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

Philippe Généreux, Philippe Pibarot, Björn Redfors, Michael J. Mack, Raj R. Makkar, Wael A. Jaber, Lars G. Svensson, Samir Kapadia, E. Murat Tuzcu, Vinod H. Thourani, Vasilis Babaliaros, Howard C. Herrmann, Wilson Y. Szeto, David J. Cohen, Brian R. Lindman, Thomas McAndrew, Maria C. Alu, Pamela S. Douglas, Rebecca T. Hahn, Susheel K. KodaliCraig R. Smith, D. Craig Miller, John G. Webb, Martin B. Leon

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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.

Original languageEnglish (US)
Pages (from-to)3351-3358
Number of pages8
JournalEuropean Heart Journal
Volume38
Issue number45
DOIs
StatePublished - Jan 1 2017

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Aortic Valve Stenosis
Aortic Valve
Mortality
Pulmonary Valve
Tricuspid Valve
Mitral Valve
Proportional Hazards Models
Echocardiography
Confidence Intervals
Morbidity

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Généreux, P., Pibarot, P., Redfors, B., Mack, M. J., Makkar, R. R., Jaber, W. A., ... Leon, M. B. (2017). Staging classification of aortic stenosis based on the extent of cardiac damage. European Heart Journal, 38(45), 3351-3358. https://doi.org/10.1093/eurheartj/ehx381
Généreux, Philippe ; Pibarot, Philippe ; Redfors, Björn ; Mack, Michael J. ; Makkar, Raj R. ; Jaber, Wael A. ; Svensson, Lars G. ; Kapadia, Samir ; Tuzcu, E. Murat ; Thourani, Vinod H. ; Babaliaros, Vasilis ; Herrmann, Howard C. ; Szeto, Wilson Y. ; Cohen, David J. ; Lindman, Brian R. ; McAndrew, Thomas ; Alu, Maria C. ; Douglas, Pamela S. ; Hahn, Rebecca T. ; Kodali, Susheel K. ; Smith, Craig R. ; Miller, D. Craig ; Webb, John G. ; Leon, Martin B. / Staging classification of aortic stenosis based on the extent of cardiac damage. In: European Heart Journal. 2017 ; Vol. 38, No. 45. pp. 3351-3358.
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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.",
author = "Philippe G{\'e}n{\'e}reux and Philippe Pibarot and Bj{\"o}rn Redfors and Mack, {Michael J.} and Makkar, {Raj R.} and Jaber, {Wael A.} and Svensson, {Lars G.} and Samir Kapadia and Tuzcu, {E. Murat} and Thourani, {Vinod H.} and Vasilis Babaliaros and Herrmann, {Howard C.} and Szeto, {Wilson Y.} and Cohen, {David J.} and Lindman, {Brian R.} and Thomas McAndrew and Alu, {Maria C.} and Douglas, {Pamela S.} and Hahn, {Rebecca T.} and Kodali, {Susheel K.} and Smith, {Craig R.} and Miller, {D. Craig} and Webb, {John G.} and Leon, {Martin B.}",
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Généreux, P, Pibarot, P, Redfors, B, Mack, MJ, Makkar, RR, Jaber, WA, Svensson, LG, Kapadia, S, Tuzcu, EM, Thourani, VH, Babaliaros, V, Herrmann, HC, Szeto, WY, Cohen, DJ, Lindman, BR, McAndrew, T, Alu, MC, Douglas, PS, Hahn, RT, Kodali, SK, Smith, CR, Miller, DC, Webb, JG & Leon, MB 2017, 'Staging classification of aortic stenosis based on the extent of cardiac damage', European Heart Journal, vol. 38, no. 45, pp. 3351-3358. https://doi.org/10.1093/eurheartj/ehx381

Staging classification of aortic stenosis based on the extent of cardiac damage. / Généreux, Philippe; Pibarot, Philippe; Redfors, Björn; Mack, Michael J.; Makkar, Raj R.; Jaber, Wael A.; Svensson, Lars G.; Kapadia, Samir; Tuzcu, E. Murat; Thourani, Vinod H.; Babaliaros, Vasilis; Herrmann, Howard C.; Szeto, Wilson Y.; Cohen, David J.; Lindman, Brian R.; McAndrew, Thomas; Alu, Maria C.; Douglas, Pamela S.; Hahn, Rebecca T.; Kodali, Susheel K.; Smith, Craig R.; Miller, D. Craig; Webb, John G.; Leon, Martin B.

In: European Heart Journal, Vol. 38, No. 45, 01.01.2017, p. 3351-3358.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Staging classification of aortic stenosis based on the extent of cardiac damage

AU - Généreux, Philippe

AU - Pibarot, Philippe

AU - Redfors, Björn

AU - Mack, Michael J.

AU - Makkar, Raj R.

AU - Jaber, Wael A.

AU - Svensson, Lars G.

AU - Kapadia, Samir

AU - Tuzcu, E. Murat

AU - Thourani, Vinod H.

AU - Babaliaros, Vasilis

AU - Herrmann, Howard C.

AU - Szeto, Wilson Y.

AU - Cohen, David J.

AU - Lindman, Brian R.

AU - McAndrew, Thomas

AU - Alu, Maria C.

AU - Douglas, Pamela S.

AU - Hahn, Rebecca T.

AU - Kodali, Susheel K.

AU - Smith, Craig R.

AU - Miller, D. Craig

AU - Webb, John G.

AU - Leon, Martin B.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - 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.

AB - 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.

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U2 - 10.1093/eurheartj/ehx381

DO - 10.1093/eurheartj/ehx381

M3 - Article

C2 - 29020232

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JO - European Heart Journal

JF - European Heart Journal

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