patients often show extra-aortic valvular injury. Recently, a new staging system for severe AS has been proposed on the basis of the extent of cardiac damage. Objectives: The present study evaluated the prevalence and prognostic impact of these different stages of cardiac damage in a large, real-world, multicenter cohort of symptomatic severe AS patients. Methods: From the ongoing registries from 2 academic institutions, a total of 1,189 symptomatic severe AS patients were selected and retrospectively analyzed. According to the extent of cardiac damage on echocardiography, patients were classified as Stage 0 (no cardiac damage), Stage 1 (left ventricular damage), Stage 2 (mitral valve or left atrial damage), Stage 3 (tricuspid valve or pulmonary artery vasculature damage), or Stage 4 (right ventricular damage). Patients were followed for all-cause mortality and combined endpoint (all-cause mortality, stroke, and cardiac-related hospitalization). Results: On the basis of the proposed classification, 8% of patients were classified as Stage 0, 24% as Stage 1, 49% as Stage 2, 7% as Stage 3, and 12% as Stage 4. On multivariable analysis, cardiac damage was independently associated with all-cause mortality and combined outcome, although this was mainly determined by Stages 3 and 4. Conclusions: In this large multicenter cohort of symptomatic severe AS patients, stage of cardiac injury as classified by a novel staging system was independently associated with all-cause mortality and combined endpoint, although this seemed to be predominantly driven by tricuspid valve or pulmonary artery vasculature damage (Stage 3) and right ventricular dysfunction (Stage 4).

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Vollema EM, Amanullah MR, Ng ACT, van der Bijl P, Prevedello F, Sin YK et al. Staging Cardiac Damage in Patients With Symptomatic Aortic Valve Stenosis. Journal of the American College of Cardiology. 2019 Jul 30;74(4):538-549. https://doi.org/10.1016/j.jacc.2019.05.048