Risk Score for Predicting Outcome in Patients With Asymptomatic Aortic Stenosis (original) (raw)
A Risk Prediction Model in Asymptomatic Patients with Severe Aortic Stenosis: CURRENT-AS risk score
European Heart Journal - Quality of Care and Clinical Outcomes
Objective Early aortic valve replacement (AVR) might be beneficial in selected high-risk asymptomatic patients with severe aortic stenosis (AS), considering their poor prognosis when managed conservatively. This study aimed to develop and validate a clinical scoring system to predict AS-related events within 1-year after diagnosis in asymptomatic severe AS patients. Methods We analysed 1274 asymptomatic severe AS patients derived from a retrospective multicentre registry enrolling consecutive patients with severe AS in Japan (CURRENT AS registry), who were managed conservatively and completed 1-year follow-up without AVR. From a randomly assigned derivation set (N = 849), we developed CURRENT AS risk score for the AS-related event (a composite of AS-related death and heart failure hospitalization) within 1-year using a multivariable logistic regression model. Results The risk score comprised independent risk predictors including left ventricular ejection fraction <60%, hemoglobin...
Outcomes in asymptomatic, severe aortic stenosis
PLOS ONE, 2021
Background and aim of the study Patients with asymptomatic, severe aortic stenosis are presumed to have a benign prognosis. In this retrospective cohort study, we examined the natural history of contemporary patients advised against aortic valve replacement due to a perceived lack of symptoms. Materials and methods We reviewed the medical records of every patient given the ICD-10-code for aortic stenosis (I35.0) at Oslo University Hospital, Rikshospitalet, between Dec 1st, 2002 and Dec 31st, 2016. Patients who were evaluated by the heart team due to severe aortic stenosis were categorized by treatment strategy. We recorded baseline data, adverse events and survival for the patients characterized as asymptomatic and for 100 age and gender matched patients scheduled for aortic valve replacement. Results Of 2341 patients who were evaluated for aortic valve replacement due to severe aortic stenosis, 114 patients received conservative treatment due to a lack of symptoms. Asymptomatic pat...
Outcome of adults with asymptomatic severe aortic stenosis
International Journal of Cardiology, 2008
Objectives: To evaluate clinical and echocardiographic variables that could be used to predict outcomes in patients with asymptomatic severe aortic valve stenosis. Management of asymptomatic severe aortic stenosis is controversial. Because prophylactic surgery may be protective, independent predictors of events that could justify early surgery have been sought. Methods: Outpatients (n = 133; mean [±SD] age, 66.2 ± 13.6 years) with isolated severe asymptomatic aortic stenosis but normal left ventricular function and no previous myocardial infarction were followed up prospectively at a tertiary care hospital. Interventions: We use a "wait-for-events" strategy. Clinical and echocardiographic variables were analyzed. Results: Nineteen patients developed angina; 40, dyspnea; 5, syncope; and 7, sudden death during a mean follow-up period of 3.30 ± 1.87 years. Event-free survival was 90.2 ± 2.6% at 1 year, 73.4 ± 3.9% at 2 years, 70.7 ± 4.3% at 3 years, 57.8 ± 4.7% at 4 years, 40.3 ± 5.0% at 5 years, and 33.3 ± 5.2% at 6 years. The mean follow-up period until sudden death (1.32 ± 1.11 years) was shorter than that for dyspnea (2.44 ± 1.84 years), syncope (2.87 ± 1.26 years) and angina (3.03 ± 1.68 years). Cox regression analysis disclosed only reduced but within normal limits ejection fraction as independent predictor of total events. Conclusions: Management on "wait-for-events" strategy is generally safe. Progressive left ventricular ejection fraction reduction even within normal limits identified patients at high risk for events in whom valve replacement surgery should be considered.
Asymptomatic versus Symptomatic Patients with Severe Aortic Stenosis
Scientific reports, 2018
It is unknown how much different are the clinical outcomes between asymptomatic and symptomatic patients with severe aortic stenosis (AS). In the CURRENT AS registry enrolling 3,815 consecutive patients with severe AS, we compared the long-term outcomes between 1808 asymptomatic and 1215 symptomatic patients (exertional dyspnea: N = 813, syncope: N = 136, and angina: N = 266) without heart failure (HF) hospitalization. Symptomatic patients had greater AS severity, and more depressed left ventricular function than asymptomatic patients without much difference in other baseline characteristics. During a median follow-up of 3.2 years, aortic valve replacement (AVR) was performed in 62% of symptomatic patients, and 38% of asymptomatic patients. The cumulative 5-year incidences for the primary outcome measure (a composite of aortic valve-related death or HF hospitalization) was higher in symptomatic patients than in asymptomatic patients (32.3% versus 27.6%, P < 0.001). After adjustin...
Journal of cardiovascular medicine (Hagerstown, Md.), 2015
Frequently in clinical practice, some physicians refer patients with aortic stenosis for an invasive approach in the asymptomatic phase of the disease. This empirical behaviour, which is in contrast with the recommendations of the current international clinical guidelines, is due to the perception that the prognosis of these patients is truly worse than retained. Actually, the management of asymptomatic patients with aortic stenosis remains controversial, and there is no clear agreement on how to reduce excess clinical events associated with the presence of aortic stenosis mortality and morbidity demonstrated in these patients by recent randomized clinical trials. The prevailing attention of the attending physicians is often limited to the assessment of the aortic stenosis severity and appearance of symptoms, but it has been clearly shown, instead, that the prognosis of these patients is associated with excessive left-ventricular mass growth and increased atherosclerosis leading to ...
How to Use Risk Score Systems on Severe Aortic Stenosis
Journal of Cardiology & Cardiovascular Therapy, 2017
The mostused score isthe STS score. This was generated from the U.S. database separated into three large cohorts with more than 100,000 patients each. In groups 2 and 3, only valve surgeries (aortic valve replacement, mitral valve replacement and mitral valve repair), combined valve surgery and coronary artery bypass grafting (CABG) were respectively included. The performance of the STS model are poor at predicting 30-day mortality post TAVR [4]
Frontiers in Cardiovascular Medicine
IntroductionClassical low-flow, low-gradient aortic stenosis (LFLG-AS) is an advanced stage of aortic stenosis, which has a poor prognosis with medical treatment and a high operative mortality after surgical aortic valve replacement (SAVR). There is currently a paucity of information regarding the current prognosis of classical LFLG-AS patients undergoing SAVR and the lack of a reliable risk assessment tool for this particular subset of AS patients. The present study aims to assess mortality predictors in a population of classical LFLG-AS patients undergoing SAVR.MethodsThis is a prospective study including 41 consecutive classical LFLG-AS patients (aortic valve area ≤1.0 cm2, mean transaortic gradient <40 mmHg, left ventricular ejection fraction <50%). All patients underwent dobutamine stress echocardiography (DSE), 3D echocardiography, and T1 mapping cardiac magnetic resonance (CMR). Patients with pseudo-severe aortic stenosis were excluded. Patients were divided into groups...
Hemodynamic Progression and Outcome of Asymptomatic Aortic Stenosis in Primary Care
The American Journal of Cardiology, 2012
The prognostic relevance of a rapid rate of hemodynamic progression of aortic stenosis (AS) has been predominantly investigated in tertiary centers. We reviewed the clinical and echocardiographic data from 153 asymptomatic patients with AS (age 77 ؎ 9 years; 65% men), with normal left ventricular function and paired echocardiograms >4 months apart (mean 2.9 ؎ 2.1 years), evaluated in a nonreferral echocardiographic laboratory. The severity of AS was graded by the peak aortic velocity (Vmax) and progression was classified as slow or fast according to a cutoff value of 0.3 m/s increase annually. The end points were all-cause mortality and a composite of all-cause mortality and aortic valve replacement (AVR). At baseline, 135 patients (88%) had mild-to-moderate and 18 (12%) severe AS. Of the 153 patients, 49 (32%) showed fast progression (0.61 ؎ 0.32 m/s/yr) and 104 (68%) had slow progression (0.10 ؎ 0.16 m/s/yr). Among the 144 patients (94%) with clinical follow-up data, 40 died and 48 underwent AVR. The mortality rate was greater than that of the general population (p <0.001). On multivariate analysis, the independent predictors of mortality were the yearly change in Vmax (hazard ratio [HR] 13.352 per m/s increase, 95% confidence interval [CI] 5.136 to 34.713, p <0.001) and age (HR 1.122 per year, 95% CI 1.0728 to 1.735, p <0.001). The predictors of the composite end point of death and AVR